上段の単純CTで右側結腸（A：上行結腸，C：盲腸）と横行結腸（T）が血腫または血液と思われる内容物を含み，出血源は小腸か右側結腸である．図６〜図８の↑は憩室または憩室内糞石を示している．下段の造影CTで△はextravasationで，盲腸または上行結腸憩室の出血である．輸血2単位を要したがバファリンとワーファリンを中止し自然止血した．

参考症例（上行結腸憩室出血）：71歳女性．脳梗塞後パナルジンを服用している．2時間前から暗赤色の下血が3回あった．血圧：130/78mmHg，脈拍：70/分．図１〜図８は単純CT，図９〜図１６は造影CT．

図１〜図８の単純CTで上行結腸に多数の憩室（↑）があり，普通便ではなく血腫または血液と思われる内容物を含むので上行結腸憩室からの出血の可能性が高い．図９〜図１２の造影CTでextravasation（△）を認め診断が確定した．CT検査後大腸ファイバー検査を行ったが右側結腸に憩室を多数認めるも自然止血しており出血部位の同定はできなかった．パナルジンを中止し，Hbは低下（12.5→8.6g/dl）したが輸血は不要であった．

参考文献
1)古川　顕、山崎道夫、田中豊彦、他．
動脈性消化管出血；診断とIVR．
IVR会誌　Jpn J Intervent Radiol 18:16-21, 2003.
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The role of dual-phase enhanced helical computed tomography in difficult intestinal bleeding.
Yoshikawa K, Yamaguti T, Nakamura M, Hirabayasi K, Hazano K, Utida M, Masuki I.

We report a case of leiomyoma of the small bowel presenting with massive gastrointestinal (GI) bleeding that was diagnosed using dual-phase enhanced helical computed tomography (CT) in the preoperative period. A 68-year-old man was admitted to our hospital because of recurrent rectal bleeding. Gastroduodenoscopic and total colonoscopic examination results were negative; however, the patient continued to show bloody stool. Dual-phase enhanced helical CT was subsequently performed. CT revealed a hypervascular tumor, with evident extravasation of the contrast medium in the bowel lumen. We were successful in establishing the point of bleeding. Exploratory laparotomy was performed the same day. A solid round extraluminal mass was found at the proximal jejunum. Bleeding was observed over the serosal side of this tumor and segmental resection of the tumorous small intestine was performed. Pathologic examination revealed leiomyoma. Enhanced helical CT proved to be useful in localizing active GI bleeding.　PMID: 10914785