INDEX TERMS: Abdominal Angiography, indications. Duodenum, hemorrhage. Gastrointestinal Tract, hemorrhage. Peptic Ulcer, hemorrhage from. Stress

I N CE 1965, selected patients with mas­ sive gastrointestinal hemorrhage have undergone preoperative selective celiac and superior mesenteric arteriography to localize the source of bleeding. Five pa­ tients who had bled while under severe physiologic stress had their bleeding points localized by arteriography near the junction of the second and third portions of the duodenum. The frequency of hemorrhage from stress ulceration at this site has not been previously emphasized in the litera­ ture. METHOD A preshaped radiopaque catheter is introduced into the femoral artery under local anesthesia, and the celiac axis is catheterized. At a rate of 5 to 8 ml per second, 0.5 mljkg body weight of a 76% methylglucamate salt of a diatrizoate compound (Renografin) is injected me­ chanically. Serial film exposures are made at the rate of 2 per second for four seconds, 1 per second for four seconds, and 1 per 3 seconds for an additional eighteen seconds. The study is then repeated with the catheter in the superior mesenteric artery. A bleed­ ing rate of at least 0.5 ml/min. is needed to localize bleeding sites (1). The patients in this report were selected for arteriography because of a suspected bleeding rate faster than 0.5 ml/rnin. and the expectation of surgery.