sodium-pertechnetate-tc-99m and Angiodysplasia

In four patients, women aged 65 and 86 years and men aged 22 and 46 years, admitted with profuse loss of fresh blood per anum, acute haemorrhage in the lower gastrointestinal tract was diagnosed. A systematic diagnostic and therapeutic strategy increases the possibility of localising the bleeding site in such patients. Urgent colonoscopy after oral purge for cleansing the colon of stool is feasible, safe and often both diagnostic and therapeutic. Dependent on local expertise, erythrocyte scintigraphy and (or) mesenteric angiography can further improve the locating of the bleeding site. However, in 10% of the patients the bleeding site remains unclear. In these cases surgical intervention may be necessary. Additional peroperative endoscopy, injection of methylene blue via a selective catheter or the construction of multiple stomas can be helpful. Blind colon resections should be avoided. The localisations in the four patients were: angiodysplastic focus in the caecum, a superficially eroded vein in the ileum, a Meckel's diverticulum, and multifocal vasculitis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Angiodysplasia; Angiography; Cecal Diseases; Colonoscopy; Diagnosis, Differential; Diagnostic Techniques, Surgical; Female; Humans; IgA Vasculitis; Ileum; Male; Meckel Diverticulum; Melena; Mesenteric Arteries; Middle Aged; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed

Topics: Aged; Aged, 80 and over; Angiodysplasia; Colon; Colonic Diseases; Diagnosis, Differential; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Male; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Bleeding angiodysplasia of the gastrointestinal tract poses frustrating challenges to clinicians because these minute vascular lesions are difficult to diagnose pre-operatively and to locate intra-operatively. During the past 12 years, 24 patients were treated for histopathologically confirmed bleeding angiodysplasia of the gastrointestinal tract. Pre-operative investigations and intra-operative localization followed a fixed protocol for patients with gastrointestinal bleeding of obscure origin. The median follow-up of these 24 patients was 51 months and the results of treatment for 22 patients were excellent. Two patients had recurrent bleeding but investigations failed to determine the bleeding source.

Topics: Adult; Aged; Aged, 80 and over; Angiodysplasia; Angiography; Barium Sulfate; Clinical Protocols; Decision Trees; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hong Kong; Humans; Male; Middle Aged; Preoperative Care; Recurrence; Sodium Pertechnetate Tc 99m; Treatment Outcome