sodium-pertechnetate-tc-99m and Cecal-Diseases

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

99mTechnetium-labelled red blood cell scintigraphy (99mTc RBC scintigraphy) was used as the second-line investigation to localise bleeding in 23 patients (11 male, 12 female; mean age 67 years) presenting with active bleeding per rectum. Scintigraphy was available on a 24 h basis. A total of 18 patients had positive scans (78%). Surgery was performed urgently in 11 patients and the site of bleeding, as predicted by scintigraphy, was confirmed in 9 (82%). 99mTc RBC scintigraphy was less useful in patients who were not bleeding actively or who were being investigated for chronic anaemia. This study suggests that 99mTc RBC scintigraphy can play a useful role in the preoperative localisation of unexplained gastrointestinal bleeding in hospitals with nuclear medicine facilities, but confirms it has little place in the management of patients unless they are bleeding actively.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Hypochromic; Cecal Diseases; Colonic Diseases; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m