sodium-pertechnetate-tc-99m and Crohn-Disease

This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed.. Patients aged ≤ 18 years treated surgically for NVGIB were analysed.. Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc. The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.

Topics: Adolescent; Algorithms; Aneurysm, False; Capsule Endoscopy; Child; Child, Preschool; Choristoma; Crohn Disease; Duodenal Ulcer; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Hepatic Artery; Humans; Infant; Male; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed; Vascular Malformations

The 99Tcm-labelled antigranulocyte antibody BW250/183 has been used in the detection of intestinal inflammation in patients with active ulcerative colitis and Crohn's disease. Planar images were obtained up to 24 h after intravenous injection of the antibody. Eight out of nine patients with ulcerative colitis and six out of seven patients with Crohn's disease gave positive images. In 11 patients distribution of the inflammation was confirmed by barium studies, colonoscopy or surgery, whilst in two the antibody scan suggested more extensive disease than barium enema. None of the patients had any adverse reactions. Imaging with BW250/183 appears to give an accurate indication of the extent of inflammation in inflammatory bowel disease.

Topics: Colitis, Ulcerative; Crohn Disease; Humans; Radioimmunodetection; Sodium Pertechnetate Tc 99m

To investigate the use of abdominal scintiscanning in the detection of small bowel pathology, the accumulation of pertechnetate (99mTc), following intravenous injection, has been studied in 21 patients with coeliac disease, 13 patients with Crohn's disease and in 83 control subjects without known small bowel disease. Although a trend for a greater accumulation of 99m Tc was noted in patients with coeliac disease and Crohn's disease compared with controls (P less than 0.025) there was a large overlap in individual studies. Under the conditions of this study the accumulation of 99mTc by the small bowel did not provide a reliable diagnostic test for coeliac disease or Crohn's disease of the small intestine. The accumulation of 99mTc pertechnetate by normal small bowel suggests that scintiscanning with this radiopharmaceutical does not provide a consistently reliable method for the detection of small bowel pathology.

Topics: Adult; Aged; Celiac Disease; Crohn Disease; Evaluation Studies as Topic; Female; Humans; Ileitis; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium