sodium-pertechnetate-tc-99m and Gastrointestinal-Hemorrhage

Meckel diverticulum, the most common congenital anomaly of the gastrointestinal tract, results from the aberrant involution of the omphalomesenteric duct and accounts for more than 50% of unexplained lower gastrointestinal bleeding in the pediatric population. The most accurate imaging tool to identify a Meckel diverticulum containing ectopic gastric mucosa is the Technetium-99m pertechnetate Meckel scan, a scintigraphic study with a reported accuracy of 90% in the pediatric population. In addition to depicting a Meckel diverticulum with ectopic gastric mucosa, careful attention to the normal biodistribution of the radiotracer can lead to the identification of unexpected pathology with implications for patient management. This article serves to review the embryological origin and anatomical features of Meckel diverticulum, highlight the role of scintigraphy in evaluating Meckel diverticulum, and discuss the proper imaging technique when performing this test. We will focus on pitfalls that can lead to an erroneous diagnosis as well as incidental findings that can affect patient management.

Topics: Child; Gastrointestinal Hemorrhage; Humans; Meckel Diverticulum; Musculoskeletal Diseases; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tissue Distribution

99mTc-pertechnetate scintigraphy has long been used for detection of ectopic gastric mucosa (EGM) in the medical practice and evaluation of children with lower gastrointestinal bleeding. In the current study, we reviewed the available medical literature in this regard.. Medline and SCOPUS were searched for relevant studies. Studies with sample size of at least 5 patients which provided enough numerical data to calculate the sensitivity and/or specificity of 99mTc-pertechnetate for detection of EGM were includ ed in the systematic review.. Overall 40 studies were included in our systematic review. Overall diagnostic indices of the 99mTc-pertechnetate scintigraphy for EGM diagnosis were: sensitivity 92.1% [95% CI: 90.2-93.8], specificity 95.4% [943-963], positive likelihood ratio 16.5 [9.9-27.], negative likelihood ratio 0.15 [0.1-0.2], diagnostic odds ratio 120.7 [73-199]. The pooled sensitivity was higher for studies using H2 blockers as a premedication (92.4% vs. 86.4%), studies using delayed imaging (943% vs. 88.4%), children (92.3% vs. 81.8%), and patients with gastrointestinal bleeding (953% vs. 75.3%).. 99mTc-pertechnetate imaging is a highly accurate diagnostic modality for detection of EGM. This imaging is more accurate in children and patients presenting with gastrointestinal bleeding. Premedication with H2 blockers and delayed imaging can increase the diagnostic accuracy and should be routinely included in the imaging protocol.

Topics: Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours. These complications, especially bleeding, are more common in the paediatric age group than in adults; however it is not uncommon to miss the diagnosis of Meckel's diverticulum in adults. Here, we reviewed the literature regarding the complications of this forgotten clinical entity in adults with potential diagnostic difficulties and management strategies.

Topics: Child; Child, Preschool; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

The initial technetium-99m pertechnetate abdominal scintigraphy revealed equivocal or normal results. However, a second scintigraphy without pentagastrin demonstrated a focal area of persistently increasing radioactivity in the right lower quadrant of the abdomen. At surgery, Meckel's diverticulum was confirmed, and histological examination of the excised specimen revealed that it was lined with ectopic gastric mucosa. It has not been satisfactorily explained why the initial imaging failed to demonstrate the ectopic gastric mucosa. The necessity to perform repeated scintigraphy must be emphasized because 50 to 91 percent of bleeding Meckel's diverticula in the pediatric age group are said to contain gastric mucosa.

Topics: Gastrointestinal Hemorrhage; Humans; Infant; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Gastrointestinal bleeding is a common and occasionally life-threatening problem in infants and children. A careful history and physical examination as well as the application of new endoscopic and radiographic techniques will reveal the source of hemorrhage in most patients. The utility of recently introduced pharmacologic agents and endoscopic techniques in the treatment of peptic disease and variceal hemorrhage in children remains to be determined. A cooperative effort among pediatricians, radiologists, and surgeons should minimize the morbidity and mortality from gastrointestinal tract bleeding in this population.

Topics: Angiography; Antacids; Barium Sulfate; Child; Colonoscopy; Digestive System; Endoscopy; Enema; Esophageal and Gastric Varices; Gastric Lavage; Gastrointestinal Hemorrhage; Hemostatic Techniques; Histamine H2 Antagonists; Humans; Infant; Infant, Newborn; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Sigmoidoscopy; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid

To present our experience with the detection of bleeding in the small intestine by means of scintigraphy with in vivo-labelled red blood cells (RBCs) in the period of 1998-2009.. A 12-year prospective study was accomplished with 40 patients (23 men, 17 women, aged 12-91, mean 56 years) who had lower gastrointestinal bleeding (obscure-overt bleeding) and underwent scintigraphy with in vivo-labelled RBCs by means of technetium 99m. The scintigraphy was usually performed after other diagnostic tests had failed to locate the bleeding.. A total of 26 patients had a positive scintigraphy with in vivo-labelled RBCs and 14 patients had negative scintigraphy. The final diagnosis was confirmed in 20 of 26 patients with a positive scintigraphy by push enteroscopy (6/20), intraoperative enteroscopy (7/20), surgery (4/20), duodenoscopy (1/20), double-balloon enteroscopy (1/20) and X-ray angiography (1/20). The correct location of the bleeding site was identified by RBC scintigraphy in 15 of 20 (75%) patients with the confirmed source. The locations of the bleeding site identified by scintigraphy and enteroscopy (push, intraoperative) and surgical investigations were highly correlated in patients with a positive scintigraphy within the first 3 h. Eleven of the 20 correctly localized studies and none of the incorrectly localized studies were positive in the dynamic phase of imaging. In 5 patients (all erroneously localized), scintigraphy was positive only at a period longer than 18 h.. RBC scintigraphy is an effective imaging modality in localizing lower gastrointestinal bleeding in patients for whom other diagnostic tests have failed to locate the bleeding. RBC scintigraphy can be successful in the detection of bleeding sites in the small intestine.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Colon; Endoscopy, Gastrointestinal; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Intestine, Small; Male; Middle Aged; Prospective Studies; Sodium Pertechnetate Tc 99m; Time Factors; Tomography, Emission-Computed, Single-Photon; Young Adult

A 14-year-old girl presented with right lower quadrant pain. A 99m Tc-pertechnetate scan with SPECT/CT was performed to exclude a Meckel's diverticulum. The images demonstrated focal tracer uptake in the right midabdomen, which appeared early and decreased over time. However, SPECT/CT revealed that this uptake corresponded to the right renal pelvis, which was located more inferior than expected. This case emphasizes the importance of recognizing anatomic variants that may cause focal tracer uptake, as well as leveraging an understanding of tracer kinetics to inform a diagnosis.

Topics: Adolescent; Female; Gastrointestinal Hemorrhage; Humans; Kidney Pelvis; Meckel Diverticulum; Radionuclide Imaging; Single Photon Emission Computed Tomography Computed Tomography; Sodium Pertechnetate Tc 99m; Technetium

One of the most common malformations of the gastrointestinal tract is Meckel diverticulum (MD). MD complications can range from minor to major, such as intestinal obstruction, intussusception, hemorrhage, ulceration, vesicodiverticular fistulae, and tumors. Bleeding from ectopic gastric mucosa is more common in children than in adults. In the current case, MD in a 25-y-old man was diagnosed by

Topics: Adult; Child; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

To investigate the correlation of computed tomography (CT) angiography and. From November 2012 to August 2017, 223 CAs performed for LGIB, including massive, ongoing, and obscure bleeding, were retrospectively identified in patients with pre-procedural CT angiography or RBC scintigraphy. Positive correlations and sensitivities were calculated for CT angiography and RBC scintigraphy using CA results as reference. Correlations were then compared while considering certain clinical presentations of LGIB. Contrast dose was compared with maximum creatinine recorded 48-72 hours after.. Thirty-eight patients underwent CT angiography; 173 patients underwent RBC scintigraphy; and 12 patients completed both studies. CT angiography had a positive correlation of 67.7% (95% confidence interval [CI]: 57.0, 76.7) and sensitivity of 85.2% (95% CI: 66.3, 95.8), whereas RBC scintigraphy had a positive correlation of 29.3% (95% CI: 27.7, 31.0) and sensitivity of 94.4% (95% CI: 84.6, 98.8). CT angiography had higher positive correlation across all clinical presentations. No dose-toxicity relationship was observed between contrast and renal function (R. CT angiography has greater positive correlation to CA than RBC scintigraphy for assessing LGIB in active stable as well as hemodynamically unstable LGIB. As such, greater adoption of CT angiography may reduce the number of nontherapeutic CAs performed. Additional contrast associated with CT angiography does not result in increased nephrotoxicity.

Topics: Adult; Aged; Aged, 80 and over; Computed Tomography Angiography; Contrast Media; Erythrocytes; Female; Gastrointestinal Hemorrhage; Hemodynamics; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Factors; Sodium Pertechnetate Tc 99m; Young Adult

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

Meckel scintigraphy with Tc-pertechnetate was performed in a 5-year-old boy to determine whether a Meckel diverticulum containing ectopic gastric mucosa caused bleeding. The images did not reveal focal activity characteristic of a Meckel diverticulum. Unexpectedly, activity in the tracheobronchial tree was visualized, consistent with aspiration of the radioactive saliva.

Topics: Child, Preschool; Gastrointestinal Hemorrhage; Humans; Incidental Findings; Male; Meckel Diverticulum; Paracentesis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The reported accuracy of pertechnetate scintigraphy (Meckel scan) in investigating children with a bleeding Meckel's diverticulum has increased steadily since it was first introduced into clinical practice in 1970. Recent studies have indicated that the examination has a sensitivity of up to 94% and a specificity of up to 97% in this scenario. There have also been several misleading reviews from Departments of Surgery, suggesting that the Meckel scan has a poor predictive value, and should not be relied upon to exclude a bleeding Meckel's Diverticulum (MD).. The aim of this study was to assess the accuracy of pertechnetate scintigraphy performed at Our Lady's Hospital for Sick Children, Crumlin (OLCHC) on children with clinical suspicion of a bleeding MD.. This was a retrospective study of all the Meckel scans performed over a 10year period (2005-2015) in OLCHC, 144 in total.. Of the total 144 scans performed, 22 were considered to be positive, and all patients were found to have a MD at surgery. 122 were negative, and in 53 of these patients, an alternative cause for symptoms was found, often at endoscopy. In the remaining 69 patients, no cause was found, despite full medical work-up. In all of these cases, symptoms resolved, and have not yet recurred, making MD very unlikely.. Pertechnetate scintigraphy, when performed using meticulous technique, can provide up to 100% sensitivity CI [85.1, 100.0] and 100% specificity CI [93.2, 100.0] in diagnosing a bleeding MD in a paediatric population. This examination is seldom of value in children with no history of rectal bleeding.

Topics: Adolescent; Child; Child, Preschool; Female; Gastrointestinal Hemorrhage; Humans; Infant; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. Clinical symptoms can result in pain, bleeding and perforation caused by peptic ulceration. Among all imaging modalities, Tc-99m pertechnetate scintigraphy is the most sensitive method for Meckel's diverticulum diagnosis, but only mentioned in a few publications. We report the case of a young child with rectal bleeding related hemorrhagic Meckel's diverticulum. Endoscopy and ultrasound were normal. The diagnosis was done by scintigraphy with technetium revealing an accumulation of radiotracer by mucous cells in ectopic gastric mucosa, which allows a detection of Meckel's diverticulum. Our case illustrates the importance of this exam to the diagnosis of gastrointestinal bleeding with normal endoscopy.

Topics: Child; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. Clinical symptoms can result in pain, bleeding and perforation caused by peptic ulceration. Among all imaging modalities, Tc-99m pertechnetate scintigraphy is the most sensitive method for Meckel's diverticulum diagnosis, but only mentioned in a few publications. We report the case of a young child with rectal bleeding related hemorrhagic Meckel's diverticulum. Endoscopy and ultrasound were normal. The diagnosis was done by scintigraphy with technetium revealing an accumulation of radiotracer by mucous cells in ectopic gastric mucosa, which allows a detection of Meckel's diverticulum. Our case illustrates the importance of this exam to the diagnosis of gastrointestinal bleeding with normal endoscopy.

Topics: Child; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Meckel scan is an effective tool for diagnosing symptomatic Meckel diverticulum (MD). However, the clinical relevance of Meckel scan remains controversial because of its rare use. To evaluate the clinical relevance of Meckel scan with initial hemoglobin (Hb) level, we investigated its diagnostic accuracy in our patient population over a 10-year period, and we propose clinical considerations for Meckel scan with initial Hb levels.. A total of 70 patients (41 males and 29 females; median age, 3 years; range, 3 months to 49 years) who underwent Meckel scans for symptomatic MD evaluation from October 2003 to August 2012 were reviewed retrospectively. Of the 70 patients, 13 were pathologically confirmed by surgery. Nine patients had MD, and the others were diagnosed with gastritis, colitis, and juvenile polyps. Overall, 57 patients were evaluated with endoscopy and clinical examinations, and were followed up for 3 to 6 years. The patients were classified into two groups by their initial Hb levels. Group I consisted of anemic patients whose initial Hb levels were less than the reference range for each individual's age and sex (n = 16), and group II consisted of patients within the normal range for Hb level (n = 52). The two groups were compared using Fisher exact test.. Of the 70 patients, 9 (12.3%) showed positive findings on Meckel scan, and the others demonstrated negative findings. In the negative scan group, 1 patient was confirmed as MD after surgery; 60 patients showed spontaneous improvement and no symptom recurrence was detected during the 3- to 6-year follow-up. In the positive Meckel scan group, eight patients were pathologically diagnosed with MD. One patient was reported as having a juvenile polyp with no evidence of ectopic gastric mucosa. The sensitivity and specificity of Meckel scan were 89 and 98%, respectively. In group I, Meckel scan was positive in seven patients (44%) and showed a significantly higher prevalence than in group II (p < 0.001). When limited to the patients with gastrointestinal bleeding and anemia, the positive predictive value and negative predictive value were 100 and 100%, respectively.. In this study, Meckel scan showed high diagnostic accuracy in detecting symptomatic MD. Meckel scan also showed the highest positive results when applied in patients with gastrointestinal bleeding who were in anemic conditions.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Gastrointestinal Hemorrhage; Hemoglobins; Humans; Male; Meckel Diverticulum; Middle Aged; Radionuclide Imaging; Reference Values; Retrospective Studies; Sodium Pertechnetate Tc 99m; Young Adult

A 28-year-old Chinese man presented with acute bleeding per rectum. Computed tomography showed a posterior outpouching arising from the distal ileum. The outpouching had hyperaemic walls, but no active contrast extravasation was detected. Technetium-99m pertechnetate scintigraphy showed focal areas of abnormal uptake in the right side of the pelvis, superior and posterior to the urinary bladder. These areas of uptake appeared simultaneously with the gastric uptake and demonstrated gradual increase in intensity on subsequent images. The diagnosis of Meckel's diverticulum was confirmed on surgery and the lesion was resected. The clinical and imaging features of Meckel's diverticulum are discussed.

Topics: Abdominal Pain; Adult; Female; Gastrointestinal Hemorrhage; Humans; Ileum; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

Lower gastrointestinal bleeding (LGIB) in infants and children is a difficult diagnostic problem largely due to limitations of small-bowel evaluation. Duplication cysts are rare congenital malformations with variable clinical presentation. This report describes seven children (five boys, two girls and median age 10 [1.5-124] months) with ileal duplication cysts who presented with LGIB of varying severity from stool occult blood positivity with anemia to fresh bleeding per rectum. Diagnosis was made by Tc(99m) pertechnetate scan (n-5), balloon enteroscopy (n-1), and at laparotomy (n-1). Ultrasonography and barium meal follow-through missed the diagnosis in six and three cases, respectively. All cases underwent surgery with resection of the duplication cyst and complete removal of the mucosa containing ectopic gastric tissue while preserving adequate bowel length. A good postoperative outcome with complete symptom resolution was seen in all. Enteric duplication cyst should always be considered in children presenting with occult or overt lower gastrointestinal hemorrhage, and Tc(99m) pertechnetate scan should be done prior to invasive tests like balloon enteroscopy.

Topics: Anemia; Child; Child, Preschool; Cysts; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Infant; Male; Occult Blood; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed; Ultrasonography

Meckel's diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from a Meckel's diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel's diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel's diverticulum and correlation with other radiological imaging.

Topics: Adult; Angiography; Gastrointestinal Hemorrhage; Humans; Intestines; Male; Meckel Diverticulum; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed; Treatment Outcome

Topics: Aged; Drug Carriers; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Adult; Capsule Endoscopy; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileum; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

We report our experience of the detection of ectopic gastric mucosa by means of perfusion Tc-99m pertechnetate disodium scintigraphy in patients with lower gastrointestinal bleeding. Gastric mucosa may be present in Meckel's diverticulum and is associated with peptic ulcer disease and lower gastrointestinal (GI) bleeding; Tc-99m pertechnetate scintigraphy can help to make the diagnosis of ectopic gastric mucosa.. Seventy-nine children (40 boys, 39 girls, aged 1 - 17, mean age 8 years) underwent Tc-99m pertechnetate scintigraphy in the last thirteen years. All patients had melena or hematochezia. Morphology imaging and endoscopy were negative in all patients. Dynamic scintigraphy of the abdomen was started immediately after i. v. administration of Tc-99m pertechnetate. The static image of the abdomen was performed subsequently. Where necessary, SPECT was additionally performed to improve the sensitivity, specificity and spatial specification.. Three patients (two boys: two and ten years old; one girl: four years old) had positive scintigraphy results. All 3 patients underwent surgery and Meckel's diverticulum with ectopic gastric mucosa found (histology). GI bleeding stopped spontaneously in patients with a negative scintigraphy. These patients did not undergo intraoperative enteroscopy or surgery.. Tc-99m pertechnetate scintigraphy can help to detect ectopic gastric mucosa in the abdomen and improve the management of patients with lower gastrointestinal bleeding.

Topics: Adolescent; Child; Child, Preschool; Choristoma; Cimetidine; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Histamine H2 Antagonists; Humans; Image Enhancement; Infant; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Ranitidine; Sodium Pertechnetate Tc 99m

To investigate potential roles of per rectal portal scintigraphy in diagnosis of esophageal varices and predicting the risk of bleeding.. Fifteen normal subjects and fifty cirrhotic patients with endoscopically confirmed esophageal varices were included. Patients were categorized into bleeder and non-bleeder groups according to history of variceal bleeding. All had completed per rectal portal scintigraphy using (99m)Technetium pertechnetate. The shunt index was calculated from the ratio of (99m)Technetium pertechnetate in the heart and the liver. Data were analyzed using Student's t-test and receiver operating characteristics.. Cirrhotic patients showed a higher shunt index than normal subjects (63.80 +/- 25.21 vs 13.54 +/- 6.46, P < 0.01). Patients with variceal bleeding showed a higher shunt index than those without bleeding (78.45 +/- 9.40 vs 49.35 +/- 27.72, P < 0.01). A shunt index of over 20% indicated the presence of varices and that of over 60% indicated the risk of variceal bleeding.. In cirrhotic patients, per rectal portal scintigraphy is a clinically useful test for identifying esophageal varices and risk of variceal bleeding.

Topics: Adolescent; Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Portal System; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rectum; Risk Factors; Sodium Pertechnetate Tc 99m

Topics: Child; Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Intestines; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Gastrointestinal Stromal Tumors; Hematocrit; Humans; Intestinal Neoplasms; Intestine, Small; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Ulcer Agents; Child; Gastrointestinal Hemorrhage; Hematemesis; Humans; Ileal Diseases; Male; Meckel Diverticulum; Melena; Pantoprazole; Proton Pump Inhibitors; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

The article presents a case of a 24-year old man with ectopic gastric mucosa in Meckel's diverticulum. Ectopic gastric mucosa may be present in Meckel's diverticulum and may be associated with peptic ulcer disease and lower gastrointestinal (GI) bleeding. Diagnosing ectopic gastric mucosa can largely benefit from 99"Tc-pertechnetate scintigraphy.. A 24-year old man underwent Meckel's diverticulum scintigraphy for timely anamnesis of GI bleeding from uncertain source (enterorrhagia, haemorrhagic anaemia). Upper tract and large bowel endoscopy, enteroclysis, ultrasound, CT and radioactive labelled red blood cells scintigraphy resluts were negative.. Ectopic gastric mucosa was detected by 99mTc-pertechnetate scintigraphy. The patient underwent surgery and part of the proximal ileum including Meckel's diverticulum with ectopic gastric mucosa detected by histology was resected.. Meckel's diverticulum scintigraphy can help detect ectopic gastric mucosa and improve the disease management in a patient with gastrointestinal bleeding.

Topics: Adult; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

A 25-year-old Caucasian woman with a medical history of acute promyelocytic leukemia presented to the emergency department with massive gastrointestinal bleeding. A bone marrow biopsy excluded hemorrhagic leukemia. Esophagogastroduodenoscopy, colonoscopy, emergency abdominal angiography, abdominal CT scan, and wireless capsule endoscopy were performed but no source of bleeding could be detected. Tc-99m RBC scintigraphy was consistent with a small bowel bleeding focus. The persistent and focal images in the right abdomen were suggestive of Tc-99m RBC trapping in the lumen of a Meckel diverticulum (MD). In accordance with this suspicion, successive Tc-99m pertechnetate scintigraphy was performed after 3 days, consistent with the diagnostic hypothesis. Due to the persisting severe bleeding (with a drop in baseline hemoglobin from 10.4 to 7.1 g/dL), despite 8 units of blood transfusion, emergency surgery was performed. Through a minilaparotomy a segmental small bowel resection, including Meckel diverticulum, was performed. The postoperative course was uneventful.

Topics: Adult; Erythrocytes; Female; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Humans; Leukemia, Promyelocytic, Acute; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium

Topics: Diverticulum, Colon; Gastrointestinal Hemorrhage; Humans; Ileum; Infant; Jejunum; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Previous studies have demonstrated low yield and conflicting results as to the ability of technetium-99m labeled red blood cell (TRBC) scintigraphy to accurately localize the site of bleeding in acute lower gastrointestinal hemorrhage. Our objective was to evaluate the accuracy of TRBC scintigraphy in clinical day-to-day practice at our institution and to determine predictors of a positive test.. A retrospective medical records review of all patients who underwent TRBC scintigraphy over a 5-year period was conducted at a single academic medical center. The site of bleeding found on TRBC scintigraphy was correlated with the endoscopic, angiographic, surgical, and pathologic findings in each patient.. A total of 127 scans were performed in 115 patients. Forty-nine scans were positive (39%) and 78 were negative (61%). Forty-two patients had further evaluation after a positive scan, and the bleeding site was confirmed to be accurate in 20 of 42 patients (48%). A contradictory bleeding site was found in 5 of 49 positive scans (10%). Patients transfused greater than 2 units of packed red blood cells within 24 hours preceding the TRBC scan were twice as likely to have a positive scan (64%) than those transfused 2 units or less (32%) (P = 0.002). Multivariate analysis demonstrated that the number of units of blood transfused within 24 hours prior to the TRBC scan and the lowest recorded hematocrit were significantly different between patients with positive and negative scans. There was no difference in the rate of endoscopy between patients with a positive or negative scan result.. TRBC scintigraphy has a relatively low yield in the evaluation of acute lower gastrointestinal bleeding. Objective selection criteria such as number of units of packed red blood cells transfused prior to obtaining the scan may increase the overall yield.

Topics: Acute Disease; Colonic Diseases; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Multivariate Analysis; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sodium Pertechnetate Tc 99m

Technetium-99m-labeled red blood cell scintigraphy, commonly used in the evaluation of acute lower gastrointestinal hemorrhage, often fails to demonstrate a source of bleeding. It would be helpful to characterize a subset of patients more likely to have a positive scan. This study was undertaken to determine whether hemodynamic instability can predict tagged red blood cell scan positivity.. The records of 50 consecutive patients who underwent tagged red blood cell scanning for the evaluation of acute lower gastrointestinal bleeding were reviewed retrospectively.. Patients presenting with a heart rate >100 beats per minute or a systolic blood pressure <100 mmHg up to 24 hours before undergoing tagged red blood cell scanning were considered hemodynamically unstable. Thirteen of 21 unstable patients (62 percent) had positive scans, whereas only 6 of 29 stable patients (21 percent) had positive scintigraphy (odds ratio, 6; 95 percent confidence interval, 1.79-22.1).. Hemodynamic instability in the setting of acute lower gastrointestinal bleeding may be a predictor of positive tagged red blood cell scanning. Incorporating this into the diagnostic algorithm used to evaluate patients with acute lower gastrointestinal bleeding may allow physicians to reserve red blood cell scintigraphy for patients who have demonstrated transient hemodynamic compromise.

Topics: Acute Disease; Aged; Algorithms; Erythrocytes; Female; Gastrointestinal Hemorrhage; Hemodynamics; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m

We describe the case of a 13-month-old boy with significant rectal bleeding in which the (99m)Tc pertechnetate scan showed an initial focus of uptake in the left iliac fossa, which faded rapidly at 15 min. At surgery an ulcerated Meckel's diverticulum was found. We therefore highlight the need to consider a Meckel's diverticulum in cases where this atypical scintigraphic appearance is seen.

Topics: Digestive System Surgical Procedures; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Infant; Male; Meckel Diverticulum; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Child; Child, Preschool; Female; Gastrointestinal Hemorrhage; Gastrointestinal Tract; Humans; Infant; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adult; Age Factors; Aged; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Intussusception; Male; Meckel Diverticulum; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

This report describes a useful application of (99m)Tc-pertechnetate abdominal scintigraphy (Meckel's scan) in the assessment of gastric viability after corrosive injury. The Meckel's scan provided information about residual gastric mucosal function and prognosis in a less invasive manner than more usual methods.

Topics: Calcium Chloride; Female; Gastrointestinal Hemorrhage; Humans; Infant; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Diagnosis, Differential; Extravasation of Diagnostic and Therapeutic Materials; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Meckel's diverticulum is one of the most common causes of lower gastrointestinal hemorrhage in the young. We report a case of a 16-year-old youth who presented with a 3-day history of bright red bleeding per rectum. Clinical examination revealed pallor but nothing else of note. The patient had a hemoglobin of 9 G% on admission. Tc-99m pertechnetate scintigraphy was performed and demonstrated an abnormal focus in the pelvis on the right that changed in position during the course of imaging. A laparotomy was done and a 5 x 2-cm Meckel's diverticulum was removed from the ileum. Histopathologic examination revealed heterotopic gastric mucosa of the body type. The patient recovered fully after operation.

Topics: Adolescent; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

The authors report poor labeling of Tc-99m red blood cells (RBCs) in vivo in a radionuclide intestinal bleeding study of a patient who had recently undergone frequent blood transfusions. The existence of RBC antibodies, as a result of the recent blood transfusions in this patient, was one of the causes of the poor labeling. In radionuclide bleeding studies with patients with recent blood transfusion, Tc-99m HSA-D must be chosen instead of Tc-99m RBCs in vivo.

Topics: Adult; Blood Transfusion; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Leukemia, Myeloid, Acute; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Pentetate; Tin Polyphosphates

Obscure gastrointestinal (GI) bleeding is often challenging for the primary care physician, but with improved diagnostic testing the cause of this blood loss is determined in most patients. However, approximately 5% of the time no underlying cause is found. One common etiology in patients younger than 40 years of age is a Meckel's diverticulum. The technetium 99m pertechnetate scan is the standard test for making this diagnosis. However, the sensitivity of the scan is only 62% in the adult population. In this case report, a patient with profound, hemodynamically significant GI blood loss had multiple negative studies. Subsequently, an abnormal vascular lesion was detected and during exploratory laparotomy, a Meckel's diverticulum was found and removed. Although the technetium pertechnetate scan is falsely negative in a number of cases, there are ways to increase its sensitivity and possibly avoid repeated testing.

Topics: Adult; False Negative Reactions; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed

Acute gastrointestinal bleeding is often intermittent and the bleeding source may be difficult to locate, resulting in delay of potentially life-saving treatment. The aim of this study was to determine the clinical utility of 99mTc labelled red blood cell imaging and [99mTc]pertechnetate (Meckel's scan) imaging in a series of 137 patients admitted over a 5 year period to hospital for management of acute gastrointestinal bleeding. Of the 137 patients, 70 had positive 99mTc red blood cell studies. Eleven of 24 patients who had imaging performed beyond 3 h had positive scans that would otherwise have been missed. Only 47 patients had a definite final diagnosis at the time of hospital discharge, of which six were negative on 99mTc red blood cell imaging. The correct site of bleeding was localized in seven of 21 patients with foregut bleeding, and 15 of 20 patients with colonic bleeding. Endoscopy yielded a diagnosis in 13 of the 47 patients (28%). Eleven patients had Meckel's scans but all were negative. Angiography was diagnostic in one of 17 patients studied. 99mTc red blood cell imaging is a useful test in the management of acute gastrointestinal bleeding. Imaging beyond 3 h may further improve the bleeding detection rate. This test, however, may be an unreliable means of localization of bleeding, particularly in the foregut.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Endoscopy; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Infant; Infant, Newborn; Male; Meckel Diverticulum; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Risk Factors; Sodium Pertechnetate Tc 99m

The objective of this study was to determine whether the Tc-99m red blood cells (Tc-99m RBC) method has a true advantage over the Tc-99m sulfur colloid (Tc-99m SC) technique in a busy clinical practice for detecting and localizing lower gastrointestinal bleeding sites.. Three hundred fifty-nine consecutive gastrointestinal bleeding studies performed during the past 4 years were reviewed retrospectively. One hundred ninety-three scans were obtained with Tc-99m SC (scan duration, 30 minutes) and 138 studies were performed after the administration of Tc-99m RBC (scan duration, 1 hour). In addition, 28 examinations with Tc-99m SC were followed immediately by Tc-99m RBC scans for a duration of several hours. The results of the two methods were analyzed and the performance of the two techniques was compared.. Among 193 scans performed using the Tc-99m SC method, 47 (24.4%) successfully identified the location of the bleeding site, whereas in 138 scans performed using Tc-99m RBC, 38 (27.5%) were successful for this purpose. In the remaining 28 scans in which the Tc-99m SC scan was followed by the Tc-99m RBC study, only 4 (14.3%) positive bleeding sites were identified after a prolonged imaging period.. The theoretical advantages of the Tc-99m RBC technique compared with the Tc-99m SC method cannot be substantiated by this study. Our findings suggest that the efficacy of these two methods is nearly equal at a practical level.. The simpler and cost-effective Tc-99m SC method is as efficient as the Tc-99m RBC method when the scanning time is limited to 1 hour and optimal imaging and interpretation schemes are used.

Topics: Adult; Aged; Aged, 80 and over; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Diverticulitis; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Jejunal Diseases; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Endoscopy and, occasionally, X-ray studies are used to discover the focus of a gastrointestinal bleeding.. We describe a case of severe gastrointestinal bleeding where these methods failed. Scintigraphy after labelling of erythrocytes with 99m technetium was performed in a continuous manner for 60 minutes. Scintigrams were also taken three, ten and 23 hours after the injection.. No bleeding was revealed after 60 minutes, but two hours later a slight radioactivity was encountered in the right part of the abdomen and the later images localised the bleeding to the right colon. The bleeding ceased after right-sided hemicolectomy.. Scintigraphy is of value in localisation of gastrointestinal bleeding and should be performed in a continuous manner until the bleeding focus is localised. Secretion of unbound technetium through the mucosa of the stomach and its presence in the urinary tract should be taken in account.

Topics: Aged; Colonic Diseases; Female; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Cecal Neoplasms; Child, Preschool; Diagnosis, Differential; Gastrointestinal Hemorrhage; Hemangioma; Humans; Male; Meckel Diverticulum; Rectum; Sodium Pertechnetate Tc 99m

The case of a 22-year-old male who bled from a Meckel's diverticulum is described. The diagnosis was achieved after 99mTechnetium pertechnetate scintigraphy. With the administration of somatostatin very clear images were obtained. The histological examination confirmed the presence of ectopic gastric mucosa. The literature, over the last 10 years, has been reviewed to identify factors associated with bleeding in adults. Ectopic gastric mucosa is the most important factor predicting bleeding. The diagnostic approach to bleeding Meckel's diverticulum and the improvement in the quality of 99mTechnetium pertechnetate scintigraphy, following administration of somatostatin, is discussed.

Topics: Adult; Biopsy; Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Sodium Pertechnetate Tc 99m

Hemangioma of the small intestine is rare, and the preoperative diagnosis of it is difficult. We report a patient with gastrointestinal bleeding for whom Tc-99m-labeled red blood cell scintigraphy was useful in diagnosing cavernous hemangioma of the small intestine. A 25-year-old man was referred to our hospital for recurrent iron deficiency anemia. Because of the patient's severe anemia, imaging was performed to locate the bleeding lesion in the gastrointestinal tract. Scintigraphy with Tc-99m-labeled red blood cells revealed pooling indicating a tumor and extravasation of blood from the tumor. Scintigraphy with Tc-99m pertechnetate revealed no abnormal accumulation. Partial resection of the small intestine was done, and cavernous hemangioma of the small intestine was diagnosed by using the specimen of resected tissue.

Topics: Adult; Anemia; Capillaries; Erythrocytes; Gastrointestinal Hemorrhage; Hemangioma, Cavernous; Humans; Intestinal Mucosa; Intestinal Neoplasms; Intestine, Small; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Adult; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Ileal Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

The aim of this study was to assess the utility of technetium (Tc) 99m pertechnetate scintigraphy in the diagnostic workup of the pediatric patient with gastrointestinal (GI) bleeding and a suspected Meckel's diverticulum.. The charts of 235 consecutive patients evaluated with a Meckel's scan (n = 165) or with the discharge diagnosis of Meckel's diverticulum (n = 70) between January 1975 and October 1997 were reviewed for presenting symptoms, bleeding characteristics, diagnostic studies and pathological diagnosis. Those patients with lower GI bleeding and a serum hemoglobin level less than 11.0 g/dL who underwent a 99mTc pertechnetate scan (n = 43) were assessed for utility of the scan.. In all patients the Meckel's scan had a positive and negative predictive value of 0.93. However, in patients with lower GI bleeding and a hemoglobin less than 11.0 g/dL the Meckel's scan had a sensitivity of 0.60, a positive predictive value of 1.0, a specificity of 0.96, but only a negative predictive value of 0.74. As such, the probability that a child who presents with GI bleeding and a serum hemoglobin less than 11 g/dL will have a Meckel's diverticulum despite a negative Meckel's scan of 0.26. We further evaluated the eight patients with a false-negative scan: ectopic gastric mucosa was present on pathological examination in all eight patients. Pentagastrin stimulation was performed at the time of scintigraphic study in three of eight. Six of these eight patients had duplicate scans that also were negative. Patients with a false-negative (FN) scan had significantly increased hospital charges when compared with those with a true positive (TP) scan (TP = $5012 +/- 1992; FN = $8554 +/- 1506; P = .0001). Clinical suspicion had a major effect on the decision-making process in these patients independent of the results of the Meckel's scan, and all eight patients ultimately underwent exploratory laparoscopy-laparotomy with Meckel's diverticulectomy despite the scan results.. The relatively low negative predictive value of the Meckel's scan may result in the need for operative evaluation despite the scan data. As such, the contribution of the scan to clinical decision making is low. These findings suggest that exploratory laparotomy or laparoscopy may be indicated instead of scintigraphic scanning in the assessment of the anemic (hemoglobin less than 11 g/dL) pediatric patient with lower GI bleeding, especially in patients in whom a high suspicion for a bleeding Meckel's diverticulum exists.

Topics: Adolescent; Child; Child, Preschool; Gastrointestinal Hemorrhage; Humans; Infant; Infant, Newborn; Meckel Diverticulum; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m

To compare the performance of 3D magnetic resonance imaging (MRI) in conjunction with an intravascular contrast agent with that of scintigraphy, with respect to detection and localisation of gastrointestinal haemorrhage in vivo in pigs.. Intraluminal bleeding sites were surgically created in the small bowel and colon of six pigs. The animals underwent scintigraphy with (99m)Tc labelled red blood cells and 3D MRI following administration of an intravascular contrast agent (NC100150) at five minute intervals over 30 minutes. For analysis, the intestinal tract was divided into six segments. Based on the two evaluated methods, each segment was characterised on a five point scale regarding the presence of a bleed. At autopsy, the surgically manipulated bowel segments were inspected for the presence of haemorrhage.. Bleeding was confirmed at autopsy in 18/36 segments. Contrast extravasation with subsequent movement through the bowel could be documented on MRI data sets. All segments were correctly characterised, resulting in 100% sensitivity and specificity for MRI. Based on scintigraphy, interpretation of seven segments (19%) was false (sensitivity/specificity of 78%/72%). Differences in diagnostic performance were evident in the receiver operator characteristic (ROC) analysis, with an area under the MRI curve of 0.99 and under the scintigraphy curve of 0.85.. In conjunction with an intravascular contrast agent, 3D MRI permits accurate detection and localisation of gastrointestinal bleeding. The extent and evolution of intestinal bleeding can be determined with repeated data acquisition.

Topics: Animals; Contrast Media; Erythrocytes; Female; Gastrointestinal Hemorrhage; Magnetic Resonance Imaging; Radiopharmaceuticals; ROC Curve; Sodium Pertechnetate Tc 99m; Swine; Tomography, Emission-Computed, Single-Photon

Both in vivo and in vitro red cell labeling methods are available for performing gastrointestinal bleeding studies. While in vitro labeling has been shown to result in higher binding efficiency, no comparison of clinical image quality has been reported between those techniques. This study compares in vivo and in vitro methods using both subjective and objective measurements of image quality.. A consecutive series of gastrointestinal bleeding studies performed on 23 patients using in vivo labeling was compared to a series of 23 studies using in vitro labeling. Images at 30 min postinjection were randomized and analyzed by two observers. Subjective evaluation of image quality, as well as renal activity, was based on a comparison of femoral vein and inferior vena cava activity to adjacent background using numerical scores with a scale of 0-3. Image quality using the subjective scores was further classified as acceptable and poor. Target-to-background measurements of femoral vein to adjacent soft tissue in the thigh and inferior vena cava to adjacent abdominal background also were made.. In vitro label subjective image quality was acceptable in 87% and 91% of cases for vascular and renal activity, respectively, but only 35% and 52% for in vivo labeling. In vitro label target-to-background ratios were significantly better than in vivo label for the femoral vein and inferior vena cava, as well as for the subjective assessment of vascular image quality, but not for renal activity.. In vitro red cell labeling improves clinical image quality as compared with in vivo labeling. Both subjective and objective measurements of image quality are useful for comparing the results of labeling methods.

Topics: Abdomen; Erythrocytes; Femoral Vein; Gastrointestinal Hemorrhage; Humans; Image Enhancement; Information Storage and Retrieval; Kidney; Observer Variation; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pyrophosphate; Thigh; Vena Cava, Inferior

Topics: Anticoagulants; Erythrocytes; Gastrointestinal Hemorrhage; Heparin; Humans; Image Enhancement; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Hirschsprung Disease; Humans; Infant; Liver; Male; Parenteral Nutrition, Total; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

99mTc red blood cell scintigraphy is a non invasive diagnostic method for low flow gastrointestinal bleeding.. To assess the diagnostic yield of this method in patients admitted with gastrointestinal bleeding in whom upper gastrointestinal endoscopy was negative.. The clinical records of 59 patients, aged 6 to 90 years old (35 male), with active gastrointestinal bleeding subjected to a 99mTc red blood cell scintigraphy were reviewed. All had non diagnostic upper gastrointestinal endoscopic studies, and in 20 a selective arteriography was performed.. In 40 patients the scintigraphy was positive for gastrointestinal bleeding, and in 57% of these the exam was positive during the first hour. Fifteen of the 19 patients with a negative scintigraphy did not have an active clinical bleeding at the moment of the examination. In 24 patients, a final etiological diagnosis was reached. In 93% of these patients scintigraphy correctly identified the bleeding site. In one patient with a negative scintigraphy, angiography disclosed a pseudo aneurysm of the splenic artery that was not bleeding actively.. In these patients with negative upper gastrointestinal endoscopy 99mTc red blood cell scintigraphy had a 91% sensitivity for the diagnosis of active gastrointestinal bleeding.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Colonic Diseases; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m

Demonstration of functioning heterotopic gastric mucosa with 99mTc-pertechnetate SPECT is reported. Abnormal tracer uptake was shown conclusively with SPECT but not with planar imaging. When a Meckel's diverticulum is suspected, we suggest SPECT be performed if the results of planar scintigraphy are equivocal and that it be considered if there is a high clinical suspicion and planar imaging is normal.

Topics: Adolescent; Choristoma; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

Topics: Abdomen; Choristoma; Erythrocytes; Gastric Mucosa; Gastrointestinal Hemorrhage; Hemangioma; Humans; Ileal Diseases; Liver Neoplasms; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

To improve the detectability of gastrointestinal (GI) bleeding, we have developed a new method, 'sequential subtraction scintigraphy' (SSS) with 99Tcm-labelled red blood cells (RBC). Sequential subtraction scintigrams were obtained by subtracting 5 min interval images from each other using a digital gamma camera. With this method, we are able to detect the bleeding site and calculate the bleeding rate earlier because of the lower background activity. The results of the present study demonstrate that the minimum detectable bleeding rate was 0.05 ml min-1 in both a phantom and an animal model. The minimum detectable activity volumes within 10 min were 0.5 ml by SSS and more that 3 ml by conventional non-subtraction scintigraphy (CNS). The bleeding rates calculated with the subtraction method correlated well with the actual syringe pump rates. The detectability of GI bleeding by SSS and CNS in animal models was compared using the area under receiver operator characteristic (ROC) curves. The results showed that SSS significantly increased the area under the ROC curves from 0.55 +/- 0.05 to 0.79 +/- 0.04 for the 10 min image set and from 0.65 +/- 0.05 to 0.83 +/- 0.04 for the 30 min image set (Z = 5.45, P < 0.0001 and Z = 4.36, P < 0.0001, respectively). These results suggest that sequential subtraction scintigraphy with 99Tcm-RBC is an effective method for the early detection of GI bleeding when compared with the conventional non-subtraction method.

Topics: Adult; Animals; Erythrocytes; Gamma Cameras; Gastrointestinal Hemorrhage; Humans; Phantoms, Imaging; Rabbits; Radionuclide Imaging; Regression Analysis; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium

This study was performed to evaluate whether the time interval from injection of technetium Tc 99m (99mTc)-labeled red blood cells to the time of a radionuclide "blush" (positive scan) can be used to improve the efficacy in predicting a positive angiogram.. A retrospective review revealed 160 patients who received 99mTc-labeled red blood cell scintigraphy for evaluation of massive lower gastrointestinal hemorrhage between 1989 and 1994. Patients were included who demonstrated signs of shock on admission, had an initial decrease in hematocrit of > or = 6 percent, or required a minimum transfusion of two units of packed red blood cells. Scanning duration was 90 minutes, with imaging every 2 minutes. Time interval from injection to a positive scan was analyzed to determine predictability of a positive angiography.. Of 160 patients, 86 demonstrated positive scans, of whom 47 underwent angiography. These 47 patients were divided into two groups according to scan results. Group 1 (n = 33) had immediate appearance of blush; Group 2 (n = 14) had blush after two minutes. In Group 1, 20 of 33 patients had a positive angiogram, yielding a positive predictive value of 60 percent (P = 0.033). Of the 14 patients with negative angiograms (13 from Group 1, and 1 with a negative scan), 6 had radiographic occlusion of the inferior mesenteric artery and 1 had spasm of the right colic artery, with scans that blushed in the respective distributions. Excluding these seven patients yielded a positive predictive value of 75 percent (P = 0.0072) for angiography. In patients with a delayed blush (Group 2), 13 of 14 had negative angiograms, yielding a negative predictive value of 93 percent (92 percent excluding those with nonvisualization of the inferior mesenteric artery). Twenty of 21 (95 percent) positive angiograms occurred in Group 1 patients. Of the 27 patients with negative angiograms, 13 were Group 2 patients.. Patients with immediate blush on 99mTc-labeled red blood cell scintigraphy required urgent angiography. Patients with delayed blush have low angiographic yields. These data suggest that patients with delayed blush or negative scans may be observed and evaluated with colonoscopy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Angiography; Colonic Diseases; Colonoscopy; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Time Factors

Disseminated islands of gastric mucosa are very rare in the small intestine. The secretion of hydrochloric acid can lead to ulceration which results in gastrointestinal bleeding. It is often difficult to localize the focus in case of gastrointestinal blood loss especially in the small bowel. Technetium-99m-pertechnetate scintigraphy may be a helpful tool in detecting ectopic gastric mucosa. We report a case of a 21-mo-old boy with recurrent gastrointestinal bleeding. By using pertechnetate scintigraphy, extensive tracer accumulation in the jejunum and proximal ileum was detected. Histologically, multiple islands of ectopic gastric mucosa were found in about 50 excited mucosal and transmural biopsies. The unusual finding of disseminated accumulation of 99mTc-pertechnetate in the small intestine was the diagnostic clue for such a rare disease.

Topics: Biopsy; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Ileum; Infant; Jejunal Diseases; Jejunum; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

To assess the role of radionuclide scintigraphy in etiologic diagnosis of gastrointestinal bleeding in children, especially in detecting the cases of Meckel's diverticulum or double intestine.. 99mTc-pertechnetate abdominal scintigraphy was undertaken in 26 children with history of gastrointestinal bleeding. Additional 99mTc-RBC scintigraphy was performed in 12 cases who gave a negative 99mTc-pertechnetate scintigraphy as they had the signs of active bleeding. The final diagnosis of all cases was proved by surgery and pathology or endoscopy.. In detecting Meckel's diverticulum and double intestine, the sensitivity, specificity and accuracy of 99mTc-Pertechnetate scintigraphy were 85. 7% (12/14), 91.7% (11/12) and 88.5% (23/26) respectively.. Radionuclide scintigraphy may be the first procedure to explore the etiology in the lower digestive tract.

Topics: Child; Child, Preschool; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

There is disagreement over the reliability of technetium Tc 99m (99mTc)-labeled erythrocyte scintigraphy in the localization of active lower gastrointestinal hemorrhage. A previous study at The New York Hospital-Cornell Medical Center that showed a superior sensitivity for localization of scintigraphy versus angiography in surgical patients led the authors to emphasize scintigraphy as the diagnostic test of first choice in the clinical diagnostic algorithm. The authors hypothesized that tagged erythrocyte scintigraphy can be used accurately as the primary diagnostic modality in localizing acute bleeding and guiding surgical intervention.. The authors conducted a 5-year, retrospective analysis of 224 inpatients who underwent scintigraphic imaging for diagnosis and localization of active lower gastrointestinal bleeding. Using scintigraphy as the primary diagnostic test, with colonoscopy, upper endoscopy, and angiography as adjunctive studies, 99mTc-labeled erythrocyte scans were performed at the clinician's discretion and were reviewed again for study purposes by two nuclear radiologists who were blinded to clinical outcome. Adjunctive diagnostic tests also were ordered for clinical indications.. Using delayed periodic scintigraphic imaging, results of 115 scans (51.3%) demonstrated bleeding, with 96 scans (42.9%) localizing to a specific anatomic site. Patients with positive scans were five times more likely to require surgery (p < 0.005) than patients with negative scans, and surgical patients were twice as likely to localize by scintigraphy (p < 0.0001). Fifty patients (22.3%) required surgical intervention to control hemorrhage and had a bleeding site confirmed by both clinical and pathologic examinations. Forty-eight of those patients (96%) had a bleeding site determined preoperatively. For 37 patients with bleeding sites localized preoperatively by scintigraphy, 36 (97.3%) had correct localization based on surgical pathology. Only one patient required a subtotal colectomy solely because of nonlocalized bleeding. No patient bled postoperatively, and there was no mortality in either operated or nonoperated patients. The mean volume of transfused erythrocytes was similar in both scan-localized and nonlocalized surgical patients.. When performed correctly and interpreted conservatively, scintigraphy is a useful and safe means of guiding segmental resection, and should be the primary tool used in the diagnosis of patients with active lower gastrointestinal bleeding.

Topics: Chi-Square Distribution; Diagnosis, Differential; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Intestines; Radionuclide Imaging; Remission, Spontaneous; Retrospective Studies; Sodium Pertechnetate Tc 99m; Time Factors; Treatment Outcome

The evaluation of gastrointestinal hemorrhage may include a Meckel's scan, particularly in children. Typically, a Meckel's diverticulum shows discrete, focal uptake in the right lower abdomen. The authors describe an adult whose bleeding Meckel's diverticulum manifested as brisk, intermittent intraluminal tracer extravasation.

Topics: Adult; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adult; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

In a retrospective analysis the diagnostic value of two scintigraphic methods was compared with each other.. 104 patients with acute or intermittent gastrointestinal haemorrhage were examined with 121 scintigraphic studies. We compared scintigraphic results with surgical findings, endoscopic results or final clinical diagnosis. We used two scintigraphic methods, colloid scintigraphy and in vivo/vitro red blood cell scintigraphy.. Our scintigraphic findings reached a sensitivity of 72% and a specificity of 100%. We calculated a sensitivity of 68% for colloid scintigraphy and a sensitivity of 79% for red blood cell scintigraphy. The correct localisation of bleeding was successful in 52 (98%) cases.. Our results demonstrate that red blood cell scintigraphy is the method of choice in detecting intermittent gastrointestinal hemorrhage. We believe that with new preparation kits for in vivo labelling red blood cell scintigraphy will become seriously competitive for the colloid scintigraphic method.

Topics: Acute Disease; Chronic Disease; Colloids; Erythrocyte Transfusion; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Rectum; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Compounds; Time Factors; Tin Compounds

The results from an ultrasound study performed on an 11-year-old boy, who had several weeks of intermittent abdominal pain, showed a nonperistaltic loop of bowel near the umbilicus, which suggested either an internal hernia or a diverticulum. Tc-99m pertechnetate imaging showed a focal collection near the umbilicus, which was consistent with a Meckel's diverticulum. No evidence was found of gastrointestinal bleeding. Exploratory laparotomy showed a Meckel's diverticulum near the terminal ileum and attached to the anterior abdominal wall close to the umbilicus. Small bowel had herniated through the loop formed by the terminal ileum and the diverticulum.

Topics: Abdominal Pain; Child; Gastrointestinal Hemorrhage; Hernia; Humans; Ileal Diseases; Laparotomy; Male; Meckel Diverticulum; Peristalsis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tissue Adhesions; Ultrasonography; Umbilicus

Topics: Child, Preschool; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileum; Intestinal Mucosa; Intestine, Small; Male; Melena; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Angiography; Diagnosis, Differential; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sex Cord-Gonadal Stromal Tumors; Sodium Pertechnetate Tc 99m; Testicular Neoplasms; Tomography, X-Ray Computed

We report a case of a bleeding Meckel's diverticulum where scintigraphic and sonographic findings were thought to suggest an ileal duplication. We are not aware of previous reports of sonographic imaging of an uncomplicated Meckel's diverticulum.

Topics: Choristoma; Diagnosis, Differential; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Infant; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Ultrasonography

An 82-year-old man had his third episode of melanotic stool. Two previous workups had failed to localize the source of bleeding. A Tc-99m labeled RBC scan visualized the gallbladder early in the study. Administration of sincalide visually decreased the activity, confirming gallbladder activity. Three months later, at his second surgery, hepatic metastases were finally identified as the source of bleeding. In retrospect, the hepatic activity is inhomogeneous with at least two cold defects that could have represented hepatic metastases.

Topics: Adenocarcinoma; Aged; Diverticulum; Erythrocytes; Gallbladder; Gastrointestinal Hemorrhage; Hemobilia; Humans; Jejunal Diseases; Liver Neoplasms; Male; Neoplasms, Unknown Primary; Radionuclide Imaging; Sincalide; Sodium Pertechnetate Tc 99m

Topics: Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Hemangiosarcoma; Humans; Neoplasms, Multiple Primary; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

The authors report a successful Meckel's scan performed 26 hours after a labeled RBC study using a commercial in-vitro labeling kit, UltraTag (Mallinckrodt Medical, Inc., St. Louis, MO). No abnormal alteration of Tc-99m distribution was observed as would be seen if an in-vivo RBC labeling technique was used. This case demonstrates that it is feasible to perform an in-vitro labeled RBC study for acute gastrointestinal bleeding in pediatric patients and to follow-up with a Meckel's scan if it is necessary for diagnostic confirmation.

Topics: Child; Erythrocytes; Feasibility Studies; Gastrointestinal Hemorrhage; Humans; Isotope Labeling; Male; Meckel Diverticulum; Radionuclide Imaging; Reagent Kits, Diagnostic; Sodium Pertechnetate Tc 99m; Time Factors

The normal biodistribution of Tc-99m pertechnetate includes the thyroid gland, salivary glands, choroid plexus, and gastric mucosa. The primary route of excretion is through renal clearance. The authors describe two cases in which hepatobiliary excretion of intravenously administered Tc-99m pertechnetate was observed during scanning for Meckel's diverticulum as a possible source of gastrointestinal bleeding.

Topics: Adult; Biliary Tract; Child; Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Liver; Male; Meckel Diverticulum; Polyps; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Time Factors; Tissue Distribution

Radionuclide scintigraphy is commonly utilized as a screening examination before performing more invasive procedures in the work-up of patients with lower gastrointestinal (GI) bleeding. We reviewed our institutional experience with technetium-labelled red blood cell scintigraphy (TRCS) in detecting and localising acute lower GI bleeding. The study group included 72 patients who had 80 red cells scans over a five year period. Thirty-eight scans were positive (47.5%), and 42 were negative (52.5%). Sites of lower GI bleeding were confirmed by endoscopy, arteriography, surgery and/or pathology in 22 of the 38 positive scans. There were four false-negative scans (9.5%). The overall sensitivity and specificity of TRCS in detecting lower GI bleeding was 84.6% (22/26) and 70.4% (38/54), respectively. The accuracy of localization of bleeding sites in the patients with confirmed positive scans was 72.7% (16/22). Thirty mesenteric arteriograms were performed on patients in this series. Eleven arteriograms were performed after negative TRCS; one was positive. Technetium-labelled red blood cell scintigraphy appears to be a useful screening examination for patients with lower GI bleeding who are hemodynamically stable. This may avoid the potential morbidity of arteriography in patients who are not actively bleeding.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Colonic Diseases; Erythrocytes; False Negative Reactions; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pyrophosphate; Time Factors; Tin Polyphosphates

To improve the early detectability of gastrointestinal (GI) bleeding, we have developed a new subtraction scintigraphic technique using in vivo labeled 99mTc red blood cells (RBC). Use of this new sequential subtraction method every 5 min makes it possible to detect early the bleeding site and calculate the bleeding rate. In phantom experiments, focal activity was detected on subtraction images at pump rates of more than 0.20 ml/min at any urethane thickness, but was negative on conventional scintigrams. The calculated pump rate by the subtraction method correlated well with the actual syringe pump rate (y = 1.07x - 0.02, r = 0.99, p < 0.01) in the case of an 8-cm urethane board as an abdominal wall. Twenty-four of 50 patients with suspected GI bleeding were confirmed to be positive within 24 hr. The subtraction method showed 15 true positive and 2 false positive cases within 60 min. On the other hand, the conventional scintigraphic method showed only 7 true positive and 1 false positive cases. Sensitivity of the subtraction method was 62.5%, which was significantly higher (p < 0.05) than that of the conventional scintigraphic method (29.2%). These results suggest that sequential subtraction scintigraphy with 99mTc-RBC is an effective method for the early detection of GI bleeding and shortening the examination time as compared with conventional scintigraphy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Diagnostic Errors; Erythrocytes; Evaluation Studies as Topic; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Phantoms, Imaging; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique

A patient with a chronic occult gastrointestinal bleeding site is described. Because an extensive examination failed to locate the site of bleeding, a heparin infusion was used in conjunction with a conventional Tc-99m labeled red cell bleeding study. A mid-jejunal ulcer was safely localized before elective surgery. A protocol for a heparin provocative bleeding study is proposed.

Topics: Aged; Chronic Disease; Erythrocytes; Female; Gastrointestinal Hemorrhage; Heparin; Humans; Jejunal Diseases; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Ulcer

A retrospective study was conducted using 36 patients with gastrointestinal bleeding in whom the diagnosis was not directly apparent from first line diagnostic procedures. Final diagnosis was established by surgery, endoscopy, or postmortem examination in 20 patients. Scintigraphic examination with Tc-99m or In-111 labeled red blood cells yielded 24 positive and 18 negative results. Nine out of 13 positive scans (verified by other diagnostic procedures) accurately identified the site of bleeding. This was considered to be a satisfactory result in this group of difficult to diagnose patients. The lowest success rate was observed in patients taking drugs that interfered with coagulation, or in patients prone to diffuse blood loss because of coagulopathy. Late scans did not offer additional information and the use of In-111 for this purpose was not thought to be of benefit. Although the technique is rather noninvasive and simple, its application should be restricted to selected patients and its interpretation related to the results of other investigations.

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Indium Radioisotopes; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m

A case of chronic gastric organoaxial volvulus, gastroesophageal reflux, esophagitis, and chronic anemia is presented. Reflux esophagitis and chronic anemia have not been reported previously as clinical signs associated with gastric volvulus in a child. A Meckel's scan is used to diagnose the displaced stomach.

Topics: Anemia, Iron-Deficiency; Child, Preschool; Diaphragmatic Eventration; Esophagitis, Peptic; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Humans; Male; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach Volvulus

A Meckel's scan was performed on a 7-yr-old boy because of rectal bleeding. He was premedicated with pentagastrin (6 micrograms/kg subcutaneously) followed by 259 MBq (7 mCi) [99mTc]pertechnetate intravenously. The study was essentially negative. Because of persistent rectal bleeding and a strong clinical suspicion of a Meckel's, a repeat study was performed 6 wk later. He received pentagastrin as before, but this time was also given a histamine H2 receptor blocker (zantac). A Meckel's diverticulum was clearly evident.

Topics: Child; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Pentagastrin; Premedication; Radionuclide Imaging; Ranitidine; Rectum; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Propranolol can reduce portal hypertension, therefore is recommended in prevention of variceal bleeding in patients with liver cirrhosis. However, in certain patients with cirrhosis portal hypotensive effect of propranolol cannot be obtained, and the reason of this finding is unknown. In 28 patients with cirrhosis the effect of seven days administration of propranolol on collateral blood flow from inferior mesenteric vein was examined by means of per-rectal portal scintigraphy. Portosystemic shunt index was significantly reduced by propranolol by 17.4 +/- 4.8%. This reduction was observed in cirrhotics classified to A and B, but not C Child-Pugh. These data suggest that propranolol increases vascular resistance in portosystemic circulation which depends on severity of liver failure. This mechanism opposes reduction of portal pressure.

Topics: Adult; Aged; Blood Pressure; Collateral Circulation; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Middle Aged; Portal System; Propranolol; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Vascular Resistance

Per-rectal portal scintigraphy with Tc-99m pertechnetate is a method to evaluate portosystemic shunting (shunt index) in inferior mesenteric vein. In this study the shunt index was estimated in patients with chronic liver disease in relation to the severity of liver injury, portal hypertension and incidence of oesophageal varices. Shunt index was elevated in patients with non-cirrhotic liver disease as compared with healthy normals (34 +/- 6% vs 8 +/- 2%; p < 0.0005). Moreover, patients with cirrhosis had the shunt index of 65 +/- 4% which was higher than in other groups. There was no correlation of the shunt index to the Child-Pugh classification, hepatic venous pressure gradient and varices size in the cirrhotic patients. Conversely, the shunt index differentiated variceal bleeders from non-bleeders (80 +/- 4% vx 59 +/- 6%; p < 0.005). These data show that peripheral collateral circulation develop in response to mild elevation of portal pressure, but its hemodynamic efficacy to alleviate portal hypertension seems to be unremarkable. High shunt index might reflect elevated risk of bleeding from varices.

Topics: Adult; Aged; Chronic Disease; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemodynamics; Humans; Hypertension, Portal; Liver Diseases; Male; Mesenteric Veins; Middle Aged; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m

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

Acute lower gastrointestinal hemorrhage in a 17-year-old boy was caused by a Meckel's diverticulum 1 day after ingestion of 500 mg acetylsalicylic acid. After conservative treatment of the bleeding, the diverticulum was diagnosed in the free interval by technetium pertechnetate scintigraphy, which showed an accumulation in the right lower quadrant simultaneously with the accumulation in the gastric mucosa. Elective explorative laparoscopy confirmed the diverticulum, and the resection was performed by laparoscopic means. Histology showed gastric-type mucosa in the diverticulum. The treatment of choice for Meckel's diverticulum, when it is diagnosed preoperatively or during laparoscopy, is laparoscopic resection.

Topics: Adolescent; Aspirin; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Laparoscopy; Male; Meckel Diverticulum; Preoperative Care; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

A 76-year-old woman presented after 1 day of melena and anemia. A Meckel's scan revealed an upper mid abdominal focus of activity that paralleled stomach activity. Later, the surgeon removed the corresponding lesion in the mid ilium. Pathology confirmed that the lesion was a carcinoid tumor, not ectopic gastric mucosa. The false-positive Meckel's scan had revealed the true source of gastrointestinal bleeding and an unsuspected solitary carcinoid tumor. This is the third published case of a carcinoid tumor discovered by a false-positive Meckel's scan.

Topics: Aged; Carcinoid Tumor; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Ileal Neoplasms; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

From 1980 to 1992, we found false negative results from Technetium (Tc)-99m abdominal scans in seven children with massive gastrointestinal bleeding from ectopic gastric mucosae. Other examinations--including endoscopy, gastrointestinal series studies, angiography, and Tc-99m-labeled red blood cell scans to search for the source of the bleeding--were all in vain. Positive results were only obtained after repeated Tc-99m abdominal scans. Surgical specimens confirmed that ectopic gastric tissue was the source of bleeding in five patients with Meckel's diverticulum and two patients with enteric duplication.

Topics: Child, Preschool; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Infant; Male; Predictive Value of Tests; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The most malformations of the gastrointestinal tract are the Meckel's diverticula. In 25% of all complications of this disease you will find a bleeding of the diverticulum. We report a case of a 12 year old boy treated laparoscopically for a bleeding diverticulum and we describe the technical procedure. The first choice in diagnosis in the scintigraphy with 99mTc-pertechnate, at which the proof of ectop stomach mucous membrane is necessary. Laparoscopic resection of a bleeding Meckel's diverticulum performed by an experienced surgeon is a safe and considerate procedure in laparoscopic technique.

Topics: Child; Gastrointestinal Hemorrhage; Humans; Laparoscopy; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

To evaluate the success of technetium-99m-labeled red blood cell scintigraphy in localizing the site of gastrointestinal bleeding, and to identify the clinical and technical factors that contribute to scan accuracy.. A retrospective review was conducted of all patients who underwent a tagged red blood cell scan for the evaluation of gastrointestinal bleeding at our institution from 1981 to 1991.. Of a total of 153 patients, 90 (59%) had positive scans, whereas, in 63 (41%), they were negative. Of the 90 patients who had positive scans, it was possible to assess scan accuracy in 44 who had corrective surgery or an additional diagnostic procedure which definitively localized the site of bleeding. Of those 44 patients, the correct bleeding site was identified by red blood cell scanning in 33 patients (75%) overall and in all six patients with a left colon bleeding site. In this group of 44 patients, 22 scans were positive within 2 h, and of these the scan was accurate in localizing the bleeding site in 19 of 22 (86%). When the three subjects with upper gastrointestinal bleeding were excluded, the scan was positive in 100% of the remaining 19 patients.. The technetium-labeled red blood cell scan is a reliable tool for the assessment of unexplained lower gastrointestinal bleeding when the scan is positive within the first 2 h, and an upper gastrointestinal source has already been excluded.

Topics: Aged; Colonic Diseases; Erythrocytes; Evaluation Studies as Topic; Female; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Male; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m

Topics: Female; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Leiomyoma; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Uterine Neoplasms

The detectability of ectopic gastric mucosa by Technetium (Tc)-99m pertechnetate abdominal scanning was investigated by reviewing 62 such scans in 52 pediatric patients with gastrointestinal hemorrhage. The histologic diagnoses and clinical conditions were correlated to the findings of the scans. There were 21 true-positives, 35 true-negatives, one false-positive and five false-negative studies. The overall sensitivity of this scan for the detection of ectopic gastric mucosa was 81%, the specificity was 97% and the accuracy was 90%.

Topics: Adolescent; Child; Child, Preschool; Choristoma; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Neoplasms; Infant; Intestinal Neoplasms; Male; Meckel Diverticulum; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Three infants younger than 2 years presented with episodic bloody-to-tarry stool of moderate amount. Two of them were diagnosed to have Meckel's diverticulum because of a positive 99mTc pertechnetate scan. Although the third infant had two negative radionuclide scans within 3 months, Meckel's diverticulum was still suspected by exclusion studies. All three infants underwent laparoscopic surgery. At laparoscopy, a Meckel's diverticulum was identified in all. Besides, an ileoileo intussusception just proximal to the diverticulum was also found in one patient. Reduction of the intussusception and diverticulectomy were performed successfully by laparoscopic procedure. Compared with conventional laparotomy, this procedure has the advantages of direct preoperative visual confirmation of the diagnosis, less traumatic access, much shorter recovery period and perhaps fewer intraoperative and postoperative complications. And thus, laparoscopic surgery has the potential of becoming regular treatment for symptomatic Meckel's diverticulum of infants.

Topics: Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Infant; Intussusception; Laparoscopy; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Gastrointestinal Hemorrhage; Humans; Omentum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Varicose Veins

The scintigrams of 76 patients with gastrointestinal bleeding referred over an 8 year period have been reviewed together with their subsequent clinical course. Twenty-five patients had either 99Tcm-sulphur colloid or 99Tcm-labelled red cell scintigraphy to localize a source of active bleeding. Fourteen patients had 99Tcm-sulphur colloid scintigraphy, of which seven were false negatives, two were false positives and two were true positives. Eleven patients had 12 99Tcm-labelled red cell scintigrams, of which three were false negatives, one was a false positive and four were true positives. Fifty patients had 99Tcm-pertechnetate scintigraphy to look for ectopic gastric mucosa in Meckel's diverticula. There were 43 true negatives, two false negatives, two true positives and three false positives in this group. Our results emphasize the need for caution in interpreting nuclear medicine studies in patients with blood loss from the gastrointestinal tract.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Chronic Disease; Erythrocytes; False Negative Reactions; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Infant; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Sulfur Colloid

In cases of severe colon bleeding, it is more important to know the site than the cause, in case surgery is required. Technetium-labeled red-cell scan (TLRCS) is known to identify the site of bleeding at the rate of 0.1 ml per minute or more. The aim of this retrospective study was to see whether TLRCS was a reliable indicator of the site of severe colon bleeding. A retrospective study was made of patients investigated in this way for acute, severe colon bleeding at St. Vincent's Hospital, Melbourne, from 1984 to 1988 (five years). TLRCS identified the site of bleeding in less than half of the cases but correctly identified the site in all nine patients in whom bleeding was so severe as to require emergency surgery, avoiding total colectomy in eight cases.

Topics: Aged; Aged, 80 and over; Colonic Diseases; Emergencies; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m

Clinical applications for Tc-99m HMPAO labeled red blood cells have not been previously reported. The authors describe a simple, aseptic, closed, one-step centrifugal procedure for red blood cell labeling with Tc-99m HMPAO and isolation from whole blood, and they report the preliminary results of using these labeled red blood cells to detect acute gastrointestinal bleeding in 11 patients. Whole blood was radiolabeled with Tc-99m HMPAO preparation and blood cells were separated by centrifugation (30 min, 200 g, 20 degrees C) using Polyprep density gradient medium. Red blood cells contained about 50% of the radioactivity. Four out of the 11 patients imaged with a gamma camera after reinjection of labeled autologous red blood cells showed abnormal accumulation, suggesting gastrointestinal bleeding that was verified at surgery and was at the site of abnormal activity in all cases. Image quality with Tc-99m HMPAO was comparable to that of Tc-99m pertechnetate labeled pretinned red blood cells. Tc-99m HMPAO can be used as a red blood cell labeler; however, its elution rate from red blood cells limits its applicability in some investigations.

Topics: Adult; Centrifugation, Density Gradient; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Isotope Labeling; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Exametazime

Topics: Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Kidney; 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

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Splenic Rupture

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

Both labeled RBC and Meckel's scans have been used to evaluate pediatric patients with gastrointestinal bleeding, sometimes sequentially in the same patient. Particularly in infants, from whom withdrawal of sufficient blood for in vitro RBC labeling is often not possible, in vivo labeling with stannous pyrophosphate is used. However, prior administration of stannous-containing agents is known to alter the in vivo distribution of Tc-99m pertechnetate and to interfere with the subsequent Meckel's scan. The authors report on a Meckel's scan performed on an infant 1 week after a GI bleeding study with Tc-99m and stannous pyrophosphate. The Meckel's scan shows abnormal tracer distribution with absent gastric uptake, rendering the scan uninterpretable. In pediatric patients with gastrointestinal bleeding, a Meckel's scan should be done before labeled RBC imaging.

Topics: Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Infant, Newborn; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Female; Gastrointestinal Hemorrhage; Humans; Middle Aged; Omentum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates; Varicose Veins

The usual scintigraphic presentation of a Meckel's diverticulum is progressive accumulation of Tc-99m pertechnetate within the ectopic gastric mucosa that parallels uptake in the stomach. The authors present a case of an adult with acute gastrointestinal bleeding, negative endoscopic and radiologic evaluation, and atypical scintigraphy. An abnormal focus of uptake appeared at the same time as the stomach but faded away in the 15-minute image before reappearing while the stomach was still progressively accumulating the radioisotope. Meckel's diverticulum was confirmed by surgery. This case emphasizes the importance of scintigraphy in the evaluation of gastrointestinal bleeding, and it further emphasizes that any uptake that cannot be physiologically related is suspicious, even in a young adult.

Topics: Adult; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Neurofibromatosis (von Recklinghausen's disease) is a neuroectodermal disorder characterized by pigmentary changes of the skin (café-au-lait spots), cutaneous and visceral tumors (neurofibromas) and systemic abnormalities. The involvement of gastrointestinal tract in neurofibromatosis is not common. The most common symptoms, refer able to lesions in the gut, are hematemesis, melena and abdominal pain. We experienced a case of intestinal neurofibroma in von Recklinghausen's disease. The patient was a 39 year-old female who had suffered from chronic iron deficiency anemia and recurrent gastrointestinal hemorrhage due to two neurofibromas of jejunum for 3 years, which was diagnosed by superior mesenteric and ileal arteriogram and 99mTc pertechnetate-labelled RBC scan, and treated by segmental resection of jejunum with end to end anastomosis.

Topics: Adult; Anemia, Hypochromic; Chronic Disease; Female; Gastrointestinal Hemorrhage; Humans; Jejunal Neoplasms; Mesenteric Artery, Superior; Neurofibromatoses; Radiography; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m

Topics: Aged; Blood; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Male; Pleura; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adult; Aged; Choristoma; Erythrocytes; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Intestinal Neoplasms; Male; Meckel Diverticulum; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

A case of multiple ileal duplications presenting with gastrointestinal bleeding is described. Technetium-99m Pertechnetate scintigraphy in conjunction with barium studies provided the initial clue and accurately localised the abnormality pre-operatively.

Topics: Adolescent; Barium Sulfate; Female; Gastrointestinal Hemorrhage; Humans; Ileum; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Aged; Aorta, Abdominal; Aortic Aneurysm; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The diagnosis of a symptomatic Meckel's diverticulum in an adult is uncommon. Still more infrequent is the presentation of a bleeding Meckel's diverticulum after childhood. We present a case report of a 24-year-old male with gastrointestinal hemorrhage secondary to a Meckel's diverticulum containing ectopic gastric mucosa. With the exception of a Meckel's Tc 99m pertechnetate scan, all other diagnostic procedures including Tc 99m-labeled red cell scan and angiography were negative.

Topics: Adult; Diarrhea; Gastrointestinal Hemorrhage; Humans; Laparotomy; Male; Meckel Diverticulum; Sodium Pertechnetate Tc 99m

Topics: Child; Diagnosis, Differential; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m

Technetium-99m-labelled red blood cell scintigraphy was used in the investigation of 41 patients with major rectal haemorrhage. Red cells were labelled in vivo with technetium-99m pertechnetate and serial scans (0-36 h) were taken using a large field gamma camera. Twenty-two men and 15 women, mean age 71.3 years (range 32-91 years), and four children were studied. Forty-three scans were performed in all and there were 31 positive and 12 negative results. In each case the accuracy of the scan in localizing the bleeding site was checked either by independent investigations or at laparotomy. A definite bleeding site was identified in 30 cases and red cell scintigraphy correctly localized 29 of these (sensitivity 97 per cent). In the remaining 13 cases a bleeding site was not identified by any of the independent investigations and in this group there were two false positive scans (specificity 85 per cent). The investigation had a high predictive value when both positive (94 per cent) and negative (92 per cent). These data suggest that technetium-99m-labelled red cell scintigraphy should be used more widely in the investigation of patients with suspected lower gastrointestinal haemorrhage.

Topics: Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Infant; Intestines; Male; Middle Aged; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m

A 5-year-old boy is described with bleeding from Meckel's diverticulum diagnosed preoperatively by technetium scintigraphy. Despite limited indications to radioisotope methods in children they are valuable diagnostic procedures in preoperative diagnosis of the presence of ectopic tissue in Meckel's diverticulum.

Topics: Child, Preschool; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Child, Preschool; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Erythrocytes; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Hemangioma; Humans; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adult; Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Angiodysplasia of the right colon may be difficult to diagnose. The usual methods of choice, selective abdominal angiography and colonoscopy, may be impracticable or fail. When bleeding occurs, 99mtechnetium blood-pool scintigraphy is a simple and reliable method of localizing vessel leakage. We present a case of an 84-year-old woman with severely bleeding angiodysplasia, where the source of bleeding was localized by means of scintigraphy using 99mTc in vivo labeled red blood cells. After right hemicolectomy, the angiodysplastic lesion was confirmed by specimen venography utilizing a barium gelatin mixture.

Topics: Aged; Barium Sulfate; Blood Vessels; Cecum; Dilatation, Pathologic; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Phlebography; Sodium Pertechnetate Tc 99m

99mTc labeled red blood cell imaging was performed in 13 patients with clinical evidence of gastrointestinal bleeding from an unknown source. In all these patients the bleeding sites had remained unclear after the standard diagnostic evaluation, including upper gastrointestinal endoscopy (13 patients), colonoscopy (12 patients) and angiography (4 patients). Nine of 13 patients (70%) had a scan indicating active bleeding. In the 10 patients in whom the bleeding site was definitely identified by endoscopy, arteriography, or surgery, scintigraphy correctly localized the bleeding site in 6 (60%). One false positive localization was noted. Bleeding was detected in 7 of 9 patients with melena and in 2 of 4 patients with occult bleeding and chronic anemia. In all but 1 patient, additional diagnostic investigations were needed to finally establish the bleeding site. In patients in whom a potential bleeding site has been identified by standard diagnostic tests, 99mTc red blood cell imaging may provide a reliable noninvasive test by which to document active bleeding from the suspected source.

Topics: Adult; Aged; Angiography; Endoscopy; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

A Tc-99m red blood cell (RBC) study in a child with acute gastrointestinal bleeding of unknown origin suggested Meckel's diverticulum because of free pertechnetate uptake in the ectopic gastric mucosa. This finding has not been reported in the literature. A scan with Tc-99m pertechnetate then demonstrated a focal area of uptake with an unusual pattern of abdominal shifting consistent with a Meckel's diverticulum. A large Meckel's diverticulum containing gastric mucosa was found at surgery. A shifting pattern of focal uptake on a meckelogram study should be included among the diagnostic criteria for Meckel's diverticulum.

Topics: Child, Preschool; Erythrocytes; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m

Topics: Adult; Aged; Angiography; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Diagnosis of gastrointestinal bleeding remains a difficult problem. Radionuclides have been used widely to detect active GI bleeding. A case of actively bleeding aortoduodenal fistula detected on radionuclide imaging is presented.

Topics: Aged; Aorta, Abdominal; Aortic Diseases; Duodenal Diseases; Fistula; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Child; Gastrointestinal Hemorrhage; Humans; Infant; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

A patient with hematochezia and a false negative Meckel's scan is presented. A Meckel's diverticulum was subsequently diagnosed on barium small bowel follow-through. Meckel's diverticulum is discussed with emphasis on the relationship of barium and radionuclide studies.

Topics: Adolescent; Barium Sulfate; False Negative Reactions; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Hemorrhage into a pancreatic pseudocyst frequently goes unrecognized. This catastrophic event can be heralded by intermittent bleeding, or may present as massive gastrointestinal hemorrhage. A high index of suspicion, proper diagnostic workup, and prompt surgical management afford the patient the best chance for survival. We report a patient with massive pseudocyst bleeding into the gastrointestinal tract via the duct of Santorini and discuss the current diagnostic and therapeutic approach.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Drainage; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Pancreatic Cyst; Pancreatic Pseudocyst; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Bleeding ulcerative lesions of the small intestine often present difficult diagnostic problems. Useful techniques to establish a diagnosis include abdominal scintigraphy using technetium 99-m pertechnetate and intraoperative endoscopic examination of the intestine. Our experience with these techniques is based on 25 patients who were treated in 1974-1983. In 18 adults, the diagnoses included Crohn's disease, non-specific ulcers and intestinal tuberculosis. In 6 of the 18 adults, the source of bleeding was difficult to determine during laparotomy and diagnosis was established by intraoperative endoscopic examination. In the seven children, the diagnoses included ectopic gastric mucosa and lymphoid hyperplasia. In the children, abdominal scintigraphy was used as a preoperative measure to detect the bleeding source.

Topics: Adolescent; Adult; Aged; Child, Preschool; Endoscopy; Female; Gastrointestinal Hemorrhage; Humans; Infant; Intestinal Diseases; Intestine, Small; Intraoperative Period; Male; Middle Aged; Preoperative Care; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Ulcer

Scintigram imaging is a new means of localization of digestive tract hemorrhage, the radiopharmaceutic agent (technetium-labelled colloidal sulfur or technetium-labelled erythrocytes) accumulating at the bleeding site. The technique used consists of early recording over 80 minutes and then later serial imaging over 24 hours after radioisotope injection. The limitations and advantages of radioisotope investigations are discussed in relation to results in 6 patients with digestive hemorrhage explored by scintigraphy. When technetium-labelled erythrocytes are used the method is a non-invasive, simple and sensitive one for locating site of bleeding during the period of active hemorrhage. It appears to be complementary to arteriography, a more aggressive and less sensitive procedure, and to endoscopy, which explores small intestine and cecum with difficulty and cannot always determine the origin of the bleeding when other lesions exist. Experimental studies in the dog have shown that scintigraphy can detect digestive bleeding of about 0.1 to 0.2 ml/min, and this method of exploration should be used routinely when endoscopy and/or arteriography have not been performed or have given inconclusive results.

Topics: Aged; Angiography; Child, Preschool; Endoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid

The use of perchlorate to block gastric uptake of free 99Tcm-pertechnetate after in vivo labelling of red cells was investigated. In 19 out of 20 cases there was no evidence that previous administration of perchlorate adversely affected red cell labelling using commercial stannous agents. Adequate scintigraphic images of the vascular system could be obtained for up to 24 h after the cells were labelled. The technique was found to be of value in the investigation of sites of gastrointestinal bleeding.

Topics: Colon; Colonic Diseases; Erythrocytes; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Perchlorates; Radionuclide Imaging; Sodium Compounds; Sodium Pertechnetate Tc 99m; Stomach

Topics: Erythrocytes; Female; Gallbladder; Gastrointestinal Hemorrhage; Humans; Isotope Labeling; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Tin Polyphosphates

Topics: Aged; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Kidney; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pentetate

Tc-pertechnetate scintigraphy was performed in 81 infants and children, clinically suspected to have Meckel's diverticulum with ectopic gastric mucosa. The predominant symptom was rectal bleeding and anemia. Twenty-two patients underwent laparotomy and 12 had Meckel's diverticulum with ectopic gastric mucosa. In operated patients the sensitivity of scintigraphy in detecting ectopic gastric mucosa was 0.75, the specificity 1.0 and the diagnostic accuracy 0.86; the diagnostic accuracy was estimated to 0.96 for the whole material. Histologic examination of the diverticula showed a smaller area of the ectopic mucosa in cases with negative scintigraphic findings. In addition, prominent fibrosis seemed to be a more consistent finding in cases with negative as opposed to those with positive scintigraphic findings. Presence of anemia may provide a guideline as to whether or not scintigraphy is indicated.

Topics: Adolescent; Child; Child, Preschool; Choristoma; False Negative Reactions; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Hemoglobins; Humans; Ileal Neoplasms; Infant; Infant, Newborn; Laparotomy; Male; Meckel Diverticulum; Radionuclide Imaging; Rectum; Retrospective Studies; Sodium Pertechnetate Tc 99m

Topics: Duodenal Ulcer; Erythrocytes; False Negative Reactions; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The experience with 62 99mTc-labeled in vivo scans performed for lower gastrointestinal bleeding is discussed. Thirty-seven scans were deemed positive. The tendency of scans to become positive correlated with observations of active bleeding. Five patients had fulminant hemorrhage, necessitating emergency operation. In this group, scanning accurately located the bleeding sources prior to intervention. Seven other patients having later operations bled less rapidly. The bleeding site was localized accurately by scanning in three of these patients. Two studies were falsely positive and two were negative, whereas angiography was positive in two patients studied. Labeled RBC scanning is a useful technique in the early evaluation of patients with lower gastrointestinal bleeding, obviating the need of arteriography in some cases.

Topics: Adult; Aged; Angiography; Blood Transfusion; Erythrocytes; Evaluation Studies as Topic; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Scanning with Technetium 99m labeled autologous red blood cells was performed in 59 patients with clinical suspicion of acute and/or intermittent, chronic gastrointestinal bleeding. In 36 patients (61%), a definite site of bleeding could be demonstrated. A strong correlation with other modalities such as upper and lower gastrointestinal endoscopy, contrast angiography, and surgical exploration was found. Overall sensitivity of the procedure was 91%; specificity 100% and accuracy 93.3%. It is suggested that radionuclide scintigraphy provides a completely noninvasive, simple, and sensitive procedure which may be routinely used for the detection and localization of gastrointestinal bleeding.

Topics: Adult; Aged; Angiography; Colonoscopy; Erythrocytes; Female; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Radionuclide Imaging; Sigmoidoscopy; Sodium Pertechnetate Tc 99m; Technetium

Twelve patients undergoing scintigraphy with Tc-99m-labeled red blood cells (RBC) exhibited abnormal small-bowel activity and were given glucagon to assess its role in detecting bleeding from the small bowel. Six demonstrated focal accumulation of activity which was not identified prior to glucagon. Endoscopy, barium studies, angiography, and colonoscopy located the small-bowel bleeding site in 4 patients; in the other 2, studies of the colon failed to show the bleeding site and the origin was presumed to be the small bowel. The authors suggest that intravenous glucagon can be beneficial as an adjuvant to Tc-99m-RBC when diagnosing bleeding from the small bowel.

Topics: Erythrocytes; Female; Gastrointestinal Hemorrhage; Glucagon; Humans; Intestine, Small; Methods; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Meckel's diverticulum is rarely seen on the standard small bowel follow-through and the diagnosis may be overlooked unless 99mTc -pertechnetate scanning or other complementary radiological examinations are performed. Three cases of bleeding Meckel's diverticulum with a negative barium sulphate meal examination and positive 99mTc -pertechnetate scanning are presented.

Topics: Adolescent; Child, Preschool; Female; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

We present what we believe is the first reported case of a spontaneous aortoduodenal fistula, with massive rupture into the duodenum during the performance of a radionuclide study of gastrointestinal bleeding. Our experience suggests that nuclear scintigraphy with labeled red blood cells can help in the diagnosis of this disorder by demonstrating both the presence of an abdominal aortic aneurysm and bleeding in the gut.

Topics: Aged; Aorta, Abdominal; Aortic Diseases; Aortic Rupture; Duodenal Diseases; Erythrocytes; Fistula; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Radionuclide Imaging; Rupture, Spontaneous; Sodium Pertechnetate Tc 99m; Technetium

Twenty patients with occult gastrointestinal bleeding underwent diagnostic evaluation with autologous TcRBC imaging, which identified a locus of bleeding in 19. Bleeding was demonstrated in the esophagogastroduodenal area in four patients, the cecum in four patients, the ascending colon or hepatic flexure in nine patients and the descending colon in two patients. In the six patients who underwent surgical intervention, the source of bleeding had been correctly located by imaging. The advantages of imaging over those of conventional arteriography included its minimally invasive nature and its ability to detect areas of intermittent minimal bleeding for a period of 30 hours. The major disadvantages of the technique were that localization of the site of bleeding was not as precise as that obtained with arteriography, imaging could not be used as a treatment modality and the nature of the lesion could not be defined. However, we believe that, as an adjunct to conventional angiography and other techniques, autologous TcRBC imaging will improve the localization of obscure foci of gastrointestinal bleeding. Studies are underway to determine the proper place of TcRBC imaging in the gastroenterologic armamentarium. Its noninvasive nature and sensitivity to intermittent hemorrhage suggest that it may become the initial investigative modality of choice in many instances.

Topics: Adult; Aged; Cecum; Colon; Colonoscopy; Erythrocytes; Female; Gastrointestinal Hemorrhage; Half-Life; Humans; Kidney; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Time Factors; Tin Polyphosphates; Urinary Bladder

Bleeding from angiodysplasia of the gastrointestinal tract has become widely recognized. In most patients there is a single focal lesion in the colon. Small bowel involvement is rare and usually associated with colonic lesions. There have been no reports of bleeding angiodysplasia affecting the small bowel only. We were able to detect bleeding from an isolated angiodysplasia of the jejunum and correctly localize it. Our diagnosis was greatly aided by the use of dynamic data collection and by the cinematic display of the data.

Topics: Aged; Angiography; Gastrointestinal Hemorrhage; Humans; Jejunal Diseases; Jejunum; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Tc-99m labeled red blood cell (RBC) preparations are gaining wide acceptance in the diagnosis and localization of gastrointestinal bleeding. A major requirement of the radiopharmaceutical is that the percentage of Tc-99m attached to red cells in the injected dose must be extremely high, since free pertechnetate is secreted into the gastrointestinal tract and may obscure a bleeding site. We have developed a combined in vivo/in vitro labeling procedure which is simple and rapid, and which enables the administration of substantial amounts of RBC-bound Tc-99m and minimizes the amount of unbound technetium present. The technique is readily utilizable in any nuclear medicine clinic and requires no investigative pharmaceuticals.

Topics: Child, Preschool; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Isotope Labeling; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Time Factors

Scintisplenoportography was performed on 33 occasions in 28 cirrhotic patients who had bled from esophagogastric varices. In 17 cases scintisplenoportography was carried out after a retroperitoneal distal splenorenal shunt procedure and in the remaining 16 instances in patients without any surgical shunt. In four patients scintisplenoportography was performed before and after a surgical shunt procedure, and in one case, before and after the shunt thrombosed. Gammagraphic patterns and spleen-heart times helped determine which patients did not have a surgical shunt, which had a patent shunt, and which patients had a thrombosed shunt. A patent shunt pattern and a thrombosed shunt pattern have been defined. It is concluded that scintisplenoportography is a useful, reproducible, and safe method to assess the patency of distal splenorenal shunts.

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Circulation; Liver Cirrhosis; Portasystemic Shunt, Surgical; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Splenorenal Shunt, Surgical; Technetium; Thrombosis; Time Factors

Gastrointestinal blood pool scintigraphy, using a modified in-vivo red blood cell labelling technique with technetium-99, is a new, easily performed, non-invasive procedure. It is valuable in screening patients with acute or intermittent gastrointestinal blood loss in whom duodenoscopic and sigmoidoscopic findings are unhelpful. This paper reviews the value of this scintigraphic technique over the first eight months of its use in a major teaching hospital, and compares the results with other published data. The high sensitivity of this procedure, and its ability to demonstrate gastrointestinal bleeding very strikingly, are illustrated with several examples. If used and interpreted appropriately, scintigraphy is sensitive in detecting and localizing the bleeding site, and is very helpful in indicating the optimal timing of emergency contrast angiography. The study further supports the view that scintigraphy should be the initial diagnostic imaging procedure in this group of patients, and that emergency angiography should be reserved primarily for patients in whom there is scintigraphic evidence of continuing blood loss.

Topics: Abdomen; Acute Disease; Adult; Aged; Angiography; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Isotope Labeling; Male; Methods; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Aged; Arteriovenous Malformations; Colon; Gastrointestinal Hemorrhage; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Localization of colorectal bleeding using a gamma camera was attempted in a prospective study of 24 patients after in-vivo labelling of their erythrocytes with 99mTc-pertechnetate. In 7 of 8 patients with bright-red rectal bleeding a correct localization was given by scintiphotos, thus helping the surgeon to plan the operative procedure. Of 11 patients with recently acute colorectal bleeding but no signs of actual haemorrhage, 8 had no scintigraphic bleeding. Five investigations had to be excluded due to technical errors. The scintigraphic classification was correct in a significant number of patients (p less than 0.02). It is concluded that bleeding can be identified in colorectum at brisk-haemorrhagic stools and be correctly localized to the right or left side of the colon. This non-invasive scintigraphic procedure should therefore be undertaken before an abdominal 2-3 vessel arteriography is performed.

Topics: Colonic Diseases; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Prospective Studies; Radionuclide Imaging; Rectal Diseases; Sodium Pertechnetate Tc 99m; Technetium

A retrospective analysis of 143 studies of abdominal scintigraphy with technetium-99m pertechnetate for the diagnosis of ectopic gastric mucosa (usually located in Meckel diverticulum) was undertaken. The rectilinear scanner was used for 57 studies and the gamma camera for 86. The final diagnosis, at laparotomy or after clinical and laboratory investigation with long-term clinical follow-up, was correlated to the interpretation of the scintigrams. Of 57 rectilinear scans, five were true positive, 46 true negative, two false positive, and four false negative. Of the 86 camera studies 10 were true positive, 74 true negative, one false negative, and one patient showed large bowel activity (positive atypical study). The results of this analysis indicate the value of the properly performed and interpreted abdominal pertechnetate scintigraphy in the diagnosis of (bleeding) ectopic gastric mucosa; it was also shown that the sensitivity and the specificity of this test have improved since the introduction of the gamma camera and the standardization of the procedure.

Topics: Abdomen; Adult; Child; Choristoma; Follow-Up Studies; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Neoplasms; Meckel Diverticulum; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium

Topics: Abdomen; Aged; Colloids; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Meckel Diverticulum; Radiography; Radionuclide Imaging; Rectal Diseases; Sigmoid Diseases; Sodium Pertechnetate Tc 99m; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Colonic Neoplasms; Gastrointestinal Hemorrhage; Humans; Intestinal Polyps; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Adult; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Erythrocytes; Evaluation Studies as Topic; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Using a modified in vivo Tc-99M red cell labeling technique, gastrointestinal bleeding scintigraphy was performed in 100 patients with GI bleeding. Sixty-two patients with melena or bright red blood per rectum had positive scintiscans. In comparison to results of angiography, endoscopy, surgery and contrast radiography, radionuclide scintigraphy correctly located the site of bleeding in 83% of patients. The procedures could be performed over a 24 hr period which increased the sensitivity of the test since 85% of the scintiscans were positive at one hr or greater after the onset of imaging. The procedure was more sensitive than angiography in detecting sources of GI bleeding. We conclude that GI bleeding scintigraphy 99mTc-red cells in an accurate and effective method to detect upper and lower GI bleeding in patients with acute intermittent gastrointestinal bleeding.

Topics: Adolescent; Adult; Aged; Angiography; Endoscopy; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Isotope Labeling; Male; Melena; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Time Factors

Out of 270 children with gastrointestinal symptoms, the indications for technitium scanning were: gastrointestinal tract bleeding (165 patients), abdominal pain (99 patients) and a history of intussusception (6 patients). Thirty children had abnormal findings, while the remaining 240 patients had "normal" scans. Four of the 30 children with positive scans were not explored, while the others underwent laparotomy. Of the 26 operated patients, 12 (46%) had a Meckel's diverticulum. Nine patients (34%) had other pathologic lesions that were detected by the scan. Five had true "false positives" as no pathologic lesions were found. Of the 240 children with negative scans, 19 were eventually explored because of persistent symptoms or clinical findings. Two of these had a Meckel's diverticulum. Eleven had a negative exploration while six had other surgical lesions. Technitium scan should reliably detect around 80%-90% of Meckel's diverticula. It will also accurately exclude the diagnosis of Meckel's diverticulum in over 90% of patients.

Topics: Abdomen; Adolescent; Child; Child, Preschool; Evaluation Studies as Topic; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Infant; Infant, Newborn; Intussusception; Male; Meckel Diverticulum; Pain; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Active lower intestinal bleeding from a Meckel's diverticulum in an infant was detected with Tc-99m-sulfur colloid scintigraphy. This technique expands the scintigraphic armamentarium for evaluation of lower intestinal bleeding in infants and children.

Topics: Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Infant; Intestine, Small; Male; Meckel Diverticulum; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Ten years of clinical experience with pertechnetate (Tc-99m) scintigraphy has proven its validity for the diagnosis of ectopic gastric mucosa in bleeding Meckel's diverticulum and other congenital anomalies. Careful patient preparation and a standardized technique based on sequential gamma imaging has resulted in an overall sensitivity of 85%. Experience in differentiating "nonspecific" accumulations of pertechnetate from true ectopic gastric mucosa had increased the specificity to 95%. When we consider all the studies reported (954) with a surgical or clinical diagnosis, the accuracy of the method is calculated at 98%. When only surgically proven cases are analyzed, the calculated accuracy is 90%. Pertechnetate excretion by the mucoid cells of gastric mucosa is the basis of this test. The effect of drugs and hormones on the test has been studied in animals and in patients. The findings suggest that an improvement can be achieved by the use of cimetidine, pentagastrin, or glucagon.

Topics: Animals; Choristoma; Dogs; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Two children with rectal bleeding were diagnosed as having ulcerative colitis and a bleeding colonic polyp respectively using abdominal scanning with Tc-99m pertechnetate. Early flow studies are recommended with careful attention paid to the amount of time abnormal areas of activity are seen on the abdominal scan.

Topics: Child; Colitis, Ulcerative; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Neoplasms; Intestinal Polyps; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m; Technetium; Time Factors

The most common complications of a Meckel's diverticulum is bleeding. With the introduction of abdominal scintigraphy we have a non-invasive examination method at our disposal which enables this condition to be diagnosed with accuracy preoperatively. A relevant case is described.

Topics: Child; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Child; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m; Technetium

Topics: Child, Preschool; Colitis; Erythrocytes; Gastrointestinal Hemorrhage; Hemolytic-Uremic Syndrome; Humans; Male; Methods; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium