technetium-tc-99m-sulfur-colloid and Biliary-Fistula

Massive lower gastrointestinal (GI) bleeding caused by gallbladder carcinoma eroding into the colonic wall was demonstrated accurately by Tc-99m RBCs. In addition, retrograde bleeding into the gallbladder was also identified while arteriography did not show contrast extravasation. This case supports the use of Tc-99m RBCs over Tc-99m sulfur colloid for more accurate localization of lower GI bleeding.

Topics: Acute Disease; Aged; Biliary Fistula; Colonic Diseases; Erythrocytes; Female; Gallbladder Diseases; Gallbladder Neoplasms; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

The diagnosis of a cholecystocolic fistula has often presented a dilemma to the practicing physician. Routine imaging modalities to confirm this diagnosis have not proven extremely successful. The presence of a small fistulous tract from the gallbladder to the colon is often difficult to demonstrate radiographically. However, with the advent of the newer hepatobiliary radioisotopic scanning agents, the ability to visualize the intrahepatic and extrahepatic bile ducts as well as the presence of the intestinal activity of the radiotracers has improved considerably. The authors present a case of cholecystocolic fistula that was adequately demonstrated with a Tc-99m-PIPIDA hepatobiliary scan. This article is the first to report demonstration of this type of fistula with hepatobiliary scanning.

Topics: Aged; Biliary Fistula; Colonic Diseases; Female; Gallbladder Diseases; Humans; Imino Acids; Intestinal Fistula; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid