technetium-tc-99m-sulfur-colloid and Melena

An elderly obese male with a lengthy history of melanotic stools was admitted and was shown to have a posterior duodenal ulcer by endoscopy. He became obtunded and developed infected ascites. Because of his obesity, ascites, and inability to cooperate, the GI radiologist felt that a Gastrografin upper GI series would not be helpful. We therefore gave the patient 99mTc-labeled sulfur colloid and tap water through his nasogastric tube. We were able to clearly image a site of perforation at the duodenal bulb communicating with the lesser sac.

Topics: Aged; Ascites; Duodenal Ulcer; Duodenoscopy; Duodenum; Humans; Male; Melena; Peptic Ulcer Perforation; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

13 patients with gastrointestinal hemorrhage underwent a scintigraphic examination to localize the bleeding. In 6 patients Tc-99m labeled red blood cells, in 7 patients Tc-99m sulfur colloid were used. Scintigraphy could demonstrate an intestinal bleeding in ten patients, in whom the conventional examinations, and among them 7 abdominal angiographies had failed. 5 of them had to be operated after that, whereby the scintigraphic findings were verified. One of the three patients with negative scintigraphy had to undergo an operation because of continuous bleeding. The methods of scintigraphy and their indication in gastrointestinal hemorrhage are discussed.

Topics: Adult; Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Melena; Middle Aged; Pentetic Acid; Radionuclide Imaging; Rectum; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

The use of radionuclide gastrointestinal scanning with 99mTc sulfur colloid, supplementing angiography, is described in the diagnosis of the source of bleeding in a 60-year-old woman with neurofibromatosis. These two procedures succeeded in locating the origin of bleeding from neurofibroma in the jejunum, which was corrected by surgery. To our knowledge, this case report is the first description of a patient with neurofibromatosis, with all the reported gastrointestinal symptoms: intermittent abdominal pains, palpable abdominal mass, gastrointestinal bleeding and small bowel obstruction.

Topics: Digestive System; Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Ileocecal Valve; Intestinal Neoplasms; Intussusception; Melena; Middle Aged; Neurofibromatosis 1; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Dynamic radionuclide angiography (5-sec. images) with technetium-99m-sulfur colloid proved to be helpful in 5 patients who presented with gastrointestinal bleeding. In 2, intermittently bleeding hypervascular lesions were seen on dynamic but not on static images; in 2 others, the dynamic images demonstrated hypervascular lesions better than the static scans; and in 1, the radionuclide angiogram localized colonic bleeding more accurately because of rapid peristalsis of extravasated tracer. The addition of the radionuclide angiogram to routine scintigraphy for gastrointestinal bleeding may be crucial for identification of hypervascular lesions and precise localization of bleeding sites.

Topics: Adult; Aged; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Humans; Male; Melena; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors