A Case of Enterocutaneous Fistula Diagnosed with Tc-99m DTPA Fistulography Using Hybrid SPECT/CT

Abstract

Enterocutaneous fistula (ECF) is a communication between the bowel lumen and the skin, which especially occurs post-operatively and is associated with significant morbidity and mortality. Correct diagnosis and anatomical information of ECF are crucial for a patient's management. Here, we present a case of ECF clearly diagnosed by hybrid single-photon emission computed tomography/computed tomography (SPECT/CT). A 61-year-old man was admitted to our hospital with persistent pus discharge from a surgical wound of previous cystectomy and ileal conduit formation. Initially, he was assessed with fistulography, and ECF was suspected by intraluminal contrast media. As clinical symptom and signs were not definitely matched with ECF, Tc99m diethylene triamine pentaacetic acid (DTPA) SPECT/ CT was performed for the evaluation of fistular tract as an alternative method. On the SPECT/CT after injection of Tc99m DTPA to the putative fistular opening, fistular as well as intraluminal radioactivity was clearly visualized. SPECT/ CT is a sensitive and safe diagnostic imaging tool for ECF.

Use of a Hepatobiliary Iminodiacetic Acid scan in the Diagnosis of Enterocutaneous Fistula: A Case Report

“…Nuclear medicine imaging techniques are less commonly used but can also aid in the diagnosis of ECFs. One report detailed using fistulography and single-photon emission computed tomography-computed tomography with Tc-99m diethylene triamine penta acetic acid which successfully enabled the visualization of the fistulous tract [10]. Meanwhile in HIDA scans, the radiotracer iminodiacetic acid is administered to evaluate the function of the hepatobiliary system whereby the radiotracer is excreted from the biliary system into the enteric tract.…”