Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography

Alavi, Abass; Ring, EJ

doi:10.2214/ajr.137.4.741

Cited by 82 publications

(31 citation statements)

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“…In two infants, preoperative localization of ectopic gastric mucosa in the ileum was made by 99 m Technetium pertechnetate scanning [2]. However, this scan cannot demonstrate intestinal hemorrhage per se, only the presence of ectopic gastric mucosa [1]. Selective arteriography in our case was able to demonstrate the site of hemorrhage from ulcerated ileal mucosa adjacent to the HGM.…”

Section: Discussionmentioning

confidence: 67%

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Angiography of ileal hemorrhage from heterotopic gastric mucosa

1983

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Abstract. The angiographic and pathologic findings of ileal hemorrhage from heterotopic gastric mucosa (HGM) without Meckel's diverticulum are presented. The pathogenesis is discussed and a short literature review is given.Key words: H eterotopic gastric mucosa -Ileal hemorrhage -Choristoma -Meckel's Diverticulum Heterotopic gastric mucosa (HGM) in the small bowel in the absence of congenital anomalies (e. g., Meckel's diverticulum) or chronic inflammation (e.g., Crohn's disease) is a rare pathologic entity. Twentyone cases of H G M in the small intestine distal to the ligament of Treitz have been reported in the Englishlanguage literature. Lee et al. [3] reviewed sixteen reported cases up to 1970. Five more cases have been added to the literature since then. This case report is the first to utilize angiography in the preoperative localization of hemorrhage from HGM. Case reportA previously healthy 13-year-old white male presented with a history of 4 days of abdominal pain, melena, and hematochezia. He had one episode of syncope. Physical examination revealed a very pale child with right lower quadrant rebound tenderness. The stool was strongly positive for occult blood. The hemoglobin was 4.0 g%. All other laboratory studies were unremarkable. Three units of packed red blood cells were transfused.Superior mesenteric arteriography showed extravasation of contrast in the region of the terminal ileum (Fig. 1). The blood supply arose from the last ileal branch of the superior mesenteric artery (SMA) and the ileal component of the ileo-colic artery branch of the SMA.Selective arterial infusion of vasopressin into the SMA failed to completely stop the bleeding. Neither a 99 m Technetium pertechnetate scan (to detect ectopic gastric mucosa) nor a 99 m Technetium sulfur colloid scan (to confirm the intestinal hemorrhage) [1] were able to be done due to the urgent need for surgical intervention. The pre-operative diagnosis was a bleeding Meckel's diverticulum.At laparotomy, a protuding mass lesion felt by the surgeon to be a Meckel's diverticulum was resected 70 cm proximal to the ileocecal valve. However, on a gross pathological examination of the resected surgical specimen, a broad-based, flat, polypoid mucosal lesion measuring 2 cm in diameter was found (Fig. 2). No diverticulum was present, and the mucosal lesion was midway between the mesenteric and antimesenteric borders of the ileum. Immediately adjacent to the lesion was a punched out, somewhat triangular shaped ulceration measuring 3 x 5 mm in diameter, Microscopic examination of the polypoid lesion revealed ectopic fundic type gastric mucosa, with chief cells, parietal cells, and gastric glands. (See Fig. 3). The ileal mucosa that was ulcerated showed typical "peptic" ulcer histology. A 3 mm wide arterial vessel appeared to have been eroded by the ulcer.

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Section: Discussionmentioning

confidence: 67%

“…Neither a 99 m Technetium pertechnetate scan (to detect ectopic gastric mucosa) nor a 99 m Technetium sulfur colloid scan (to confirm the intestinal hemorrhage) [1] were able to be done due to the urgent need for surgical intervention. The pre-operative diagnosis was a bleeding Meckel's diverticulum.…”

Section: Case Reportmentioning

confidence: 99%

Angiography of ileal hemorrhage from heterotopic gastric mucosa

1983

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“…bleeding. 6 In the present study we have taken LGIB as the acute or chronic loss of blood from a source in the colon or anorectal region. Clinically LGIB may be subdivided into overt (melena/haematochezia) and concealed (occult bleeding).…”

Section: Initial Evaluationmentioning

confidence: 99%

Common Causes of Gastrointestinal Bleeding Diagnosed by Endoscopy/Colonoscopy at Hospital Sultanah Bahiyah, Alor Setar, Malaysia

Mallick¹,

Kamil²

2014

IOSRJDMS

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Acute gastro-intestinal bleeding is potentially a life-threatening abdominal emergency and has been a common cause of hospitalization.1 It is always fascinating as well as informative to know the various causes of upper and lower gastro-intestinal bleeding prevalent in a particular region. It helps us in early diagnosis and prompt management of the case in thatarea. Keeping this in mind we started a project to see the common causes of gastro-intestinal bleeding as confirmed by direct endoscopy methods in patients admitted in

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“…Radionuclide bleeding studies have proven to be safe, noninvasive, relatively simple to perform, and more sensitive than angiography for the detection of bleeding sites [1]. Because even massive GI bleeding [2] is at times intermittent, the persistence of radionuclide activity in the blood pool enables detection of bleeding sites over a longer period of time than the several seconds of an angiographic injection.…”

mentioning

confidence: 99%

“…Because even massive GI bleeding [2] is at times intermittent, the persistence of radionuclide activity in the blood pool enables detection of bleeding sites over a longer period of time than the several seconds of an angiographic injection. Radiopharmaceuticals currently used in bleeding studies include 99m-technetium-labeled sulfur colloid [1,3,4] and 99m-technetium-labeled red blood cells (99mTC RBCs) [5][6][7][8].…”

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confidence: 99%

Radionuclide enemas for localization of gastrointestinal bleeding sites

Cohen

McCalley

Braunstein

1983

Gastrointest Radiol

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Abstract. The anatomical site of gastrointestinal bleeding may not be determined accurately with a scintigraphic bleeding scan. A case in which a radionuclide enema following a positive scintigraphic bleeding scan helped to guide the surgeon to the appropriate bleeding site, is presented. The radionuclide enema also obviates the need for barium examinations that would interfere with subsequent angiography.Key words: Acute gastrointestinal bleeding -Abdominal scintigraphy -Radionuclide enema.Localization of the anatomical site of gastrointestinal bleeding is often an urgent and perplexing clinical problem. Radionuclide bleeding studies have proven to be safe, noninvasive, relatively simple to perform, and more sensitive than angiography for the detection of bleeding sites [1]. Because even massive GI bleeding [2] is at times intermittent, the persistence of radionuclide activity in the blood pool enables detection of bleeding sites over a longer period of time than the several seconds of an angiographic injection. Radiopharmaceuticals currently used in bleeding studies include 99m-technetium-labeled sulfur colloid [1, 3, 4] and 99m-technetium-labeled red blood cells (99mTC RBCs) [5][6][7][8].The bleeding site is demonstrated on the radionuclide scan as an area of focal activity that has leaked into the gut from the circulating blood pool.For a bleeding study to be of any value in planning surgical or interventional angiographic therapy, the site of bleeding must be determined. SomeAddress reprint requests to:

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Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography

Cited by 82 publications

References 0 publications

Angiography of ileal hemorrhage from heterotopic gastric mucosa

Angiography of ileal hemorrhage from heterotopic gastric mucosa

Common Causes of Gastrointestinal Bleeding Diagnosed by Endoscopy/Colonoscopy at Hospital Sultanah Bahiyah, Alor Setar, Malaysia

Radionuclide enemas for localization of gastrointestinal bleeding sites

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