Detection of the site of recurrent bleeding in small bowel in patient with m. Rendu-Osler-Weber by means of scintigraphy with ^99mTc-pertechnetate in vivo labeled red blood cells

Česká verzia

Authors: J. Doležal ¹; J. Vižďa ¹; M. Kopáčová ²; J. Bureš ²; I. Šteiner ³; J. Příborský ⁴
Authors place of work: Oddělení nukleární medicíny FN Hradec Králové, přednosta MUDr. Ing. Jaroslav Vižďa ¹; II. interní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ²; Fingerlandův ústav patologie Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Ivo Šteiner, CSc. ³; Chirurgická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Zbyněk Vobořil, DrSc. ⁴
Published in the journal: Vnitř Lék 2005; 51(5): 583-587
Category: Case Reports

Summary

Fifty-three years old woman was examined for severe gastrointestinal bleeding. She had positive history of recurrent gastrointestinal (GI) bleeding with enterorrhagia but the source of bleeding was not identified. The woman had severe anemia (hemoglobin 67 g/l), repeated blood transfusions were given. Gastroscopy, push-enteroscopy and coloscopy were negative. Therefore scintigraphy with red blood cells labeled in vivo by means of ^99mTc was performed. Scintigraphy with red blood cells (RBCs) was positive for active gastrointestinal bleeding and showed spreading of the labeled RBCs into small bowel, the site of bleeding was detected in jejunum above urinary bladder on the left side. The patient underwent intra- operative enteroscopy, a vascular malformation was detected in jejunum and per for distal part of the jejunum (0.5 m) was resected. Both the gross and histological finding corresponded to Rendu-Osler-Weber disease. However, the typical gross skin lesions around the lips, nose and buccal mucosa were lacking. Four years after operation the patient had been well with normal hemoglobin level (150 g/l). Last year the woman had next GI bleeding with enterorrhagia. Intra-operative enteroscopy detected a few small vascular malformations in jejunum and terminal ileum. Malformation was coagulated by bipolar probe.

Key words:
gastrointestinal bleeding – 99mTc-pertechnetate labeled red blood cells scintigraphy – m. Rendu-Osler-Weber

Zdroje

1. Bagga S, Gupta SM et al. Scintigraphic localization of recurrent anastomotic site bleeding in the gastrointestinal tract. Clin Nucl Med 1996; 21(4): 296–298.

2. Bureš J, Rejchrt S et al. Vyšetření tenkého střeva a enteroskopický atlas. Praha: Grada Publishing: 2001.

3. Caruana V, Swayne LC et al. Scintigraphic localization of a bleeding leiomyosarcoma of the proximal jejunum. Clin Nucl Med 1991; 16(4): 230–232.

4. Doležal J, Vižďa J, Bureš J. Přínos scintigrafie s autologními erytrocyty k určení místa krvácení v tenkém střevě. Folia Gastroenterologica et Hepatologica 2004; 2(1): 13–20.

5. Dusold R, Burke K et al. The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding. Am J Gastroenterol 1994; 89(3): 345–348.

6. Ford PV, Bartold SP et al. Procedure Guideline for Gastrointestinal Bleeding and Meckel’s Diverticulum Scintigraphy. J Nucl Med 1999; 40(7): 1226–1232.

7. Gutierrez C, Mariano M et al. The use of technetium-labeled erythrocyte scintigraphy in the evaluation and treatment of lower gastrointestinal hemorrhage. Am Surg 1998; 64(10): 989–992.

8. Hansen ME, Coleman RE. Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices. Clin Nucl Med 1990; 15(7): 488–490.

9. Harbert JC, Eckelman WC et al. Nuclear Medicine – Diagnosis and Therapy. New York: Thieme Medical Publ Inc 1996.

10. Hušák V, Petrová K et al. Aplikované aktivity radiofarmak, radiační zátěž a radiační riziko vyšetřovacích postupů v nukleární medicíně. Čas Lék Čes 1998; 138(11): 323–328.

11. Iwata Y, Shiomi S et al. A case of cavernous hemangioma of the small intestine diagnosed by scintigraphy with Tc-99m-labeled red blood cells. Ann Nucl Med 2000; 14(5): 373–376.

12. Klener P et al. Vnitřní lékařství. Praha: Galén 1999.

13. Kopáčová M, Bureš J et al. Intraoperační enteroskopie – vlastní zkušenosti z období 1995–2002. Čas Lék Čes 2003; 142(5): 303–306.

14. Kopáčová M, Bureš J et al. Intraoperační enteroskopie. Endoskopie 2003; 12(1): 3–6.

15. Krishnamurthy GT, Krishnamurthy S. Nuclear Hepatology. Berlin: Springer- Verlag 2000.

16. Miller TR. Cardiopulmonary Nuclear Medicine: Radionuclide Ventriculography. In: Brown ML, Collier BD. Syllabus: A Categorical Course in Nuclear Medicine. Oak Brook: Radiological Society of North America Inc. 1996: 97–104.

17. Orellana P, Vial I et al. 99mTc red blood cell scintigraphy for assessment of active gastrointestinal bleeding. Rev Med Chil 1998; 126: 413–418.

18. Šťovíček J, Keil R et al. Endoskopické stavění krvácení v horní části trávicího ústrojí pomocí hemostatických klipů. Vnitř Lék 2004; 50(2): 143–146.

19. Thrall JH, Ziessman HA. Nuclear Medicine – The requisites. 2^nd ed. St. Louis: Mosby Harcourt Health Sciences 2001.

20. Van Geelen JA, De Graaf EM et al. Clinical value of labeled red blood cell scintigraphy in patients with difficult to diagnose gastrointestinal bleeding. Clin Nucl Med 1994; 19(11): 949–952.