Angiodysplasia as a source of gastrointestinal bleeding detected by scintigraphy – case report

Summary

Goal: To present a pattern of bleeding into the jejunum on a dynamic study and SPECT/ldCT with subsequent confirmation of angiodysplasia.

Case report: A 78-year-old female patient with 3 days of vertigo, shortness of breath and melena was sent for scintigraphic detection of the source of gastrointestinal bleeding. An extremely low hemoglobin level (50 g/l) and mild leukocytosis were detected in the laboratory. An emergency gastroscopy was performed, there were no signs of bleeding. After acute transfusion therapy, the patient was sent to our departement. The amount of 20 ml of blood was taken from the patient. Autologous erythrocytes were obtained by centrifugation, they were labeled in vitro with a commercially available kit with ^99mTc with an activity of 842 MBq. The erythrocytes were then administrated back into the patient. The examination was performed as a standard one-hour dynamic study on a two-detector OPTIMA NM/CT 640 camera with an HR collimator with the addition of tomographic images. Already during the dynamic study, extravasation activity in the area of the mesogastrium was detected. Activity shifted aborally in the intestine over time. Abdominal SPECT/low dose CT was added, which showed extravasation of activity into the jejunal lumen. The patient underwent a gastroduodenoenteroscopy, where angiodysplasia of the proximal jejunum was confirmed. As part of the angiodysplasia procedure, she was simultaneously treated with an adrenaline injection and a vascular clip.

Conclusion: In our case report, we confirm the importance of imaging gastrointestinal bleeding using labeled erythrocytes. In the diagnosis of bleeding from the small intestine, this method is irreplaceable. Other methods, such as gastroscopy and colonoscopy, are capable of displaying only the oral and terminal parts of the digestive tract in the standard version.

Keywords:

SPECT/CT – gastrointestinal bleeding – angiodysplasia – dynamic study