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

Czech version

Authors: J. Doležal ¹; J. Vižďa ¹; M. Kopáčová ²; J. Bureš ²; I. Šteiner ³; J. Příborský ⁴
Authors‘ workplace: 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: Vnitř Lék 2005; 51(5): 583-587
Category: Case Reports

Overview

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

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