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Arch Surg. 2000 Sep;135(9):1076-81; discussion 1081-2.

Cinematic nuclear scintigraphy reliably directs surgical intervention for patients with gastrointestinal bleeding.

Author information

1
Department of Surgery, San Francisco General Hospital, Ward 3A, 1001 Potrero Ave, San Francisco, CA 94110-3518, USA.

Abstract

HYPOTHESIS:

Cinematic technetium Tc 99m red blood cell ((99m)Tc-RBC) scans, in which real-time scanning is performed and analyzed, can accurately localize gastrointestinal bleeding and thus direct selective surgical intervention.

DESIGN:

Retrospective medical record review with historical controls.

SETTING:

Large, university-affiliated public hospital in urban setting.

PATIENTS:

Twenty-six patients presenting with upper and lower gastrointestinal hemorrhage who underwent cinematic (99m)Tc-RBC scan examinations between 1990 and 1997 and required surgical intervention to control the bleeding.

INTERVENTIONS:

All patients with gastrointestinal bleeding underwent open surgical procedures to provide cessation of bleeding and resection of appropriate abnormalities.

MAIN OUTCOME MEASURES:

Patient outcome was based on correlation between preoperative RBC scans and intraoperative findings, surgical pathology, and postoperative clinical course.

RESULTS:

Twenty-five (96%) of 26 scans were interpreted as positive for gastrointestinal bleeding. In 22 of these 25 scans, the site of bleeding was correctly identified for a sensitivity of 88%. One or more additional diagnostic tests were performed on 19 (73%) of 26 patients, and included angiography and flexible endoscopy. The most common operation performed to control bleeding was a hemicolectomy (14/26). Diverticulosis was the most prevalent diagnosis (46%). Two patients (8%) experienced rebleeding after operation. The overall mortality rate was 19% (5/26).

CONCLUSIONS:

Cinematic (99m)Tc-RBC scintigraphy is a sensitive, noninvasive alternative to mesenteric angiography for accurately localizing the site of gastrointestinal hemorrhages. As such, this technique can be reliably used to direct selective surgical intervention.

PMID:
10982513
DOI:
10.1001/archsurg.135.9.1076
[Indexed for MEDLINE]

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