Case report
Accurate localization of life threatening colonic hemorrhage during nuclear medicine bleeding scan as an aid to selective angiography
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* Corresponding author: Mubin I Syed mubinsyed@aol.com
1 Wright State University School of Medicine, Dept of Radiological Sciences, Dayton, Ohio, USA
2 Dayton Interventional Radiology, 3075 Governors Place Blvd, Suite 120 Dayton, Ohio 45409, USA
3 Department of Interventional Radiology, Springfield Regional Medical Center, 2615 East High St, Springfield, Ohio 45504, USA
World Journal of Emergency Surgery 2009, 4:20 doi:10.1186/1749-7922-4-20
Published: 27 May 2009Abstract
Purpose
To describe a new technique to help localize life threatening colorectal bleeding during nuclear medicine bleeding scan to aid in selective angiography.
Methods
During the gastrointestinal bleeding scan, a simple metallic marker (paper clip) was used to localize the bleeding site on the patient body. Angiography was then performed within 2 hours. The marker was then used to guide superselective angiography and embolization.
Results
5 cases of patients with colorectal bleeding were performed using this technique with cessation of bleeding in 4/5 initial attempts. 1 patient required a repeat angiogram that did demonstrate the bleeding on the second attempt allowing superselective angiography and embolization that resulted in cessation of bleeding. This patient with a rectal bleed required selection of additional vessels guided by the marker on the second attempt.
Conclusion
The dilemma of positive scintigraphic evidence of colonic bleeding with negative arteriography can be resolved with the use of a metal marker during the scintigram to guide superselective angiography. Although in our small series of patients this technique appears to be simple and effective, further clinical investigation is warranted with a larger patient population. This technique may offer a role in therapy in coordination with the colorectal surgeon for the high risk patient in an otherwise life threatening situation.