| Possible Role of Meckel's Scan Fused with SPECT CT Imaging: Unraveling the Cause of Abdominal Pain and Obscure-Overt Gastrointestinal Bleeding. | |
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MedLine Citation:
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PMID: 21490844 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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A 27-year-old male presented with recurrent abdominal pain and high volume hematochezia despite undergoing extensive testing and a right hemicolectomy 3 years prior for a linear bleeding ulceration in the ascending colon. Studies at the University of Michigan included esophagogastroduodenoscopy (EGD), colonoscopy and video capsule endoscopy (VCE), revealing an arteriovenous malformation (AVM) in the terminal ileum. He was hospitalized for recurrent symptoms. His presentation suggested a small bowel source of obscure-overt GI bleeding based on prior non-diagnostic colonoscopy and EGD and a bilious nasogastric lavage. Tagged red blood cell scan localized bleeding to the right lower quadrant. Colonoscopy showed fresh blood in the terminal ileum without a clear source. Angiography showed no evidence of bleeding or terminal ileal AVM. A novel Meckel's scan fused with SPECT imaging showed focal uptake in the terminal ileum. The patient underwent Meckel's diverticulectomy with sparing of adjacent bowel and has remained asymptomatic for 19 months. This case illustrates that patients with obscure-overt GI bleeding require a step-wise multi-modality diagnostic work-up. Because Meckel's scans are false-positive in 28% of adults, Meckel's scan fused with SPECT imaging may offer an approach to refine diagnostic accuracy of either scan alone, but requires further investigation. Exploratory laparotomy should be reserved as a last option and is best performed with intraoperative endoscopy. |
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Authors:
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D Kim Turgeon; Darren Brenner; Richard K J Brown; Matthew J Dimagno |
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Publication Detail:
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Type: Journal Article Date: 2008-03-13 |
Journal Detail:
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Title: Case reports in gastroenterology Volume: 2 ISSN: 1662-0631 ISO Abbreviation: Case Rep Gastroenterol Publication Date: 2008 |
Date Detail:
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Created Date: 2011-04-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101474819 Medline TA: Case Rep Gastroenterol Country: Switzerland |
Other Details:
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Languages: eng Pagination: 83-90 Citation Subset: - |
Affiliation:
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Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Mich., USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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