title: Cinematic nuclear scintigraphy reliably directs surgical intervention for patients with gastrointestinal bleeding.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective medical record review with historical controls.
  
  
  METHODS
  Large, university-affiliated public hospital in urban setting.
  
  
  METHODS
  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.
  
  
  METHODS
  All patients with gastrointestinal bleeding underwent open surgical procedures to provide cessation of bleeding and resection of appropriate abnormalities.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, San Francisco General Hospital, Ward 3A, 1001 Potrero Ave, San Francisco, CA 94110-3518, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: O'Neill
authors.forename: J E
authors.initials: JE
authors.lastname: Gosnell
authors.forename: R J
authors.initials: RJ
authors.lastname: Lull
authors.forename: W P
authors.initials: WP
authors.lastname: Schecter
authors.forename: J
authors.initials: J
authors.lastname: Koch
authors.forename: R A
authors.initials: RA
authors.lastname: Halvorsen
authors.forename: H W
authors.initials: HW
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004241:Diverticulum, Colon / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017556:Technetium Compounds
chemical_list: D017556:Technetium Compounds