title: 111Indium-labelled red-cell scintigraphy to detect intermittent gastrointestinal bleeding from synchronous small- and large-bowel adenocarcinomas.
abstract: A 70-year-old woman presented with symptoms of profound anaemia and evidence of intermittent gastrointestinal haemorrhage. Oesophagogastroduodenoscopy, colonoscopy, abdominal computerised tomography, sulphur colloid scintigraphy and selective mesenteric angiography were non-diagnostic. An indium-labelled red-cell scan was performed, which suggested bleeding from the ileum at 36 h. At laparotomy, a primary small-bowel adenocarcinoma was resected. Six weeks later, she was again anaemic. Repeat colonoscopy showed a synchronous primary colonic adenocarcinoma, which had been masked by intraluminal blood during the original indium scan. The lesion was impalpable, even after full mobilisation of the colon. A right hemicolectomy was performed. Indium has a longer half-life (67 h) than the more commonly used technetium isotope (18 h). This allows serial imaging for up to 5 days, which may increase diagnostic efficiency in intermittent gastrointestinal bleeding. Clinicians should be aware that persisting activity from intraluminal blood may mask synchronous lesions.
authors.affiliation: Department of Surgery and Department of Radiology, Royal Victoria Hospital, Belfast, Northern Ireland.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Mole
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hughes
authors.forename: Kourosh
authors.initials: K
authors.lastname: Khosraviani
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis; D003113:Colonoscopy; D004912:Erythrocytes / Q000000981:diagnostic imaging*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D007078:Ileal Neoplasms / Q000000981:diagnostic imaging; D007205:Indium Radioisotopes; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging*; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography
chemical_list: D007205:Indium Radioisotopes