Gamma-guided diagnostic peritoneal lavage for detection of bowel perforation.
OBJECTIVE
Bowel perforation can be diagnosed by detection of orally administered technetium Tc 99m sulfur colloid ((99m)Tc SC) in diagnostic peritoneal lavage (DPL) fluid using a handheld gamma-detection probe.


METHODS
A canine intestinal-injury model was used to test the hypothesis. The (99m)Tc SC (55.5 MBq) was administered in 500 mL of saline via a nasogastric tube. A DPL with 500 mL of saline was performed at 60, 90, and 120 minutes after administration of (99m)Tc SC. The radioactivity in the DPL effluent was measured using a handheld gamma probe. A DPL effluent count that was 3 SDs above the background count was considered a positive test result. Twenty animals with perforation and 5 without perforation (negative control) were studied.


RESULTS
There were no false-positive gamma-DPL test results. Sensitivity improved by time up to 90 minutes. The lowest positive count in the DPL effluent measured by the gamma probe corresponded to 0.2% of the administered activity. No radioactivity was detected in blood and urine samples or liver and spleen specimens. The sensitivity, specificity, accuracy, positive predictive values, and negative predictive values at 90 minutes were 95%, 100%, 96%, 100%, and 83%, respectively.


CONCLUSIONS
gamma-Guided DPL is a highly sensitive and 100% specific test in the detection of small-bowel perforation. Clinical studies are warranted to determine the patient-specific factors affecting diagnostic accuracy.
Gulec
Seza A
SA
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
Weintraub
Sharon
S
Wang
Yi-Zarn
YZ
Cundiff
Jason
J
Albarado
Ron
R
Moulder
Peter
P
O'leary
J Patrick
JP
Hunt
John P
JP
D000818:Animals; D003102:Colloids; D004285:Dogs; D007416:Intestinal Perforation / Q000000981:diagnostic imaging*; D010533:Peritoneal Lavage / Q000379:methods*; D011877:Radionuclide Imaging; D012211:Rhenium; D013671:Technetium Tc 99m Sulfur Colloid
D003102:Colloids; C030406:technetium Tc rhenium-sulfur colloid; D013671:Technetium Tc 99m Sulfur Colloid; D012211:Rhenium