title: Gamma-guided diagnostic peritoneal lavage for detection of bowel perforation.
abstract: 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.
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
authors.forename: Seza A
authors.initials: SA
authors.lastname: Gulec
authors.forename: Sharon
authors.initials: S
authors.lastname: Weintraub
authors.forename: Yi-Zarn
authors.initials: YZ
authors.lastname: Wang
authors.forename: Jason
authors.initials: J
authors.lastname: Cundiff
authors.forename: Ron
authors.initials: R
authors.lastname: Albarado
authors.forename: Peter
authors.initials: P
authors.lastname: Moulder
authors.forename: J Patrick
authors.initials: JP
authors.lastname: O'leary
authors.forename: John P
authors.initials: JP
authors.lastname: Hunt
mesh_terms: 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
chemical_list: D003102:Colloids; C030406:technetium Tc rhenium-sulfur colloid; D013671:Technetium Tc 99m Sulfur Colloid; D012211:Rhenium