Meckel's diverticulum findings on Tc-99m red blood cell scintigraphy in a bleeding leukemic patient confirmed by Tc-99m pertechnetate scintigraphy.
A 25-year-old Caucasian woman with a medical history of acute promyelocytic leukemia presented to the emergency department with massive gastrointestinal bleeding. A bone marrow biopsy excluded hemorrhagic leukemia. Esophagogastroduodenoscopy, colonoscopy, emergency abdominal angiography, abdominal CT scan, and wireless capsule endoscopy were performed but no source of bleeding could be detected. Tc-99m RBC scintigraphy was consistent with a small bowel bleeding focus. The persistent and focal images in the right abdomen were suggestive of Tc-99m RBC trapping in the lumen of a Meckel diverticulum (MD). In accordance with this suspicion, successive Tc-99m pertechnetate scintigraphy was performed after 3 days, consistent with the diagnostic hypothesis. Due to the persisting severe bleeding (with a drop in baseline hemoglobin from 10.4 to 7.1 g/dL), despite 8 units of blood transfusion, emergency surgery was performed. Through a minilaparotomy a segmental small bowel resection, including Meckel diverticulum, was performed. The postoperative course was uneventful.
Department of General Surgery, Catholic University of Rome, Rome, Italy.
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L
Ciccoritti
V
V
Valenza
F
F
Pierconti
D
D
Di Giuda
G
G
D'Errico
A
A
Antinori
A
A
Crucitti
D000328:Adult; D004912:Erythrocytes / Q000000981:diagnostic imaging*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000000981:diagnostic imaging*; D008467:Meckel Diverticulum / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m; D013667:Technetium
D019275:Radiopharmaceuticals; D013667:Technetium; D013670:Sodium Pertechnetate Tc 99m