Abstract
Abdominal scintigraphy with99mTc-pertechnetate, using a gamma-camera linked to a data processor, was done in 8 patients with acute massive intestinal hemorrhage and in 34 patients with chronic recurrent intestinal hemorrhage. Endoscopy and x-ray studies had failed in all patients to reveal a bleeding source. All but 3 patients underwent exploratory laparotomy, confirming the abnormal findings of scintigraphy. In all acutely bleeding patients, scintigraphy was positive. The bleeding was proven by laparotomy to be due to Meckel's diverticulum with gastric mucosa in 5, jejunal neurinoma in 1, and sigmoid colon carcinoma in 1 patient. Scintigraphy was positive in only 3 chronically bleeding patients, 1 of whom had a Meckel's diverticulum with gastric mucosa and 2 of whom had bleeding colon polyps. Scintigraphy was equivocal in 10 patients, 7 of whom were found to have chronic inflammation of the appendix, and it was negative in 21 patients, including 1 who had a Meckel's diverticulum without gastric mucosa. In chronic intestinal hemorrhage, abdominal scintigraphy was only occasionally helpful for locating a bleeding source. In acute intestinal bleeding, however, scintigraphy was a useful test, particularly in identifying a Meckel's diverticulum with gastric mucosa in children.
Résumé
Chez 8 malades en hémorragie digestive aiguë et 34 patients présentant des hémorragies intestinales chroniques récidivantes, une scintigraphie abdominale au99mTc-pertechnétate a été réalisée, la gamma-caméra étant reliée à un ordinateur. Chez ces malades, ni l'endoscopie, ni la radiographie n'avaient mis en évidence la source de l'hémorragie. Tous les malades, sauf 3, ont subi une laparotomie exploratrice confirmant les données de la scintigraphie. Dans tous les cas d'hémorragie aiguë, la scintigraphie a été positive. La laparotomie en a révélé la source: 5 diverticules de Meckel avec muqueuse gastrique, 1 neurinome jéjunal et 1 cancer du sigmoïde. La scintigraphie n'a été positive que dans 3 cas d'hémorragie chronique: 1 diverticule de Meckel et 2 polypes coliques. Le résultat des scintigrammes a été douteux dans 10 cas, dont 7 avaient une appendicite chronique, et négatif dans 21 cas dont 1 avait un diverticule de Meckel non tapissé de muqueuse gastrique. Dans l'hémorragie intestinale chronique, il est rare que la scintigraphie aide à localiser la source des hémorragies. L'examen est, par contre, utile dans l'hémorragie aiguë, surtout pour identifier chez l'enfant des diverticules de Meckel bordés de muqueuse gastrique.
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Seitz, W., Keim, H.J. & Hahn, K. Abdominal scintigraphy for diagnosis of intestinal bleeding. World J. Surg. 2, 613–618 (1978). https://doi.org/10.1007/BF01556057
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DOI: https://doi.org/10.1007/BF01556057