%0 Journal Article
%T Accurate localization of life threatening colonic hemorrhage during nuclear medicine bleeding scan as an aid to selective angiography
%A Mubin I Syed
%A Azim Shaikh
%J World Journal of Emergency Surgery
%D 2009
%I BioMed Central
%R 10.1186/1749-7922-4-20
%X During the gastrointestinal bleeding scan, a simple metallic marker (paper clip) was used to localize the bleeding site on the patient body. Angiography was then performed within 2 hours. The marker was then used to guide superselective angiography and embolization.5 cases of patients with colorectal bleeding were performed using this technique with cessation of bleeding in 4/5 initial attempts. 1 patient required a repeat angiogram that did demonstrate the bleeding on the second attempt allowing superselective angiography and embolization that resulted in cessation of bleeding. This patient with a rectal bleed required selection of additional vessels guided by the marker on the second attempt.The dilemma of positive scintigraphic evidence of colonic bleeding with negative arteriography can be resolved with the use of a metal marker during the scintigram to guide superselective angiography. Although in our small series of patients this technique appears to be simple and effective, further clinical investigation is warranted with a larger patient population. This technique may offer a role in therapy in coordination with the colorectal surgeon for the high risk patient in an otherwise life threatening situation.Gastrointestinal hemorrhage is a life-threatening situation with up to a 10% mortality rate when emergent surgery is performed. [1] Localization of the hemorrhage by a nuclear medicine scan is a useful first step for treatment with endoscopy, surgery, and/or by catheter directed embolization. Embolization has gained widespread acceptance for the treatment of upper gastrointestinal hemorrhage and more recently for lower gastrointestinal hemorrhage. The limitation of the technique has always been the lack of the active bleeding during arteriography despite active bleed on the nuclear medicine scan. This can be due to the intermittent nature of gastrointestinal bleed as well as the discrepancy in sensitivity between angiography and the nuclear scan. The nuclear s
%U http://www.wjes.org/content/4/1/20