Detection of the site of recurrent bleeding in small bowel in patient with m. Rendu-Osler-Weber by means of scintigraphy with 99mTc-pertechnetate in vivo labeled red blood cells
Abstract
Woman (53) was examined for severe GI bleeding. She had positive history of recurrent GI bleeding with enterorrhagia but the source of bleeding was not identified.
Gastroscopy, push-enteroscopy and coloscopy were negative. Scintigraphy with red blood cells (RBCs) was positive for active gastrointestinal bleeding and showed spreading of the labeled RBCs into small bowel.
The patient underwent intra-operative enteroscopy, a vascular malformation was detected in jejunum and per for distal part of the jejunum was resected. Both the gross and histological finding corresponded to Rendu-Osler-Weber disease.
However, the typical gross skin lesions around the lips, nose and buccal mucosa were lacking. Four years after operation the patient had been well with normal hemoglobin level.
Last year the woman had next GI bleeding with enterorrhagia. Intra-operative enteroscopy detected a few small vascular malformations in jejunum and terminal ileum.
Malformation was coagulated by bipolar probe.