Case Author(s): Lisa Oakley, M.D., Keith Fischer, M.D., Jerold Wallis, M.D. , 07/11/97 . Rating: #D2, #Q3

Diagnosis: Small bowel gastrointestinal bleed

Brief history:

53 year old with dizziness and maroon stools.



View main image(gi) in a separate image viewer

If you have a Java-enabled browser and wish to view this study in cine format, try our prototype cine viewer. (If you wish to leave a comment on its performance on your machine, send us a note.)

Full history/Diagnosis is available below

Diagnosis: Small bowel gastrointestinal bleed

Full history:

53 year old with dizziness and maroon stools, who presents with hematocrit of 15 requiring transfusion. NG tube aspirate is reportedly negative.


Tc99m tagged RBC


Sequential images demonstrate tracer activity accumulation in a small bowel pattern in the midline/left upper quadrant beginning at 5-10 minutes.


Accurate localization of the site of GI bleeding is crucial for initiating effective therapy. A tagged RBC scan is well suited for this task because of its great sensitivity and its ability to detect hemorrhage even when it is intermittent. It is important to obtain early sequential images to locate the exact site of hemmorhage because blood travels quickly through bowel and can even relux proximally. In fact, it is the movement of activity thru the abdomen (in the expected course of bowel) that suggests the diagnosis of GI bleed. If persistent gastric activity is seen with no movement through bowel, this may indicate the presence of free Tc99m Pertechnetate which can be verified by images of the neck showing uptake in the thyroid and salivary glands.


Subsequent esophagoduodenoscopy showed a bleeding doudenal bulb ulcer.

Major teaching point(s):

This case is an example that nasogastric tube aspiration of the stomach is not always a reliable indicator of an upper GI source of bleeding.

ACR Codes and Keywords:

References and General Discussion of Gastrointestinal Bleeding Scintigraphy (Anatomic field:Gasterointestinal System, Category:Misc)

Search for similar cases.

Edit this case

Add comments about this case

Return to the Teaching File home page.

Case number: gi005

Copyright by Wash U MO