Case Author(s): Charles Pringle, M.D., Keith Fischer, M.D. , 06/03/96 . Rating: #D3, #Q4

Diagnosis: small bowel infarction in the right lower quadrant

Brief history:

Abdominal bloating


Anterior static image of the abdomen

View main image(iw) in a separate image viewer

View second image(xr). Plain radiograph of the abdomen

Full history/Diagnosis is available below

Diagnosis: small bowel infarction in the right lower quadrant

Full history:

84-year old man with abdominal pain. Now in intensive care unit with new onset abdominal bloating.


12 mCi Tc-99m HMPAO labeled white blood cells i.v.


There is markedly increased uptake in a dilated loop of small bowel in the right upper pelvis, which roughly correlates with dilated bowel on plain radiographs. These findings are suggestive of an infarcted/ischemic bowel loop in this region.


White blood cells can concentrate in the bowel for multiple reasons. In this patient bowel ischemia was thought most likely from his clinical course. Other diagnostic considerations include inflamatory bowel disease or bleeding into the bowel. White blood cells can be swallowed as well and a pneumonia can result in white blood cells in the GI tract if they are swallowed.


This patient was treated conservatively (as ischemic bowel) and did not subsequently have further evidence of bowel infarction.

Differential Diagnosis List

1) bowel infarction; 2) ischemic bowel; 3) inflammatory bowel disease; 4) bleeding; 5) swallowed cells

ACR Codes and Keywords:

References and General Discussion of Indium -111 WBC Scintigraphy (Anatomic field:Gasterointestinal System, Category:Inflammation,Infection)

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Case number: iw004

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