Nucpaedia
Nucpaedia
Gastrointestinal · ⁹⁹ᵐTc-labelled red blood cells · Intermediate

Recurrent fresh rectal bleeding in a 79-year-old man

History

79-year-old man on apixaban for atrial fibrillation with three episodes of maroon and fresh rectal bleeding over 36 h; haemoglobin 128 → 92 g/L, pulse 96, blood pressure 118/70 after 2 units. CT angiography 8 h ago, during a lull, showed sigmoid and descending colon diverticulosis without contrast extravasation. Colonoscopy was limited by blood. He bled again an hour ago. Request: is he bleeding, and from where?

Step 1 · The first 15 minutes

Simulated ⁹⁹ᵐTc-labelled red-cell study (in vitro labelling): 1-min anterior frames at 2, 6, 10 and 14 min.
Simulated ⁹⁹ᵐTc-labelled red-cell study (in vitro labelling): 1-min anterior frames at 2, 6, 10 and 14 min.

What does the change across these frames show?