Red blood cell scintigraphy in children with acute massive gastrointestinal bleeding

Background: The main topic of the current review is the usefulness of technetium-99m-labeled red blood cell scintigraphy (Tc-99m RBC scan) in children with acute massive gastrointestinal (GI) bleeding. Methods: The medical records of pediatric patients who experienced massive GI bleeding and who underwent Tc-99m RBC scanning between November 1991 and December 2004 were reviewed and analyzed retrospectively. Results: The study included 22 patients who underwent 23 Tc-99m RBC scans. The scans were usually performed after other diagnostic tests failed to locate the bleeding. The diagnostic sensitivity of the scans was nine out of 23 (39.1%). The test demonstrated a positive scan within the first 2 h in six patients, and three patients had positive results at 24 h. The locations of the lesions identified on scanning and surgical investigation were highly correlated in patients with a positive scan within 2 h. Conclusions: The Tc-99m RBC scan is a sensitive, albeit non-specific, method for detecting GI bleeding. The location of a lesion as indicated by a positive scan within 2 h is helpful for guiding surgical intervention and angiography, although a definitive diagnosis should be made with other methods, particularly laparotomy.