Parastomal hemorrhage demonstrated on a red blood cell-labeled gastrointestinal bleeding site study

초록

A 70-year-old man underwent a red blood cell (RBC)-labeled gastrointestinal bleeding site study for hematochezia observed in his colostomy bag. He had a colostomy after a Miles' operation for rectal cancer 3 years before the study. Angiography of the superior and inferior mesenteric arteries performed before the nuclear medicine study showed no focus of active bleeding. The RBC-labeled study revealed no focus of bleeding in the gastrointestinal tract. However, an area of increased radioactive uptake was observed at the site of the colostomy. Immediately after this positive study, the patient was taken to the operating room, where the presence of a bleeding focus at the colostomy site was confirmed and treated by ligation. A detailed history revealed that the patient had chronic liver disease and splenomegaly. Parastomal hemorrhage with portal hypertension has been reported in the surgical literature, but hemorrhage revealed in such a case by a nuclear medicine study has not been reported.

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