Preoperative intestinal transit scintigraphy for targeted surgery in pediatric intestinal pseudo-obstruction

Pediatric intestinal pseudo-obstruction (PIPO) is a severe gastrointestinal motility disorder for which surgical enterostomy is often required to achieve effective bowel decompression and optimize nutrition, although the optimal site of diversion remains uncertain. We report the first pediatric case series utilizing hybrid Intestinal Transit Scintigraphy with Single Photon Emission Computed Tomography/Computed Tomography (ITS-SPECT/CT) to guide enterostomy placement. Five children with confirmed PIPO underwent ITS-SPECT/CT with ^67Ga-citrate to map functionally impaired segments. Unlike conventional planar scintigraphy, this 3D tomographic approach eliminated tissue overlap, precisely localizing stable regions of tracer retention that directly informed surgical planning. All patients underwent targeted interventions without major complications. At 12-24 months of follow-up, all patients showed improved stoma output and enteral feeding tolerance, with discontinuation or substantial reduction of parenteral nutrition. These findings suggest that ITS-SPECT/CT is a safe and objective preoperative tool for individualized surgical planning in PIPO, enabling precise, functionally guided interventions.