Gastrointestinal bleeding from an unusual etiology. Demonstration by Tc-99m RBC scintigraphy

A 42-year-old man was admitted with hematochezia. Approximately one hour prior to admission, this industrial worker was attempting to disengage a jammed staple gun when a staple dislodged accidently . Approximately one-half hour later, he noted bright red blood per rectum. Shortly after admittance an emergency gastrointestinal bleeding scintigraphy study was performed. Ten mCi of in vitro labeled Tc-99m RBCs were injected. Sequential 500 K images were obtained over the abdomen every 5 minutes for 40 minutes. Three representative images are shown, demonstrating active gastrointestinal bleeding. The patient was taken to the operating room were a distal jejunal bleed was seen. Enterostomy was performed and the vessel was ligated. This interesting case demonstrates the pathophysiology of an unusual cause of gastrointestinal bleeding.