Positive technetium-99m-red blood cell gastrointestinal bleeding scan after barium small-bowel study

A 53-yr-old man with hepatic insufficiency and portal hypertension was hospitalized and underwent a work-up for gastrointestinal bleeding requiring multiple transfusions. The initial evaluation included a negative upper and lower endoscopy and a barium exam of the small bowel. Both studies failed to demonstrate any pathology to explain the bleeding. Immediately following the barium study, the patient had active bleeding. Because of the significant amount of intestinal barium, angiography was deferred. Technetium-99m-red blood cell (RBC) scintigraphy was undertaken to identify the site of bleeding. Despite intestinal barium, the 99m-Tc-RBC scan demonstrated an active bleeding site in the small bowel in the left abdomen. Therefore, 99mTc-RBC scintigraphy can be of clinical utility for identification of gastrointestinal bleeding, despite the presence of intestinal barium.