Lee S M, Lee R G, Clouse M E, Hill T C
Clin Nucl Med. 1986 Jan;11(1):52. doi: 10.1097/00003072-198601000-00018.
A 75-year-old woman, who presented with obstructive jaundice, was shown by percutaneous transhepatic cholangiography to have a markedly dilated biliary system and stones within the common bile duct. The stones were removed percutaneously using the transduodenal approach, and an internal drainage catheter was placed. Following the procedure, the patient experienced gastrointestinal bleeding manifested by melanotic stools. Blood-tinged bile was withdrawn from the biliary drainage catheter, leading to the suspicion that the bleeding might be originating from the biliary tract. A Tc-99m red blood cell (Tc-99m RBC) scan was performed to try to designate the biliary tract as the site of bleeding, and to determine if there were any other bleeding sites present. The study demonstrated bleeding from the biliary tract, which was confirmed by angiography and endoscopy. The technique for the detection of gastrointestinal bleeding using Tc-99m RBCs is well described. This case suggests that when doing studies to localize occult bleeding, the liver should be included in the field-of-view to exclude bleeding from the liver.
一名75岁女性因梗阻性黄疸就诊，经皮经肝胆管造影显示其胆道系统明显扩张，胆总管内有结石。采用经十二指肠途径经皮取出结石，并放置了内引流导管。术后，患者出现黑便，提示胃肠道出血。从胆道引流导管抽出带血胆汁，怀疑出血可能来自胆道。进行了锝-99m红细胞（Tc-99m RBC）扫描，试图确定胆道为出血部位，并确定是否存在其他出血部位。该研究证实了胆道出血，血管造影和内镜检查也证实了这一点。使用Tc-99m RBC检测胃肠道出血的技术已有详细描述。该病例表明，在进行隐匿性出血定位研究时，应将肝脏纳入视野范围，以排除肝脏出血。
