Localisation of lower gastrointestinal bleeding with 99mTc red blood cell scan and single photon emission CT (SPECT)

When considering surgery, it is important to localise the bleeding site, as a blind resection can result in increased morbidity and mortality. 1 Hybrid imaging with single photon emission CT (SPECT) can provide this anatomical information with a higher overall accuracy compared to nuclear scanning alone. 2 In a study by Schillaci et al, nuclear scanning with SPECT/CT correctly identified the bleeding site in 12 of 13 patients. 3 In addition, it correctly changed the results of six of seven sites identified through nuclear scan alone. 2 In our case, the bleeding site was localised to the caecum and proximal transverse colon after hybrid scanning with a 99mTc red blood cell scan ( figure 1 A, B) and SPECT/CT ( figure 2 A, B).