Repeated bleeding scintigraphy may reveal that stationary foci of activity represent sites of active hemorrhage

The goal of bleeding scintigraphy is to localize the site of origin of a hemorrhage to within general regions of the large or small bowel. Activity is typically seen to extravasate from the blood pool into the lumen, and the collection of activity then moves on sequential images, as a result of the cathartic action of blood. Sometimes, bleeding studies show a stationary focus of activity without subsequent movement. It is generally assumed that these foci represent fixed structures, such as the urinary tract or prominent vasculature, rather than acute extravasation of labeled blood into the bowel. The authors report three cases in which repeated studies showed that fixed foci of activity were, in fact, related to gastrointestinal bleeding. In two instances, the fixed foci represented extravasated blood that, for unexplained reasons, did not move during the study. In an additional case, the fixed activity visualized was ultimately shown to be prominent varices, which were implicated in the bleeding. Recognition of these possibilities, and consideration of possible strategies to localize the bleeding site further, should facilitate optimal patient treatment.