Importance of Heparin Provocation and SPECT/CT in Detecting Obscure Gastrointestinal Bleeding on (99m)Tc-RBC Scintigraphy: A Case Report

We presented a pediatric case with a history of intermittent melena for 3 years because of angiodyplasia of small intestine. The results of frequent upper gastrointestinal endoscopies and colonoscopies as well as both (99m)Tc-red blood cell (RBC) and Meckel's scintigraphies for several times were negative in detection of bleeding site. However, (99m)Tc-RBC scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT) after heparin augmentation detected a site of bleeding in the distal ileum which later was confirmed during surgery with final diagnosis of angiodysplasia. It could be stated that heparin provocation of bleeding before (99m)Tc-RBC scintigraphy accompanied by fused SPECT/CT images should be kept in mind for management of intestinal bleeding especially in difficult cases.