Successful Localization of the Source of Hemorrhage in Patient with Post-Whipple Surgery by (99m)Tc-Labelled Red Blood Cell Scintigraphy

Gastrointestinal Bleeding Scintigraphy (GIBS) of (99m)Tc-labelled red blood cells is a relatively simple examination to perform, with high diagnostic accuracy and a relatively lower radiation dose. A positive scan can either suggest surgery without further investigation or can indicate angiography, a more targeted procedure. Whipple pancreatoduodenectomy is most often performed for tumors of the head of the pancreas. Pancreatoduodenectomy has 30%–40% morbidity and mortality, and while post-pancreatoduodenectomy hemorrhage is seen in less than 10% of patients, it accounts for 11%–38% mortality. The role of imaging in patients to detect relative hemodynamic stability is essential. Computed tomography angiography (CTA) shows the cause, site, and nature of bleeding, while digital subtraction angiography (DSA) has a diagnostic as well as a therapeutic role. We present a patient who presented with active gastrointestinal bleeding (GI) bleeding after undergoing a Whipple procedure, to highlight the role of GIBS in the successful localization of a bleeding site and the guidance of digital DSA in the embolization and control of the active bleeding.