Diagnostic dilemma and surgical management of recurrent small bowel bleeding detected by SPECT/CT

We present a 65-year-old patient with recurrent gastrointestinal bleeding and severe anemia due to previous metastatic renal cell carcinoma. Despite multiple hospitalizations and standard endoscopic examinations (EGD, colonoscopy), the cause of bleeding was unclear for a long time. The diagnostic key was scintigraphy with labeled red blood cells using SPECT/CT. The last one revealed focal pathological radiotracer fixation in projection of jejunum. Finally, the patient underwent laparotomy with resection of extensive tumor lesion of small intestine as a cause of bleeding. Histological and immunohistochemical data (PAX8+, CD10+, CK7-, CK20-) confirmed metastatic nature of tumor (metastasis of clear cell renal cell carcinoma). This case demonstrates high diagnostic value of radionuclide methods (scintigraphy) for occult small bowel bleeding not detectable by standard endoscopy and justifies surgical intervention even in patients with generalized tumor process to eliminate life-threatening complications.