Terminal ileal micro-perforation from an ingested fish bone incidentally diagnosed with 111 In-leukocyte scintigraphy in an asymptomatic patient

• Published in: Radiology case reports Vol. 16; no. 10; p. 2969
• Main Authors: Crowley, Connor D, Rieter, William J, Gordon, Leonie
• Format: Journal Article
• Language: English
• Published: Netherlands 01-10-2021
• Subjects: White blood cells; Perforation; Fish bone; Leukocytes; Indium-111; SPECT/CT
• ISSN: 1930-0433; 1930-0433

In-leukocyte scintigraphy has generally been considered a sensitive diagnostic test for the evaluation of infectious or inflammatory processes in the abdomen due to a lack of normal physiologic bowel activity. Herein we present a case of a patient status post endovascular repair of an abdominal aortic aneurysm for which an
In-leukocyte scan was ordered to assess for graft infection. Planar imaging revealed an abnormal focus of radiotracer activity in the right lower quadrant of the abdomen. A SPECT-CT obtained to further delineate the anatomic location of abnormal activity showed abnormal leukocyte activity localizing to the terminal ileum secondary to a micro-perforation from an ingested fishbone. This case underscores the principle that in the absence of known intra-abdominal pathology,
In-leukocyte activity in the abdomen should always be considered abnormal, and that further evaluation with dedicated cross-sectional imaging should be performed to assist with the localization of abnormal activity.