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Accidental Small-Bowel Puncture, and Importance of Patient Positioning, During Isotopic Peritoneography: A Case Report

Nuclear Medicine Section, Department of Radiology, Marshfield Clinic, Marshfield, Wisconsin

A 47-y-old woman with chronic liver disease, who had previously undergone placement of a peritoneal venous shunt without ascites, presented with a chronic right pleural effusion. The first attempt at radionuclide injection resulted in an accidental small-bowel injection with consequent intraalimentarily induced nuclear small-bowel followthrough. I have not read of this interesting complication in the literature. She did not have a bowel obstruction. A repeated study 2 d later demonstrated an obstructed peritoneal shunt and right hemidiaphragmatic pleural leak best seen with the patient upright.

Key Words: peritoneal shunt; pleural effusion; ^99mTc-macroaggregated albumin; diaphragmatic leak