Incidental diagnosis of intestinal perforation on a 99mTc DTPA renogram

Document Type : Case report


Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Science, Kochi, Kerala, India



Perforation of the bowel can be a life-threatening condition and is usually clinically diagnosed when a patient presents with such features as severe abdominal pain, tenderness, and tachycardia. Bowel perforation may be corroborated by various conventional imaging modalities, including X-ray, ultrasonography, computed tomography, and magnetic resonance imaging. Nuclear medicine imaging modalities seldom have a role to play in these settings. Rarely diagnosis of perforation may be missed if it is concealed and does not present with the usual signs. Mostly the perforation will eventually be diagnosed if they develop signs and symptoms and is taken up for an exploratory laparotomy. A delay in diagnosis can later lead to significant patient morbidity or even mortality. This report describes a case where possible intestinal perforation was suspected on a 99mTc-DTPA renogram in a postoperative patient with significant urine leak, the presence of which was confirmed intraoperatively. To our knowledge, this was the first such case in the literature.


Main Subjects

  1. Yalçın H, Özen A, Günay EC, Özaslan İA, Özer C. Can 99m Tc DTPA be used in adult patients in evaluation of relative renal function measurement as the reference 99mTc DMSA method? Mol Imaging Radionucl Ther. 2011; 20(1):14-8.
  2. Morton KA, Pisani DE, Whiting JH Jr, Cheung AK, Arias JM, Valdivia S. Determination of glomerular filtration rate using technetium-99m-DTPA with differing degrees of renal function. J Nucl Med Technol. 1997; 25(2): 110-4.
  3. Esparaz AM, Pearl JA, Herts BR, LeBlanc J, Kapoor B. Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol. 2015; 32(2):195-208.
  4. Peyton CC, Hajiran A, Morgan K, Azizi M, Tang D, Chipollini J, et al. Urinary leak following partial nephrectomy: a contemporary review of 975 cases. Can J Urol. 2020; 27(1):10118-10124.
  5. Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 2003; 23(5): 1133-47.
  6. Goldwasser J, Wahdat R, Espinosa J, Lucerna A. Urinoma: Prompt Diagnosis and Treatment Can Prevent Abscess Formation, Hydronephrosis, and a Progressive Loss of Renal Function. Case Rep Emerg Med. 2018; 2018:5456738.
  7. Engelsgjerd JS, LaGrange CA. Ureteral Injury. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
  8. Subramanyam P, Palaniswamy SS, Tewari A, Praveen Kumar SL. Iatrogenic Urinomas Identified by 99mTc DTPA Renal Scintigraphy. Trop Med Surg. 2013; 1(131):2.
  9. Paolantonio P, Rengo M, Ferrari R, Laghi A. Multidetector CT in emergency radiology: acute and generalized non-traumatic abdominal Br J Radiol. 2016; 89(1061): 20150859.