Radiology Case Reports (Oct 2021)

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

  • Connor D. Crowley, MD,
  • William J. Rieter, MD, PhD,
  • Leonie Gordon, MBChB

Journal volume & issue
Vol. 16, no. 10
pp. 2969 – 2971


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111In-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 111In-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, 111In-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.