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Wandering Meckel's diverticulum on 99m technetium-pertechnetate scintigraphy: A diagnostic dilemma?

Uz Zaman M, Fatima N, Zaman U, Sajjad Z - Indian J Nucl Med (2014)

Bottom Line: Meckel's diverticulum (MD) is the most common gastrointestinal anomaly with heterotopic mucosa in 60% of cases. 99m technetium-pertechnetate scintigraphy is a sensitive tool for detection of MD containing heterotopic gastric mucosa.It is usually located in the right lower quadrant or umbilical region and less frequently in other quadrants.However, presence of temporal correlation with gastric activity and compactness of focus during wandering period could make this riddle easy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.

ABSTRACT
Meckel's diverticulum (MD) is the most common gastrointestinal anomaly with heterotopic mucosa in 60% of cases. 99m technetium-pertechnetate scintigraphy is a sensitive tool for detection of MD containing heterotopic gastric mucosa. It is usually located in the right lower quadrant or umbilical region and less frequently in other quadrants. A mobile or wandering MD is a rare clinical presentation and may pose a diagnostic dilemma. However, presence of temporal correlation with gastric activity and compactness of focus during wandering period could make this riddle easy.

No MeSH data available.


Related in: MedlinePlus

99m technetium-pertechnetate Meckel's diverticulum scintigraphy: Sequential images showing appearance of abnormal focus (arrow) having temporal correlation with gastric activity and wandering in various quadrants maintaining its compactness
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Figure 1: 99m technetium-pertechnetate Meckel's diverticulum scintigraphy: Sequential images showing appearance of abnormal focus (arrow) having temporal correlation with gastric activity and wandering in various quadrants maintaining its compactness

Mentions: A 2-year-old male child admitted to the emergency room with 2 days history of 3 episodes of painless per rectal fresh bleeding. On examination, child was irritable, grossly anemic, afebrile with mild abdomen distention, but audible gut sounds. Per-rectal examination revealed only traces of fresh blood. His hemoglobin was 4.9 g/dl (normal 11-14 g/dl) while other biochemical and bleeding parameters were within the normal limits. Ultrasound abdomen was unremarkable and child had blood transfusions with and started on oral ranitidine (2 mg/kg 12 hourly). On the 3rd admission day, MD scintigraphy was performed with 3 mCi of 99m technetium-pertechnetate injected intravenously with 3 h fasting. Dynamic study for 60 min with a frame rate of 20s/frame was acquired in anterior projection under a dual head digital gamma camera (Ecam, Siemens, Germany) fitted with low energy high resolution collimators. Early images showed the appearance of focus of abnormal tracer deposition in hypogastric region concomitant with the appearance of gastric activity in left hypochondrium and better delineation in subsequent frames same as native gastric activity. Sequential images revealed gross shifting of abnormal focus to left iliac region, hypogastrium, right lumbar, umbilical and finally in epigastric region [Figure 1]. As this abnormal focus remained compact during its tortuous path with no sign of change in its morphology during its whole path, an intraluminal source of radiotracer like bleed (which keeps on changing its shape in lumen of small or large bowel) was ruled out and provisional diagnosis of a wandering MD with heterotopic gastric mucosa was made. The child underwent an exploratory laparotomy and MD was resected and histopathology revealed MD with heterotopic gastric and pancreatic mucosa.


Wandering Meckel's diverticulum on 99m technetium-pertechnetate scintigraphy: A diagnostic dilemma?

Uz Zaman M, Fatima N, Zaman U, Sajjad Z - Indian J Nucl Med (2014)

99m technetium-pertechnetate Meckel's diverticulum scintigraphy: Sequential images showing appearance of abnormal focus (arrow) having temporal correlation with gastric activity and wandering in various quadrants maintaining its compactness
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928747&req=5

Figure 1: 99m technetium-pertechnetate Meckel's diverticulum scintigraphy: Sequential images showing appearance of abnormal focus (arrow) having temporal correlation with gastric activity and wandering in various quadrants maintaining its compactness
Mentions: A 2-year-old male child admitted to the emergency room with 2 days history of 3 episodes of painless per rectal fresh bleeding. On examination, child was irritable, grossly anemic, afebrile with mild abdomen distention, but audible gut sounds. Per-rectal examination revealed only traces of fresh blood. His hemoglobin was 4.9 g/dl (normal 11-14 g/dl) while other biochemical and bleeding parameters were within the normal limits. Ultrasound abdomen was unremarkable and child had blood transfusions with and started on oral ranitidine (2 mg/kg 12 hourly). On the 3rd admission day, MD scintigraphy was performed with 3 mCi of 99m technetium-pertechnetate injected intravenously with 3 h fasting. Dynamic study for 60 min with a frame rate of 20s/frame was acquired in anterior projection under a dual head digital gamma camera (Ecam, Siemens, Germany) fitted with low energy high resolution collimators. Early images showed the appearance of focus of abnormal tracer deposition in hypogastric region concomitant with the appearance of gastric activity in left hypochondrium and better delineation in subsequent frames same as native gastric activity. Sequential images revealed gross shifting of abnormal focus to left iliac region, hypogastrium, right lumbar, umbilical and finally in epigastric region [Figure 1]. As this abnormal focus remained compact during its tortuous path with no sign of change in its morphology during its whole path, an intraluminal source of radiotracer like bleed (which keeps on changing its shape in lumen of small or large bowel) was ruled out and provisional diagnosis of a wandering MD with heterotopic gastric mucosa was made. The child underwent an exploratory laparotomy and MD was resected and histopathology revealed MD with heterotopic gastric and pancreatic mucosa.

Bottom Line: Meckel's diverticulum (MD) is the most common gastrointestinal anomaly with heterotopic mucosa in 60% of cases. 99m technetium-pertechnetate scintigraphy is a sensitive tool for detection of MD containing heterotopic gastric mucosa.It is usually located in the right lower quadrant or umbilical region and less frequently in other quadrants.However, presence of temporal correlation with gastric activity and compactness of focus during wandering period could make this riddle easy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.

ABSTRACT
Meckel's diverticulum (MD) is the most common gastrointestinal anomaly with heterotopic mucosa in 60% of cases. 99m technetium-pertechnetate scintigraphy is a sensitive tool for detection of MD containing heterotopic gastric mucosa. It is usually located in the right lower quadrant or umbilical region and less frequently in other quadrants. A mobile or wandering MD is a rare clinical presentation and may pose a diagnostic dilemma. However, presence of temporal correlation with gastric activity and compactness of focus during wandering period could make this riddle easy.

No MeSH data available.


Related in: MedlinePlus