Meckel's diverticulum other imaging findings

Meckel's diverticulum Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Meckel's Diverticulum from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Meckel's diverticulum other imaging findings On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Meckel's diverticulum other imaging findings All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Meckel's diverticulum other imaging findings
CDC on Meckel's diverticulum other imaging findings
Meckel's diverticulum other imaging findings in the news
Blogs on Meckel's diverticulum other imaging findings
Directions to Hospitals Treating Meckel's diverticulum
Risk calculators and risk factors for Meckel's diverticulum other imaging findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A technetium-99m (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric (stomach) cells contained within them, this is displayed as a spot on the scan distant from the stomach itself.

Other Imaging Findings

• Meckel's diverticulum is identified as a saccular, blind-ending structure located on the antimesenteric border of the ileum.
• Meckel's diverticulum is usually found in the right lower quadrant and pelvic region.
• The junction of the diverticulum with the ileum may show a mucosal triangular plateau or triradiate fold pattern (represents the site of omphalomesenteric duct attachment to the ileum).
• Filling defects within the diverticulum may represent enteroliths, fecoliths, or foreign bodies.

• Pertechnetate scan: A technetium-99m (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric (stomach) cells contained within them, this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence.
  • Technetium-99m pertechnetate scintigraphy is the modality of choice for evaluating pediatric patients with gastrointestinal hemorrhage and a suspected Meckel diverticulum.
  • A Meckel diverticulum containing gastric mucosa will manifest as a small rounded area of increased activity in the right lower quadrant.
  • Normal activity will simultaneously appear in the stomach.

Positive Technetium-99m pertechnetate scan

Technetium-99m pertechnate radioisotope scanning:

Helps in the detection of a symptomatic bleeding Meckel’s diverticulum investigation of choice to diagnose Meckel's diverticula in children: highly accurate and noninvasive, with 95% specificity and 85% sensitivity False negative rates high in adults: only 9% specific and 62% sensitive The Technetium-99m pertechnate radioisotope is taken up by the gastric mucosa on intravenous administration In order to obtain a positive result, atleast 1.8 cm2 of ectopic gastric mucosa in Meckel diverticulum is required approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them, this is displayed as a spot on the scan distant from the stomach itself.

Requires 30 images, taken at 1-minute intervals to demonstrate terminal ileal activity

Pentagastrin: Histamine-2 (H2) receptor blocker Enhances radioisotope uptake by the cells: Promotes isotope retention Blocks intraluminal release of isotope Minimizes false negative results

False-positives seen in: Intussusception Volvulus obstruction of the small intestine acute appendicitis carcinoid of the appendix carcinoma of the caecum.

September 2014: Guidelines for the Scintigraphy for Meckel’s diverticulum: Society of Nuclear Medicine and Molecular Imaging (SNMMI) European Association for Nuclear Medicine (EANM)

Angiography angiography may assist in determining the location and severity of bleeding In patients presenting with acute GI bleeding, superior mesenteric angiography is effective if blood loss exceeds 0.5 mL/min(brisk bleeding)