A case of intermittent bleeding Meckel’s diverticulum

Abstract

The initial technetium-99m pertechnetate abdominal scintigraphy revealed equivocal or normal results. However, a second scintigraphy without pentagastrin demonstrated a focal area of persistently increasing radioactivity in the right lower quadrant of the abdomen. At surgery, Meckel's diverticulum was confirmed, and histological examination of the excised specimen revealed that it was lined with ectopic gastric mucosa. It has not been satisfactorily explained why the initial imaging failed to demonstrate the ectopic gastric mucosa. The necessity to perform repeated scintigraphy must be emphasized because 50 to 91 percent of bleeding Meckel's diverticula in the pediatric age group are said to contain gastric mucosa.

Bleeding Meckel’s diverticulum in a 4-month-old infant: Treatment with laparoscopic diverticulectomy. A case report and review of the literature

“…However, according to a report by Vane and colleagues,4 the age range of 48 patients with a bleeding MD was four months to four years, but no further age details were given. Imaeda and colleagues5 reported a 7-month-old boy with an intermittently bleeding MD. In a review of 158 infants less than one year old with intestinal bleeding (no further age details), only six (3.8%) presented with a bleeding MD 6…”

Repeated Technetium‐99m Pertechnetate Scanning for Children with Obscure Gastrointestinal Bleeding

“…Although Tc-99m abdominal scan is reliable for the detection of ectopic gastric tis sue, false negative results have been reported frequently in adults (9). Fal se negative scans in children , though uncommon , do occur (3,4). Fal se negative studies may be due to an insufficient mass of gastric tissue , impaired blood supply, downstream washout of pertechnetate, excessive secretions, or suboptimal technique (9,10).…”

Where are we with nuclear medicine in pediatrics?

“…Diverticula are mobile and although most often located in the right lower quadrant, can move about the abdomen during the examination. Transit of contents of the diverticulum, dilution of radiopharmaceutical by bowel content, insufficient gastric mucosa, impaired vascular supply, and poor positioning are potential causes for uncommon falsenegative studies [223]. Careful positioning ensuring the entire bladder is included on the images and the use of additional positional and postvoid images will minimize false-negative studies.…”