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Joseph Junewick, MD FACR
over 6 years ago
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Meckel Diverticulum with Gastric Mucosa

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: NM CT
Activities:
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History

10 year old with crampy abdominal pain, bloody stool and anemia.


Case Images


Diagnosis

Meckel Diverticulum with Gastric Mucosa

Findings

CT – Blind ending tubular structure anteriorly in the right pelvis with enhancing irregularly thickened mucosa.

NM – Focal photodensity in the pelvis appearing simultaneously with the stomach.

Discussion

Meckel’s diverticulum is the vestigial remnant of the omphalomesenteric duct. It is normally located on the antimesenteric border of the terminal ileum within 60 cm of the ileocecal valve and it averages 6 cm in length. More than half of these contain ectopic gastric mucosa, commonly leading to clinical presentations of peptic ulceration and hemorrhage. Other complications of Meckel’s diverticulum include diverticulitis, intussusception, perforation, and obstruction. Most cases that present with these complications require surgery. 99m-Tc pertechnetate is selectively taken up by the surface mucous-secreting cells that line the gastric mucosa. Pertechnetate scanning has a reported sensitivity of 80-90% in children, a specificity of 95% and an accuracy of 90% but is less reliable in adults. Both Meckel diverticulum and intestinal duplication accumulate 99mTc pertechnetate. Both conditions are treated surgically, although at surgery, these conditions are easily differentiated because a Meckel diverticulum is located on the antimesenteric margin of the bowel, whereas intestinal duplication is located on the mesenteric side of the bowel.

Reference

Satya R, OMalley JP. Case 86: Meckel Diverticulum with Massive Bleeding. Radiology (2005);236:836-840.

Contributor

David Reynolds, MD



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