Meckel's Diverticulum

Leyla Azmoun, MD
J Stevan Nagel, MD

July 1, 1994

Presentation

A 20-year-old man described an acute episode of rectal bleeding (bright red).

Imaging Technique

Technetium-99m pertechnetate (10 mCi) is injected intravenously. Serial dynamic images of abdomen are obtained over 30 minutes.

Imaging Findings

Tc-99m pertechnetate scintigraphy

Tc-99m pertechnetate scintigraphy reveals an abnormal focus of radiotracer accumulation in the suprapubic region of the abdomen, slightly to the right of midline (arrow). The focus of activity is visible at 1 minute after injection (same time stomach becomes visible) and gradually disappears over 30 minutes.

Differential Diagnosis

Meckel's diverticulum is the most likely diagnosis given the clinical presentation and the location of radiotracer accumulation. The differential diagnoses include a small bowel lesion leading to intussusception, inflammatory bowel disease, and intestinal duplication yst containing gastric mucosa.

Diagnosis

Meckel's diverticulum

Discussion

Meckel's diverticulum occurs in approximately 2-3% of the population, predominantly in males. While the majority of patients remain asymptomatic, complications may include hemorrhage, volvulus, and intussusception, mostly in children younger than 10 years of age. In virtually all patients who present with bleeding, ectopic gastric mucosa can be demonstrated in the diverticulum. Tc-99m pertechnetate scintigraphy has an overall specificity and sensitivity of 90% for establishing the diagnosis.

References

1. Mettler F, Milton J. Essentials of nuclear medicine imaging. 3rd ed. Philadelphia: WB Saunders, 1991: 195-196.

2. Eisenberg R. Gastrointestinal radiology: a pattern approach. 2nd ed. Philadelphia: JB Lippincott, 1990:536-538.

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