Meckelīs Diverticulum  (Prepared by Dr Gabriel Castro)

  

                                                                                                        

 

 

 

 

 

 

 

 


            1 y/o male, with no previous disease, presented with 2 week intermitent painless, moderately large quantities of dark rectal blood causing a decrease in haemoglobin level (11g/dl) not associated with vomiting, haematemesis, nor other findings. He was treated with omeprazole 1mg/kg p.o., 1 week prior to the test. Gastroscopy : without important findings and a Tc99m meckelīs scan was requested, who was reported as positive.  Tc99m pertechnetate meckelīs scan (2 min AP images):  Progresive normal intense gastric activity and a round periumbilical  focus of abnormal concentration that is seen around 10 minutes (arrow), reported as ectopic gastric tissue in Meckelīs diverticulum.

            Laparotomy revealed a bleeding  lesion in terminal ilium that was resected and correlated at histopatology with meckelīs diverticulum (MD) with ectopic gastric tissue.

            MD is the most common congenital anomaly of the gastrointestinal tract. Only 4–6% of MD is known to be symptomatic (1). The prerequisite for the detection of a MD by Tc99 sodium pertechnetate scintigraphy is the presence of ectopic gastric mucosa. The high affinity of the isotope for parietal cells of gastric mucosa allows visualisation of both eutopic as well as ectopic gastric tissue. The residual isotope is concentrated in the urinary bladder. Certain substances, such as pentagastrin, histamine-2 (H-2) blockers and glucagons, have been reported to increase the diagnostic  specificity. (2) The Tc-99m Meckel’s scan is the most accurate noninvasive examination for identifying ectopic gastric mucosa in MD with a sensitivity and specificity 85% and 95%, respectively  (3).

            Among other conditions that have to be included in the differential diagnosis are: bowel intussusception, intestinal duplication, activity in the kideneys and ureters, etc.

References:
1) Yahchouchy EK, Marano AF, Etienne JF, et al. (2001) Meckel’s diverticulum. J Am Coll Surg 192(5):658–661.
2) Menezes M, Tarren F, Saeed A, et al. (2008)  Symptomatic Meckel’s diverticulum in children a: 16 year review. Pediatr Surg Int 24:575-577.
3) Tseng Y, Yang Y. (2009) Clinical and diagnostic relevance of Meckel’s diverticulum  in children.  Eur J Pediatr 168: 1519-1523.
 

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