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Meckels Diverticulum



     A Case File
Presentation


  •   11/12 male
  •   Painless PR Bleed (fresh & clot)
  •   x 1 vomit
  •   Decreased BP
  •   Mild tachycardia
  •   Bronchiolitis
  •   Previously well
History


  •   Unremarkable pregnancy
  •   Full term
  •   Normal birth weight and size
  •   Bronchiolitis at 1/12 (under treatment)
  •   Developmentally age appropriate
  •   No Hx bleed
  •   No Hx haemophilia
Signs & Symptoms


  •   In AM noted pale by mother
  •   Small stool with fresh blood
  •   No pain, not febrile
  •   No Hx ingestion or bruising
  •   No Hx ENT or GIT bleed
  •   Blood noted at anus, no tear
  •   Estimated 200ml bleed (1/4 blood vol.)
  •   Alert
Physiology of Meckels


 • Most common congenital malformation of GI tract
 • Present in 2% of routine autopsies
 • Usually presented by age 2
 • Vestigial remnant of the omphalomesenteric duct
   approx. 2ft from terminal ileum
 • Approx. 50% of diverticula contain ectopic tissue,
   more often gastric than pancreatic
 • Peptic ulceration secondary to functioning gastric
   mucosa typically is cause of bleed
Technique


  •   Nil by mouth for at least 4hrs
  •   Tc99m Pertechnetate 400Mbq
  •   128x Med/High Resolution Col
  •   2sec/60sec - 120sec/19mins
  •   Anterior Abdomen
  •   Planar views as required
Scan Appearance - Normal


  • Increased gastric uptake 10-20mins
  • Pertechnetate may leave stomach and
    undergo peristalsis distally. Usually appears
    linear but may be focal
  • Renal activity is seen early
  • Bladder activity
  • Liver activity
Scan Appearance - Normal




               Anterior
  Rt Lateral               Lt Lateral
Scan Appearance -Abnormal


  • Well filled large stomach
  • Accumulated technetium well during accq
  • Small focus of uptake
  • Diverticula appear at same time
    pertechnetate appears in normal gastric
    mucosa
  • Uptake increases with time, paralleling
    stomach
Scan Appearance -Abnormal




               Anterior     Anterior “Milk”
  Rt Lateral
Scan Appearance -Abnormal




               Anterior
  Rt Lateral                Anterior
Outcome


 • Rt Iliac Fossa incision
 • 55mm length of bowel surgically removed
   of 10mm diameter
 • Meckels diverticulum 35mm length &
   14mm diameter found
 • Histopathology showed ulcerated gastric
   mucosa
 • Other sections of bowel unremarkable
 • Discharged 2 days later

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Meckels diverticulum - a nuclear medicine case study

  • 1. Meckels Diverticulum A Case File
  • 2. Presentation • 11/12 male • Painless PR Bleed (fresh & clot) • x 1 vomit • Decreased BP • Mild tachycardia • Bronchiolitis • Previously well
  • 3. History • Unremarkable pregnancy • Full term • Normal birth weight and size • Bronchiolitis at 1/12 (under treatment) • Developmentally age appropriate • No Hx bleed • No Hx haemophilia
  • 4. Signs & Symptoms • In AM noted pale by mother • Small stool with fresh blood • No pain, not febrile • No Hx ingestion or bruising • No Hx ENT or GIT bleed • Blood noted at anus, no tear • Estimated 200ml bleed (1/4 blood vol.) • Alert
  • 5. Physiology of Meckels • Most common congenital malformation of GI tract • Present in 2% of routine autopsies • Usually presented by age 2 • Vestigial remnant of the omphalomesenteric duct approx. 2ft from terminal ileum • Approx. 50% of diverticula contain ectopic tissue, more often gastric than pancreatic • Peptic ulceration secondary to functioning gastric mucosa typically is cause of bleed
  • 6. Technique • Nil by mouth for at least 4hrs • Tc99m Pertechnetate 400Mbq • 128x Med/High Resolution Col • 2sec/60sec - 120sec/19mins • Anterior Abdomen • Planar views as required
  • 7. Scan Appearance - Normal • Increased gastric uptake 10-20mins • Pertechnetate may leave stomach and undergo peristalsis distally. Usually appears linear but may be focal • Renal activity is seen early • Bladder activity • Liver activity
  • 8. Scan Appearance - Normal Anterior Rt Lateral Lt Lateral
  • 9. Scan Appearance -Abnormal • Well filled large stomach • Accumulated technetium well during accq • Small focus of uptake • Diverticula appear at same time pertechnetate appears in normal gastric mucosa • Uptake increases with time, paralleling stomach
  • 10. Scan Appearance -Abnormal Anterior Anterior “Milk” Rt Lateral
  • 11. Scan Appearance -Abnormal Anterior Rt Lateral Anterior
  • 12. Outcome • Rt Iliac Fossa incision • 55mm length of bowel surgically removed of 10mm diameter • Meckels diverticulum 35mm length & 14mm diameter found • Histopathology showed ulcerated gastric mucosa • Other sections of bowel unremarkable • Discharged 2 days later