sodium-pertechnetate-tc-99m and Ileal-Diseases

The extirpation of Meckel's diverticulum (MD) via conventional or laparoscopic surgery is the definitive treatment. However, certain circumstances may modify or alter this situation and require the application of exceptional measures.We report a case under our observation who previously had an exploratory abdominal laparotomy for a suspected MD; however, the findings were negative. At that time, the diagnosis was established based on low-level gastrointestinal bleeding and isotopic tests that confirmed the existence of the diverticulum. Given the findings of gamma-graphic exploration and the previous negative surgical exploration, a decision was made to remove the lesion by laparoscopic radioguided surgery.The patient underwent bilateral laparoscopic radioguided surgery using a gamma radiation detection probe. The exploration of the abdominal cavity noted the existence of the diverticulum about 60 to 70  cm from the ileocecal valve. In this way, it was possible to proceed with the resection of the bowel loop and perform an intracorporeal anastomosis termino lateral. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day.We believe that the combination of radioguided surgery and single photon emission computed tomography/computed tomography could be useful for treating lesions in locations that are surgically difficult because of the characteristics of the lesion itself or the peculiarities of an individual patient.

Topics: Adult; Humans; Ileal Diseases; Laparoscopy; Laparotomy; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tissue Adhesions

Topics: Abdomen, Acute; Diagnosis, Differential; Diverticulitis; Humans; Ileal Diseases; Intestinal Perforation; Male; Meckel Diverticulum; Middle Aged; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed; Ultrasonography

Lower gastrointestinal bleeding (LGIB) in infants and children is a difficult diagnostic problem largely due to limitations of small-bowel evaluation. Duplication cysts are rare congenital malformations with variable clinical presentation. This report describes seven children (five boys, two girls and median age 10 [1.5-124] months) with ileal duplication cysts who presented with LGIB of varying severity from stool occult blood positivity with anemia to fresh bleeding per rectum. Diagnosis was made by Tc(99m) pertechnetate scan (n-5), balloon enteroscopy (n-1), and at laparotomy (n-1). Ultrasonography and barium meal follow-through missed the diagnosis in six and three cases, respectively. All cases underwent surgery with resection of the duplication cyst and complete removal of the mucosa containing ectopic gastric tissue while preserving adequate bowel length. A good postoperative outcome with complete symptom resolution was seen in all. Enteric duplication cyst should always be considered in children presenting with occult or overt lower gastrointestinal hemorrhage, and Tc(99m) pertechnetate scan should be done prior to invasive tests like balloon enteroscopy.

Topics: Anemia; Child; Child, Preschool; Cysts; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Infant; Male; Occult Blood; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed; Ultrasonography

Intestinal duplication is an uncommon congenital condition in young adults. A 25-year-old man complained of chronic, intermittent abdominal pain for 3 years following previous appendectomy for the treatment of suspected appendicitis. Abdominal discomfort and pain, suggestive of intestinal obstruction, recurred after operation. A tubular mass was palpable in the right lower quadrant. Computed tomography enterography scan identified suspicious intestinal intussusception, while Tc-99m pertechnetate scintigraphy revealed a cluster of strip-like abnormal radioactivity in the right lower quadrant. On exploratory laparotomy, a tubular-shaped ileal duplication cyst was found arising from the mesenteric margin of the native ileal segment located 15 cm proximal to the ileocecal valve. Ileectomy was performed along with the removal of the duplication disease, and the end-to-end anastomosis was done to restore the gastrointestinal tract continuity. Pathological examination showed ileal duplication with ectopic gastric mucosa. The patient experienced an eventless postoperative recovery and remained asymptomatic within 2 years of postoperative follow-up.

Topics: Abdominal Pain; Adult; Anastomosis, Surgical; Choristoma; Cysts; Diagnosis, Differential; Gastric Mucosa; Humans; Ileal Diseases; Ileum; Intussusception; Male; Predictive Value of Tests; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Drug Carriers; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

A 7-month-old male infant who presented with bleeding per rectum was evaluated and diagnosed to have ileocolic intussusception on ultrasonography. Despite ultrasonography-guided saline reduction, there was persistence of bleeding per rectum. He was given blood transfusion and referred for Tc-99m pertechnetate scan to rule out ectopic gastric mucosa. The scan was done as per the standard institution protocol and the images revealed a focus of progressively increasing tracer uptake in the right lower abdominal quadrant suggesting the presence of ectopic gastric mucosa. An exploratory laparotomy revealed ileocolic intussusception secondary to Meckel diverticulum acting as a pathologic lead point (PLP). A wedge resection of the intestinal wall containing the diverticulum with suture closure was performed. The presence of Meckel diverticulum and ectopic gastric mucosa was confirmed on subsequent histopathological examination of the specimen. The patient rapidly improved postoperatively and was discharged 9 days after surgery. Bleeding per rectum can be seen in both intussusception and in Meckel diverticulum with ectopic gastric mucosa. Intussusception originating from a Meckel diverticulum as PLP remains a diagnostic challenge because of the overlapping symptoms.The Meckel scan findings, in this case, avoided the further CT scan, angiography, and endoscopy for the diagnosis of the cause of symptoms, sparing not only the time but cost of investigations and unnecessary radiation exposure to the patient.

Topics: Humans; Ileal Diseases; Infant; Intussusception; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Ultrasonography

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Ulcer Agents; Child; Gastrointestinal Hemorrhage; Hematemesis; Humans; Ileal Diseases; Male; Meckel Diverticulum; Melena; Pantoprazole; Proton Pump Inhibitors; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

The article presents a case of a 24-year old man with ectopic gastric mucosa in Meckel's diverticulum. Ectopic gastric mucosa may be present in Meckel's diverticulum and may be associated with peptic ulcer disease and lower gastrointestinal (GI) bleeding. Diagnosing ectopic gastric mucosa can largely benefit from 99"Tc-pertechnetate scintigraphy.. A 24-year old man underwent Meckel's diverticulum scintigraphy for timely anamnesis of GI bleeding from uncertain source (enterorrhagia, haemorrhagic anaemia). Upper tract and large bowel endoscopy, enteroclysis, ultrasound, CT and radioactive labelled red blood cells scintigraphy resluts were negative.. Ectopic gastric mucosa was detected by 99mTc-pertechnetate scintigraphy. The patient underwent surgery and part of the proximal ileum including Meckel's diverticulum with ectopic gastric mucosa detected by histology was resected.. Meckel's diverticulum scintigraphy can help detect ectopic gastric mucosa and improve the disease management in a patient with gastrointestinal bleeding.

Topics: Adult; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

We highlight the spectrum of scintigraphic findings likely to be encountered in patients with ectopic gastric mucosa with illustrative cases for each such finding. 11 children (aged 4 months to 120 months, all males) underwent (99)Tc(m)-pertechnetate scintigraphic evaluation for ectopic gastric mucosa. Functioning ectopic gastric mucosa was detected in Meckel's diverticulae in three patients, in small bowel duplications in four, in a gastric duplication in one, and in intrathoracic foregut duplication cysts in three. Ectopic functioning gastric mucosa in Meckel's diverticulum, and gastric duplication is visualized simultaneously with the stomach while in intestinal duplications tracer activity can be visualized in the dynamic sequence and even before gastric tracer visualization. In the three patients with intrathoracic duplication cysts, the functioning ectopic gastric mucosa was evident only in the delayed (99)Tc(m)-pertechnetate images, much later than the visualization of stomach activity. Therefore, acquisition of delayed images are useful when the initial images are equivocal or negative in children with intrathoracic foregut duplication cysts. In addition, we suggest a hypothesis of a possible mechanism for the uptake of pertechnetate in ectopic gastric mucosa in some patients with intrathoracic forget duplication cysts. In conclusion, a variety of scintigraphic patterns may be found in patients with ectopic gastric mucosa undergoing (99)Tc(m)-pertechnetate scintigraphy depending upon the location and size of the ectopic tissue.

Topics: Child; Child, Preschool; Choristoma; Cysts; Gastric Mucosa; Gastrointestinal Diseases; Humans; Ileal Diseases; Infant; Intestinal Diseases; Intestine, Small; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Stomach; Stomach Diseases

Topics: Anemia; Burkitt Lymphoma; Child, Preschool; Diagnosis, Differential; Humans; Ileal Diseases; Ileal Neoplasms; Incidental Findings; Intussusception; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Meckel's diverticulum is the most common congenital gastrointestinal anomaly. (99m )Technetium pertechnetate imaging (Meckel's scan) is the best noninvasive method used to diagnose this condition when heterotopic gastric mucosa (HGM) is present. Although cimetidine enhancement has been shown to improve sensitivity of the Meckel's scan, ranitidine enhancement has also been advocated; however, this recommendation is based on unpublished data. Thirty-seven children with confirmed Meckel's diverticulum were reviewed retrospectively. Of eight children with HGM in the Meckel's diverticulum who presented with profuse rectal bleeding and underwent the conventional Meckel's scan, three of them (37.5%) had a false negative study. Ranitidine, when administered either intravenously or orally for 24 h prior to the Meckel's scan, enhanced the sensitivity of this test to 87.5% in our patient cohort.

Topics: Adolescent; Child; Child, Preschool; Choristoma; Female; Gastric Mucosa; Histamine H2 Antagonists; Humans; Ileal Diseases; Image Enhancement; Infant; Infant, Newborn; Male; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Ranitidine; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Topics: Adult; Age Factors; Aged; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Intussusception; Male; Meckel Diverticulum; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Topics: Choristoma; Gastric Mucosa; Humans; Ileal Diseases; Ileum; Infant; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Abdomen; Choristoma; Erythrocytes; Gastric Mucosa; Gastrointestinal Hemorrhage; Hemangioma; Humans; Ileal Diseases; Liver Neoplasms; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

Meckel's diverticulum (MD) is the most common anomaly of the large intestinal tract (1-3%) and is more frequent in children (62% < 2 years) and in males (66%). It often involves ectopic gastric mucosa which manifests through gastrointestinal bleeding in 50% of cases. 99m-Technetium scintigraphy (99mTcO4) is one of the procedures available for the non-invasive diagnosis of ectopic gastric mucosa.. Twenty-eight patients (11 females, 17 males), including 16 children and 12 adults, aged 8 months-80 years old, were included in the study. The patients were admitted to hospital for hematochezia and melena (22) associated with abdominal pain (5): 3 patients repeatedly presented occult blood in their stools. Two patients only suffered from abdominal cramps and one only anemia. Patients were studied using plain abdominal radiographs and ultrasound; 10 underwent gastroscopy and colonoscopy; radiological contrast studies were performed in 5 patients. All tests were inconclusive. All the patients were premedicated with oral cimetidine (20 mg/kg in pediatric patients and 300 mg q.i.d. for adults, 48 hours before the test) or with ranitidine i.v. (1 mg/kg, max 50 mg, in 20 minutes, one hour before the test); barium meals and colonoscopy were deferred for 2-3 days after examination. An intravenous injection of 37-180 Mbq of 99mTcO4 was given followed by a dynamic study of the abdomen in anterior projection. Images were acquired for one hour or until the visualisation of abnormal foci of intake: in this case, lateral and oblique images were acquired for a better localisation of the suspicious area. Some patients were administered furosemide i.v. (0.75 mg/kg). All underwent a follow-up period of 12 months.. Pertechnetate scintigraphy was positive in 10 cases and the presence of ectopic gastric mucosa was confirmed by surgery. The study was negative in 18 cases: 3 of them were discharged with a diagnosis of Salmonella infection, polyp of the small bowel or ulcer of the large bowel respectively; the other 15 patients did not show symptoms of onset during follow-up.. These results confirm the high diagnostic accuracy of pertechnetate scintigraphy to detect ectopic gastric mucosa if associated with H2-receptor-blocking agent premedication.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Choristoma; Cimetidine; Diagnosis, Differential; Female; Gastric Mucosa; Histamine H2 Antagonists; Humans; Ileal Diseases; Infant; Male; Meckel Diverticulum; Middle Aged; Premedication; Radionuclide Imaging; Radiopharmaceuticals; Ranitidine; Retrospective Studies; Sodium Pertechnetate Tc 99m

Disseminated islands of gastric mucosa are very rare in the small intestine. The secretion of hydrochloric acid can lead to ulceration which results in gastrointestinal bleeding. It is often difficult to localize the focus in case of gastrointestinal blood loss especially in the small bowel. Technetium-99m-pertechnetate scintigraphy may be a helpful tool in detecting ectopic gastric mucosa. We report a case of a 21-mo-old boy with recurrent gastrointestinal bleeding. By using pertechnetate scintigraphy, extensive tracer accumulation in the jejunum and proximal ileum was detected. Histologically, multiple islands of ectopic gastric mucosa were found in about 50 excited mucosal and transmural biopsies. The unusual finding of disseminated accumulation of 99mTc-pertechnetate in the small intestine was the diagnostic clue for such a rare disease.

Topics: Biopsy; Choristoma; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Ileum; Infant; Jejunal Diseases; Jejunum; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The results from an ultrasound study performed on an 11-year-old boy, who had several weeks of intermittent abdominal pain, showed a nonperistaltic loop of bowel near the umbilicus, which suggested either an internal hernia or a diverticulum. Tc-99m pertechnetate imaging showed a focal collection near the umbilicus, which was consistent with a Meckel's diverticulum. No evidence was found of gastrointestinal bleeding. Exploratory laparotomy showed a Meckel's diverticulum near the terminal ileum and attached to the anterior abdominal wall close to the umbilicus. Small bowel had herniated through the loop formed by the terminal ileum and the diverticulum.

Topics: Abdominal Pain; Child; Gastrointestinal Hemorrhage; Hernia; Humans; Ileal Diseases; Laparotomy; Male; Meckel Diverticulum; Peristalsis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tissue Adhesions; Ultrasonography; Umbilicus

We report a case of a bleeding Meckel's diverticulum where scintigraphic and sonographic findings were thought to suggest an ileal duplication. We are not aware of previous reports of sonographic imaging of an uncomplicated Meckel's diverticulum.

Topics: Choristoma; Diagnosis, Differential; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Infant; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Ultrasonography

Three infants younger than 2 years presented with episodic bloody-to-tarry stool of moderate amount. Two of them were diagnosed to have Meckel's diverticulum because of a positive 99mTc pertechnetate scan. Although the third infant had two negative radionuclide scans within 3 months, Meckel's diverticulum was still suspected by exclusion studies. All three infants underwent laparoscopic surgery. At laparoscopy, a Meckel's diverticulum was identified in all. Besides, an ileoileo intussusception just proximal to the diverticulum was also found in one patient. Reduction of the intussusception and diverticulectomy were performed successfully by laparoscopic procedure. Compared with conventional laparotomy, this procedure has the advantages of direct preoperative visual confirmation of the diagnosis, less traumatic access, much shorter recovery period and perhaps fewer intraoperative and postoperative complications. And thus, laparoscopic surgery has the potential of becoming regular treatment for symptomatic Meckel's diverticulum of infants.

Topics: Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Infant; Intussusception; Laparoscopy; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Cysts; Humans; Ileal Diseases; Infant; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m