sodium-pertechnetate-tc-99m and Intussusception

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

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: Anemia; Burkitt Lymphoma; Child, Preschool; Diagnosis, Differential; Humans; Ileal Diseases; Ileal Neoplasms; Incidental Findings; Intussusception; Male; Radionuclide Imaging; Radiopharmaceuticals; 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

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

Out of 270 children with gastrointestinal symptoms, the indications for technitium scanning were: gastrointestinal tract bleeding (165 patients), abdominal pain (99 patients) and a history of intussusception (6 patients). Thirty children had abnormal findings, while the remaining 240 patients had "normal" scans. Four of the 30 children with positive scans were not explored, while the others underwent laparotomy. Of the 26 operated patients, 12 (46%) had a Meckel's diverticulum. Nine patients (34%) had other pathologic lesions that were detected by the scan. Five had true "false positives" as no pathologic lesions were found. Of the 240 children with negative scans, 19 were eventually explored because of persistent symptoms or clinical findings. Two of these had a Meckel's diverticulum. Eleven had a negative exploration while six had other surgical lesions. Technitium scan should reliably detect around 80%-90% of Meckel's diverticula. It will also accurately exclude the diagnosis of Meckel's diverticulum in over 90% of patients.

Topics: Abdomen; Adolescent; Child; Child, Preschool; Evaluation Studies as Topic; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Infant; Infant, Newborn; Intussusception; Male; Meckel Diverticulum; Pain; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium