Purpose
Since its earliest description by Fabricus Heldanus (1598) 1 and elaborated further by Johann Friedrick Meckel (1808) as a remnant of the incomplete obliteration of the omphalomesenteric duct,
2 Meckel’s Diverticulum (MD) remains the most frequent diverticulum of the small bowel.
The use of 99mTc-pertechnetate,
first described for detecting ectopic gastric mucosa (EGM)3 and later in determining the location of a MD,
4 has proved an effective diagnostic tool in children (reported sensitivity of 80-90%,
specificity of 95%) but less so in adults (sensitivity 62%,...
Methods and Materials
A prospectively recorded hospital database was reviewed to identify children presenting with per rectum (PR) bleeding and investigated with a Meckel’s scan (1993-2011).
As per the guidelines of the American College of Radiology (ACR),
all scanned patients were standardised with respect to:
(A) Scan preparation:An H2-antagonist (cimetidine/ranitidine) premedication prescribed over 48hours prior to scanning,
and
(B) Image acquisition: Tc-99m pertechnetate injection (activity being weight-adjusted from 150MBq) followed by imaging comprising,
(i) 60-minute dynamic acquisition (one frame/ minute);
(ii) Static images of the abdomen/ pelvis after...
Results
183 children were identified (at age 4days–16years; median 3.3years) all presenting with PR bleeding,
amongst other symptoms including abdominal pain,
nausea & vomiting,
failure to thrive.
All patients with a Positive Scan (n=22; 12%; figure 1) underwent surgery.
MD was confirmed in 17 patients (82%),
whilst five had false positive scans (negative exploration [n=2],
tubular duplication [n=1],
intussusception [n=1],
small bowel mucosa [n=1]).
161 patients (88%) had a Negative Scan.
Amongst these:
(i) surgery was still performed in 5% (n=8),
demonstrating one MD,
negative laparotomy...
Conclusion
This study,
the largest reported series in children,
demonstrates Meckel’s scan retains a high diagnostic accuracy in detecting MD with EGM when performed adhering to recommended guidelines and interpreted using a defined scoring system.
Personal Information
Author affilitation:
(1) Great Ormond Street Hospital for Children,
London,
UK: M Chowdhury,
A Pallewatte,
C Sinha,
M Easty,
P De Coppi,
A Pierro,
L Biassoni
(2) The Royal London Hospital,
London,
UK: D Misra
References
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U ̈ber die divertikel am darmkanal.
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