Experiences with Detection of the Ectopic Gastric Mucosa by Means of Tc-99m Pertechnetate Disodium Scintigraphy in Children with Lower Gastrointestinal Bleeding

Abstract

Aim and Background: We report our experience of the detection of ectopic gastric mucosa by means of perfusion Tc-99m pertechnetate disodium scintigraphy in patients with lower gastrointestinal bleeding. Gastric mucosa may be present in Meckel's diverticulum and is associated with peptic ulcer disease and lower gastrointestinal (GI) bleeding; Tc-99m pertechnetate scintigraphy can help to make the diagnosis of ectopic gastric mucosa. Patients and Method: Seventy-nine children (40 boys, 39 girls, aged 1 – 17, mean age 8 years) underwent Tc-99m pertechnetate scintigraphy in the last thirteen years. All patients had melena or hematochezia. Morphology imaging and endoscopy were negative in all patients. Dynamic scintigraphy of the abdomen was started immediately after i. v. administration of Tc-99m pertechnetate. The static image of the abdomen was performed subsequently. Where necessary, SPECT was additionally performed to improve the sensitivity, specificity and spatial specification. Results: Three patients (two boys: two and ten years old; one girl: four years old) had positive scintigraphy results. All 3 patients underwent surgery and Meckel's diverticulum with ectopic gastric mucosa found (histology). GI bleeding stopped spontaneously in patients with a negative scintigraphy. These patients did not undergo intraoperative enteroscopy or surgery. Conclusion: Tc-99m pertechnetate scintigraphy can help to detect ectopic gastric mucosa in the abdomen and improve the management of patients with lower gastrointestinal bleeding.

Key words

Meckel's diverticulum - bleeding - scintigraphy

References

• 1 Adams B K, Abudia A, Awadh S. A moving Meckel's diverticulum on Tc-99m pertechnetate imaging in a patients with lower gastrointestinal bleeding.  Clin Nucl Med. 2003;  28 908-910
• 2 Bures J, Rejchrt S, Kopacova M. et al .Small Bowel Investigation & Atlas of Enteroscopy. Prague; Grada Publishing 2001: 407-420
• 3 Feller A A, Movson J, Shah S A. Meckel diverticulum: a geriatric disease masquerading as common gastrointestinal tract disorders.  Arch Intern Med. 2003;  163 2093-2096
• 4 Ford P V, Bartold S P, Fink-Benett D M, Jolles P R, Lull R J, Maurer A H, Seabold J E. Procedure guideline for gastrointestinal bleeding and Meckel's diverticulum scintigraphy.  J Nucl Med. 1999;  40 1226-1232
• 5 Lüdtke F E, Menda V, Köhler H. et al . Incidence and frequency of complications and management of Meckel's diverticulum.  Surg Gynecol Obstet. 1989;  169 537
• 6 Poulsen K A, Qvist N. Sodium pertechnetate scintigraphy in detection of Meckel's diverticulum: is it usable?.  Eur J Pediatr Surg. 2000;  10 228-231
• 7 Rampin L, Donner D, Zucchetta P. et al . Tc-99m pertechnetate scintigraphy and premedication for the search for ectopic gastric mucosa in Meckel's diverticulum.  Minerva Chir. 1998;  53 877-882
• 8 Rerksuppaphol S, Huston J M, Oliver M R. Ranitidine-enhanced 99m technetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum.  Pediatr Surg Int. 2004;  20 323-325
• 9 Ross P, Gourtsoyiannis N, Bezzi M, Rastopulos V, Massa R, Capanna G, Pedicini V, Coe M. Meckel's diverticulum: imaging diagnosis.  Am J Roentgenol. 1996;  166 567-573
• 10 Sandler M P, Coleman R E, Patton J A, Wackers F JT, Gottschalk A. Diagnostic Nuclear Medicine. 4th ed. Philadelphia; Lippincott Williams & Wilkins 2003: 547-550
• 11 Swaniker F, Soldes O, Hirschl R B. The utility of technetium 99m pertechnetate scintigraphy in the evaluation of patients with Meckel's diverticulum.  J Pediatr Surg. 1999;  34 760-765
• 12 Thrall J H, Ziessman H A. Nuclear Medicine – The Requisites. 2nd ed. St. Louis, Missouri, USA; Mosby, Inc., A Harcourt Health Sciences Company 2001: 287-291
• 13 Yahchouchy K E, Marano A F, Etienne J CHF, Fingerhut A L. Meckel's diverticulum.  J Am Coll Surg. 2001;  192 658-662