Tc99m Meckel`s Scan Although Simple but Effective Arare Case Report of Intestinal Duplication with Ectopic Gastric Mucosa


  • Ibrahim Eltayeb 1
  • Sahar Alsubai 2
  • Ahmed Yasen3
  • Maysa Taybe 1
  • Meshal Melibri1
  • Bothina Abdulshakoor 1


Nuclear Medicine


1. AL-Noor Specialist Hospital (Makkah)
2.National Guard Hospital (Jeddah )
3.Maternity and Childern Hospital (MCH,Makkah)


    Gastrointestinal bleeding in infants and children can be quite alarming and anxiety-provoking for parents and caregivers alike. In most cases the cause is benign. Meckel's diverticula and intestinal duplications may cause gastrointestinal bleeding in almost any age group and require a high index of suspicion for diagnosis. Bleeding usually is painless but may be massive. The significance of ectopic gastric mucosa is that it contains acid-secreting parietal cells, which may cause ulceration and bleeding. Only rarely are intestinal duplications diagnosed preoperatively1. Intestinal duplications share a common wall and blood supply with native bowel. Segmental resection is indicated if it can be performed without sacrificing a significant porton of bowel.     Technetium-99m pertechnetate scintigraphy in a child with acute gastrointestinal bleeding of unknown origin suggests ectopic gastric mucosa caused by Meckel's diverticulum or gastrointestinal duplication cysts. Senestivity and specificity of planner meckle`s scan can be affected by low signal to noise relation hence the provided SPECT/CT image fusion is readily available, it may significantly enhance diagnostic  outcome 3.

Summary of Work

   We present a case of 17 months old girl, medically free, presented to ER AS referred case to MCH Makkah complaining  of bleeding per rectum. There is a history of similar attack when she was 8 months of age there is no history of bleeding from other site, no history of bruising or ecchymosis, no history of loss of weight. Routine laboratory tests was normal apart from low Hb 7.3 received blood transfusion >> 9.7g/dl.

Abdominal U/S was performed which was normal with no evidence of intssupesion as well as normal x ray. Refferd to our institute  for meckel’s scan

  Dynamic meckle`s scan was performed following administartion of 74 Mbq Tc99m pertechentate  for 60 minutes  1 frame/mine,low energy high resolution paralell collimator  Position patient supine under camera with xiphoid to symphysis pubis in field of view ,matrix 64 x 64 followed by SPECT/CT Aquistion Single-photon emission computed tomography (GE Healthcare NM/CT 640, 120 steps, 20 s/step ,low energy high resolution paralell collimator ,matrix 128 x128, axial, coronal and sagittal single-photon emission computed  tomography, computed tomography and fused images using xelerisis software.




Summary of Results

   Dynamic images revealed abnormal focal inhomogeneous area of intense tracer uptake is noted in the left lower quadrant  in the same time with the appearance of the stomach fig.1, SPECT/CT images confined the area to the small bowel fig.2 so intestinal duplicatin with heterotopic gastric mucosa was considerd. Next day ptatient underwent surgary started labroscopic then turned to open surgarey.  Intraopertively long segment of duplicated small 90 cm in length proximal to it: 125 cm length of normal bowel from the DJ-junction Distal to it: 75cm length of normal bowel to the ileocecal valve.  Stripping of the proximal 45cm of the duplication with Resection of the distal 45cm of the duplication and anastomosis of the bowel Opening of the muscle of the stripped part Fig.3.

  Post-operative Duplicated small bowel, pathologic examination showed gastric mucosa lining the lumen of the duplication .


   Duplications of the alimentary tract are unusual congenital anomalies that frequently present a diagnostic as well as therapeutic challenge to .the surgeon.  Ectopic functioning gastric mucosa in Meckel's diverticulum is visualized simultaneously with the stomach, whereas in intestinal duplications tracer activity can be visualized in the dynamic sequence or before gastric tracer visualization in an irregular pattern .

Meckel's scintigraphy dynamic and SPECT/CT imaging can help detect ectopic gastric mucosa and improve the disease management in a patient with gastrointestinal bleeding with high seneitivity specificity and accurcy with limit dose of radiation.

   The 99mTc pertechnetate scan causes a radiation exposure far below 0.05 mSv effective dose, being a small fraction of a regular thyroid scan dose. Attenuation correction CT has an exposure of additionally 2 mSv, which is below the annual exposure from natural sources. This severely contrasts with the suggestion to use high resolution CT in the first line because its radiation exposure of 10 to 20 mSv is considerably higher 3.

Take-home Messages

  Meckel`s scan though simple is highly effective in preoperative diagnosis of Meckel`s Divrticoliosis and Enteric Duplication (ED)  with ectopic gastric mucosa. .

 SPECT/CT added incremental value to the routine dynamic meckle`s scan with minimal  dose of radiation.

  1. Brown RL, Azizkhan RG. Gastrointestinal bleeding in infants and children: Meckel’s diverticulum and intestinal duplication. Semin Pediatr Surg. 1999;8(4):202-209. http://www.ncbi.nlm.nih.gov/pubmed/10573430.
  2. Ildstad ST, Tollerud DJ, Weiss RG, Ryan DP, McGowan MA, Martin LW. Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations. Ann Surg. 1988;208(2):184-189. http://www.ncbi.nlm.nih.gov/pubmed/3401062. 
  3. Papathanassiou D, Liehn JC, Menéroux B, Amans J, Domange-Testard A, Belouadah M, et al. SPECT-CT of Meckel diverticulum. Clin Nucl Med. 2007;32:218–20. [PubMed}
Summary of Work



















Summary of Results



      Fig.1.  99mTc Meckle's Scan Dynamic image 1 frame/min shows gastric uptake small arrow and the abnormal                                focal area of uptake in the left lower quadrant of the abdomen.



Fig .2. Single-photon emission computed tomography (GE Healthcare NM/CT 640, 120 steps, 20 s/step, low-dose                    non-diagnostic computed tomography); transverse, coronal and sagital single-photon emission computed                       tomography, computed tomography and fused images using xelerisis software . Localization of Tc-99m                           pertechnetate activity on the intestinal  wall and lumen suggested the diagnosis of intestinal duplication                           with functioning ectopic gastric mucosa.



fig.3. intraoperative finding of intestinal duplication surgarey stsrted laproscopically the the shifted to open surgary                   due to the long involved segment.


Take-home Messages
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