Malhotra Gaurav, Asopa Ramesh, Shah Himanshi, Joshi Milind, Baghel Nawab S
Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, India.
Clin Nucl Med. 2009 Mar;34(3):158-60. doi: 10.1097/RLU.0b013e3181966f88.
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.
一名7个月大的男婴因直肠出血接受评估,超声检查诊断为回结肠套叠。尽管在超声引导下进行了盐水灌肠复位,但仍有直肠出血。他接受了输血治疗,并被转诊进行锝-99m高锝酸盐扫描以排除异位胃黏膜。扫描按照标准的机构方案进行,图像显示右下腹象限有一个放射性示踪剂摄取逐渐增加的区域,提示存在异位胃黏膜。剖腹探查发现回结肠套叠继发于梅克尔憩室,梅克尔憩室作为病理引导点(PLP)。对包含憩室的肠壁进行楔形切除并缝合关闭。随后对标本进行组织病理学检查证实存在梅克尔憩室和异位胃黏膜。患者术后迅速康复,术后9天出院。直肠出血在套叠和伴有异位胃黏膜的梅克尔憩室中均可见。起源于梅克尔憩室作为PLP的套叠由于症状重叠仍然是一个诊断挑战。在这种情况下,梅克尔扫描结果避免了进一步的CT扫描、血管造影和内镜检查来诊断症状原因,不仅节省了时间,还节省了检查成本以及患者不必要的辐射暴露。