INTERESTING IMAGES
Year : 2017  |  Volume : 32  |  Issue : 4  |  Page : 361-362

Tubular intestinal duplication harboring gastric ectopia accurately diagnosed by Tc-99m pertechnetate single-photon emission computed tomography/computed tomography meckel's scan

Ioannis Spyridakis¹, Domenica Lopresti², Stamata Georga², Chrysostomos Kepertis¹, Ioannis Efstratiou³, Georgios Arsos^2
1 Department of Pediatric Surgery, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
² Department of Nuclear Medicine, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
³ Department of Pathology, Papageorgiou General Hospital, Thessaloniki, Greece

Correspondence Address:
Ioannis Spyridakis
Department of Pediatric Surgery, School of Medicine, Aristotle University, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 56403 Thessaloniki
Greece

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijnm.IJNM_25_17

Abstract

A 7-year-old girl with an episode of hematochezia and melena, suspicious for bleeding Meckel's diverticulum, was referred for a Tc-99m pertechnetate Meckel's scan. On dynamic planar scan, apart from prompt gastric visualization an oval-shaped, area of inhomogeneous tracer uptake was observed in the left lower quadrant of the abdomen. Subsequent single-photon emission computed tomography/computed tomography localized this to intestinal lumen, thus establishing the diagnosis of intestinal duplication (ID) with functional gastric mucosa. Surgical exploration confirmed the presence of a tubular ID in a distance of 1.5 m from the ileocecal valve and pathologic examination showed gastric mucosa lining the lumen of the duplication.

Keywords: Ectopic gastric mucosa, intestinal duplication, single-photon emission computed tomography/computed tomography, Tc-99m pertechnetate scintigraphy

Figure 1: The case of a 7-year-old girl with hematochezia and melena is presented. A noncontrast computed tomography was negative for abdominal pathology. Suspected for bleeding Meckel's diverticulum, the patient was referred for a Tc-99m pertechnetate Meckel's scan after ranitidine premedication. Planar abdominal scintigraphy after bolus intravenous administration of 74 MBq (2 mCi) Tc-99m pertechnetate; (a) flow phase showing moderately increased blood flow (arrow) at the left lower quadrant of abdomen; (b) subsequent dynamic imaging showing prompt uptake by both the stomach and an oval-shaped area in left lower quadrant (arrow); (c) anterior static image 1 h postinjection: Distribution of activity suggestive of intestinal ectopic gastric mucosa; (d) time-activity curves of the stomach (upper, rising) and the left lower quadrant structure (lower, first rising, then almost horizontal; partial tracer washout through intestinal lumen, induced by hemorrhage-enhanced peristalsis, could explain the nonrising course of the activity curve) Click here to view

Figure 2: Single-photon emission computed tomography (GE Healthcare NM/CT 640, 120 steps, 20 s/step, low-dose nondiagnostic computed tomography); (a) transverse, (b) coronal; from left to right single-photon emission computed tomography, computed tomography and fused representative sections for both a and b. Localization of Tc-99m pertechnetate activity on the intestinal wall and lumen suggested the diagnosis of intestinal duplication with functioning ectopic gastric mucosa Click here to view

Figure 3: During surgical exploration a 6 cm length by 2 cm diameter tubular intestinal duplication arising from the mesenteric border was found in a distance of 1.5 m from the ileocecal valve, removed en block with the adjacent segment of the normal intestine and was shown to communicate with the later via a caudal small foramen. (a) Intraoperative photo of the duplication (arrow) before resection. Of notice, the shape similarity with the planar static image. The abudance of dilated subserosal vessels, suggestive of local inflammation, explains the hyperemia observed in the flow study; (b) histological section (H and E, ×100) shows gastric mucosa of body type lining the lumen of the duplication. A muscular layer common to the duplication and the adjacent normal intestine was also identified Click here to view

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