155 Meckel 2

Clinical Presentation

A 7-year-old boy presents with two episodes of blood in his stool. A Nuclear Medicine study was requested (Figs. 155.1 and 155.2).

Fig. 155.1

Technique

• ^99mTc-pertechnetate

• Nothing by mouth for 4 to 12 hours.

• No barium or Gastrografin for 2 to 3 days before the study. If there is uncertainty as to whether residual oral contrast may interfere with the scan, obtain a radiograph of the abdomen.

• Pharmacologic intervention with pentagastrin, histamine H₂-receptor blockers, or glucagon has been advocated (see below).

• 10 mCi

• Intravenous injection

• Low energy, all purpose collimator

• 140-keV photopeak, 20% window

• Dynamic imaging of the abdomen and pelvis

1 frame per second for 60 seconds

1 frame per minute for 30 minutes

• Post-void view, as a Meckel diverticulum may be located adjacent to the bladder

Fig. 155.2

Image Interpretation

The flow study (not shown) was normal. The ensuing 30-minute study (Fig. 155.1) demonstrates normal accumulation within the stomach (arrowheads) and excretion into the bladder. There is also accumulation throughout the study within a structure in the upper abdomen to the left of midline (arrows). A posterior image (Fig. 155.2) reveals this activity to be within the left renal collecting system.