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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


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

Date of Web Publication12-Oct-2017

Correspondence Address:
Ioannis Spyridakis
Department of Pediatric Surgery, School of Medicine, Aristotle University, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 56403 Thessaloniki
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_25_17

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   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


How to cite this article:
Spyridakis I, Lopresti D, Georga S, Kepertis C, Efstratiou I, Arsos G. Tubular intestinal duplication harboring gastric ectopia accurately diagnosed by Tc-99m pertechnetate single-photon emission computed tomography/computed tomography meckel's scan. Indian J Nucl Med 2017;32:361-2

How to cite this URL:
Spyridakis I, Lopresti D, Georga S, Kepertis C, Efstratiou I, Arsos G. Tubular intestinal duplication harboring gastric ectopia accurately diagnosed by Tc-99m pertechnetate single-photon emission computed tomography/computed tomography meckel's scan. Indian J Nucl Med [serial online] 2017 [cited 2021 Mar 2];32:361-2. Available from: https://www.ijnm.in/text.asp?2017/32/4/361/216546



Gastrointestinal (GI) tract duplications are rare congenital malformations across the entire length of the GI tract, most common (44%) across the small intestine, lined with various types of GI mucosa.[1],[2],[3] The presence of acid-secreting gastric mucosa can produce ulceration and bleeding; gastric mucosa often occurs in tubular intestinal duplication (ID).[3] Nonradionuclide preoperative diagnosis of ID is difficult. Detection of ectopic gastric mucosa in pediatric lower GI bleeding using Tc-99m pertechnetate scintigraphy, in both Meckel's diverticulum and ID, is well established.[4],[5],[6],[7] As planar Tc-99m pertechnetate scintigraphy is prone to false positive results arising mainly from activity within the genitourinary tract, hybrid Single-photon emission computed tomography/computed tomography (SPECT/CT) imaging is a useful adjunct best suited for accurate characterization of abdominal radionuclide findings. Despite increasing use of SPECT/CT, reports on pertechnetate scintigraphy for either Meckel's diverticulum localization [8],[9] or ID diagnosis [10] are sparse [Figure 1], [Figure 2], [Figure 3].
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)

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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

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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

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Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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Sfakianakis GN, Conway JJ. Detection of ectopic gastric mucosa in Meckel's diverticulum and in other aberrations by scintigraphy: II. Indications and methods – A 10-year experience. J Nucl Med 1981;22:732-8.  Back to cited text no. 4
    
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Schwesinger WH, Croom RD 3rd, Habibian MR. Diagnosis of an enteric duplication with pertechnetate 99m Tc scanning. Ann Surg 1975;181:428-30.  Back to cited text no. 5
    
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Barkley RM, Munoz O, Parkey RW. Intestinal duplication detected with technetium-99m sodium pertechnetate imaging of the abdomen. Am J Dig Dis 1977;22:1122-6.  Back to cited text no. 6
    
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Alenizi EK, Alfeeli MA. Intestinal duplication mimicking Meckel diverticulum. Clin Nucl Med 2008;33:189-90.  Back to cited text no. 7
    
8.
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.  Back to cited text no. 8
    
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Turgeon DK, Brenner D, Brown RK, Dimagno MJ. Possible role of Meckel's scan fused with SPECT CT imaging: Unraveling the cause of abdominal pain and obscure-overt gastrointestinal bleeding. Case Rep Gastroenterol 2008;2:83-90.  Back to cited text no. 9
    
10.
Sharma P, Singh H, Nazar AH, Srinivas M, Kumar R.99m Tc-pertechnetate SPECT/CT for detecting recurrent foregut duplication cyst in a case with negative planar scintigraphy. Clin Nucl Med 2013;38:641-2.  Back to cited text no. 10
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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