Meckel’s Diverticulum Imaging

INDICATIONS

1. Localization of a Meckel’s diverticulum with functioning gastric mucosa

2. Explanation of unexplained gastrointestinal bleeding

3. Evaluation of blood in feces

4. Evaluation of abdominal pain

5. Evaluation of bleeding, diverticulitis, or intestinal obstruction

CONTRAINDICATIONS

1. Pregnant/breast-feeding: Pregnancy must be excluded in accordance with local institutional policy. If the patient is breast-feeding, appropriate radiation safety instructions should be provided.

2. Active bleeding at the time of the study

3. Recent administration of potassium perchlorate; potassium perchlorate may be given after completion of the study

4. Cathartics or other bowel irritants within 24 h of examination

5. Barium study within 3 to 4 days of the study

6. Recent nuclear medicine study, especially studies with labeled red blood cells

PATIENT PREPARATION/EDUCATION

1. The patient should not eat or drink for 2 to 4 hours before the examination.

2. A focused history containing the following elements should be obtained:

   1. History of past bleeding episodes

   2. Results of prior studies to localize the bleeding site

   3. Recent nuclear medicine study using in vivo red blood cell labeling

   4. Clinical signs of active bleeding

PHARMACEUTICAL IDENTITY, DOSE, AND ROUTE OF ADMINISTRATION

See common options in the following text (Table 1).

ACQUISITION INSTRUCTIONS (TABLE 2)

1. Ask the patient to void before beginning the procedure.

2. Position the patient supine on the imaging table, with the detector positioned over the right lower quadrant of the abdomen.

3. Inject the dose intravenously and acquire a flow study at 1 second/frame for 1 minute.

4. Continue to acquire a dynamic study in the same position every minute for 30 to 60 minutes.

5. Obtain additional static images after dynamic images in the anterior oblique, lateral, and posterior projections.

6. Ask the patient to void and then acquire postvoid anterior, oblique, lateral, and posterior projections as necessary.

7. Images in the decubitus or upright position can aid in moving the Meckel’s diverticulum away from the bladder.

COMMON OPTIONS

1. The patient may be pretreated with cimetidine (Tagamet) to enhance the sensitivity of the Meckel’s scan. The dose is 20 mg/kg orally starting 24 hours before the study and last taken 1 hour before the study.

2. The patient may be given potassium perchlorate orally after the scan (adult, 250 mg; child, 6 mg/kg) to facilitate the washout of ^99mTc from the thyroid gland.

PROCESSING INSTRUCTIONS

1. Sum the dynamic images and display for optimal visualization of the area of interest.

2. Scale planar images to accurately visualize areas of normal anatomy and increased uptake.

ADJUNCT IMAGING/INTERVENTIONS

If the Meckel’s diverticulum is adjacent to the bladder and the patient is unable to void, a urinary catheter to drain the bladder of activity may be helpful.

PRECAUTIONS

None