Skip to main content

Main menu

  • Home
  • Content
    • Current
      • JNMT Supplement
    • Ahead of print
    • Past Issues
    • Continuing Education
    • JNMT Podcast
    • SNMMI Annual Meeting Abstracts
  • Subscriptions
    • Subscribers
    • Rates
    • Journal Claims
    • Institutional and Non-member
  • Authors
    • Submit to JNMT
    • Information for Authors
    • Assignment of Copyright
    • AQARA Requirements
  • Info
    • Reviewers
    • Permissions
    • Advertisers
    • Corporate & Special Sales
  • About
    • About Us
    • Editorial Board
    • Contact Information
  • More
    • Alerts
    • Feedback
    • Help
    • SNMMI Journals
  • SNMMI
    • JNMT
    • JNM
    • SNMMI Journals
    • SNMMI

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
Journal of Nuclear Medicine Technology
  • SNMMI
    • JNMT
    • JNM
    • SNMMI Journals
    • SNMMI
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Journal of Nuclear Medicine Technology

Advanced Search

  • Home
  • Content
    • Current
    • Ahead of print
    • Past Issues
    • Continuing Education
    • JNMT Podcast
    • SNMMI Annual Meeting Abstracts
  • Subscriptions
    • Subscribers
    • Rates
    • Journal Claims
    • Institutional and Non-member
  • Authors
    • Submit to JNMT
    • Information for Authors
    • Assignment of Copyright
    • AQARA Requirements
  • Info
    • Reviewers
    • Permissions
    • Advertisers
    • Corporate & Special Sales
  • About
    • About Us
    • Editorial Board
    • Contact Information
  • More
    • Alerts
    • Feedback
    • Help
    • SNMMI Journals
  • Watch or Listen to JNMT Podcast
  • Visit SNMMI on Facebook
  • Join SNMMI on LinkedIn
  • Follow SNMMI on Twitter
  • Subscribe to JNMT RSS feeds
Research ArticleTeaching Case Study

99mTc-Pertechnetate in Diagnosis of Meckel Diverticulum in an Adult

Sami Ahmed Kulaybi, Jaber Abdulwahab Asiri, Zain Mohammed Asiri, Musab Atif Alamri, Habib Hassine and Ali Ibrahim Aamry
Journal of Nuclear Medicine Technology June 2023, 51 (2) 162-163; DOI: https://doi.org/10.2967/jnmt.122.265142
Sami Ahmed Kulaybi
Medical Imaging Department, King Saud Medical City, Riyadh, Saudi Arabia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jaber Abdulwahab Asiri
Medical Imaging Department, King Saud Medical City, Riyadh, Saudi Arabia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Zain Mohammed Asiri
Medical Imaging Department, King Saud Medical City, Riyadh, Saudi Arabia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Musab Atif Alamri
Medical Imaging Department, King Saud Medical City, Riyadh, Saudi Arabia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Habib Hassine
Medical Imaging Department, King Saud Medical City, Riyadh, Saudi Arabia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ali Ibrahim Aamry
Medical Imaging Department, King Saud Medical City, Riyadh, Saudi Arabia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

One of the most common malformations of the gastrointestinal tract is Meckel diverticulum (MD). MD complications can range from minor to major, such as intestinal obstruction, intussusception, hemorrhage, ulceration, vesicodiverticular fistulae, and tumors. Bleeding from ectopic gastric mucosa is more common in children than in adults. In the current case, MD in a 25-y-old man was diagnosed by 99mTc-pertechnetate scanning. 99mTc-pertechnetate scanning helps to diagnose MD noninvasively and has a potential role in the evaluation of MD even in adults.

  • Meckel diverticulum
  • GI bleeding
  • 99mTc-pertechnetate

One of the most common malformations of the gastrointestinal tract is Meckel diverticulum (MD), which is common in young children and rare in adults. MD complications can range from minor to major, such as intestinal obstruction, intussusception, hemorrhage, ulceration, vesicodiverticular fistulae, and tumors. Bleeding from ectopic gastric mucosa is more common in children than in adults (1). In the current case, MD in a 25-y-old man was diagnosed by 99mTc-pertechnetate scanning.

CASE REPORT

A 25-y-old man presented at King Saud Medical City. The patient complained of blood in his stool. There was no abdominal pain or discomfort. Physical examination did not show any specific indication for the bleeding. There was no history of trauma. In addition, the patient had a high white blood cell count of 13.16/μL. The reference range for white blood cell counts at King Saud Medical City is 4–10/μL. Also, the patient’s hemoglobin level dropped to 6 (the reference range is 13–17 g/dL). Because of the patient’s symptoms, the drop in hemoglobin level, the melena, and small-bowel bleeding found on gastrointestinal endoscopy, CT angiography was ordered.

The CT scan revealed no sign of active bleeding within the bowel loops. There was a focal blind-ended tubular structure forming the distal ileal loop, which measured 2.3 × 1.3 cm and showed wall thickening and mural hyperenhancement (Fig. 1). There were no signs of an abdominopelvic collection or hematoma. The final impression from the CT angiogram was that there were signs of MD that needed to be confirmed by a 99mTc-pertechnetate scan.

FIGURE 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 1.

Abdominopelvic CT scan of late arterial phase in axial (A), coronal (B), and sagittal (C) views. Focal blind-ended tubular structure forms distal ileal loop (arrows), measuring 2.3 × 1.3 cm.

The patient was instructed to take nothing by mouth for at least 4 h before the scan. Also, barium or contrast studies can affect nuclear medicine scans. The patient was injected with 370 MBq (10 mCi) of 99mTc-pertechnetate while lying supine under the γ-camera. The included area was from the xiphoid to the pubis. Flow dynamic images were obtained at a rate of 15 s per frame for 30 min. Also, a static image was acquired anteriorly over the same area for 5 min. Afterward, SPECT/CT was performed over the same region, using a 360° rotation and 128 × 128 matrix, at a rate of 30 s per frame.

The study demonstrated a focus of high-intensity uptake in the right lower quadrant. It was similar to the kinetics of the gastric mucosa (Fig. 2). The focus increased during the scan, suggesting active bleeding by an MD measuring 3.5 × 2.5 cm. On the posterior image, another focus was seen below the liver and was thought to be clearing of 99mTc uptake through the kidney. SPECT/CT confirmed that suspicion (Fig. 3). The patient was taken to the operating room for a laparotomy to remove the diverticulum, and the surgery was successful (Fig. 4). A surgical biopsy sample was sent to the histopathology unit, which confirmed the initial diagnosis.

FIGURE 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 2.

99mTc-pertechnetate scan in anterior views for dynamic acquisition. (A) Focal uptake (arrow) is not fully visualized, even though slight uptake is seen. (B) Uptake (arrow) increased over time and was completely visualized by 50 min.

FIGURE 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 3.

99mTc-pertechnetate scan in axial (A), coronal (B), and sagittal (C) views, with SPECT/CT obtained for conformation and anatomic purposes. Abnormal focus (arrows) increased during scan, suggesting active bleeding by MD.

FIGURE 4.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 4.

(A and B) Intraoperative MD photographs before surgery (A) and showing resected diverticulum (B). (C) Photomicrograph showing small intestine mucosa (horizontal arrow) adjacent to gastric heterotopic mucosa (vertical arrow).

DISCUSSION

MD is one of the most common congenital malformations of the vitellointestinal duct. Historically, the first time MD was mentioned was in 1598, but it was not until 100 years later that MD was understood and recognized (1). Bleeding from ectopic gastric mucosa, especially chronic bleeding, is not common in adults (1). The main reason for bleeding is secretion of acid from the ectopic mucosa, with consequent ulceration of the ileal mucosa (2).

A “rule of 2s” applies to MD: it is usually 2 ft from the ileocecal junction; it is about 2 in (5 cm) long; it is present in 2% of the population; it is common in children under 2 y old; and it affects males 2 times as often as females (3).

Many adults with MD present with abdominal pain or bleeding, symptoms that might be confused with other conditions. In addition, laboratory tests and physical examinations are not helpful in MD (4). In this case, the MD could be seen on the CT angiogram but could not be confirmed until the 99mTc-pertechnetate scan was performed.

99mTc-pertechnetate scanning is superior to other modalities for diagnosis of MD, with a sensitivity of 80%–90% and a specificity of 95%, particularly in pediatric patients. Sensitivity may be less in adults, but to what extent is unknown because there are few reported cases of adults with MD being diagnosed using 99mTc-pertechnetate (5). In our patient, 99mTc-pertechnetate scanning was able to confirm the CT indication of MD and the histopathology results.

CONCLUSION

99mTc-pertechnetate scanning helps to diagnose MD noninvasively and has a potential role in the evaluation of MD even in adults.

DISCLOSURE

No potential conflict of interest relevant to this article was reported.

Footnotes

  • Published online Feb. 7, 2023.

REFERENCES

  1. 1.↵
    1. Sagar J,
    2. Kumar V,
    3. Shah DK
    . Meckel’s diverticulum: a systematic review. J R Soc Med. 2006;99:501–505.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Lequet J,
    2. Menahem B,
    3. Alves A,
    4. Fohlen A,
    5. Mulliri A
    . Meckel’s diverticulum in the adult. J Visc Surg. 2017;154:253–259.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Dumper J,
    2. Mackenzie S,
    3. Mitchell P,
    4. Sutherland F,
    5. Quan ML,
    6. Mew D
    . Complications of Meckel’s diverticula in adults. Can J Surg. 2006;49:353–357.
    OpenUrl
  4. 4.↵
    1. Motta-Ramírez GA,
    2. Reyes-Méndez E,
    3. Campos-Torres J,
    4. et al
    . Meckel’s diverticulum in adults. Anales de Radiología México. 2015;14:20–30.
    OpenUrl
  5. 5.↵
    1. Schwartz MJ,
    2. Lewis JH
    . Meckel’s diverticulum: pitfalls in scintigraphic detection in the adult. Am J Gastroenterol. 1984;79:611–618.
    OpenUrlPubMed
  • Received for publication November 3, 2022.
  • Revision received January 13, 2023.
PreviousNext
Back to top

In this issue

Journal of Nuclear Medicine Technology: 51 (2)
Journal of Nuclear Medicine Technology
Vol. 51, Issue 2
June 1, 2023
  • Table of Contents
  • About the Cover
  • Index by author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Journal of Nuclear Medicine Technology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
99mTc-Pertechnetate in Diagnosis of Meckel Diverticulum in an Adult
(Your Name) has sent you a message from Journal of Nuclear Medicine Technology
(Your Name) thought you would like to see the Journal of Nuclear Medicine Technology web site.
Citation Tools
99mTc-Pertechnetate in Diagnosis of Meckel Diverticulum in an Adult
Sami Ahmed Kulaybi, Jaber Abdulwahab Asiri, Zain Mohammed Asiri, Musab Atif Alamri, Habib Hassine, Ali Ibrahim Aamry
Journal of Nuclear Medicine Technology Jun 2023, 51 (2) 162-163; DOI: 10.2967/jnmt.122.265142

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
99mTc-Pertechnetate in Diagnosis of Meckel Diverticulum in an Adult
Sami Ahmed Kulaybi, Jaber Abdulwahab Asiri, Zain Mohammed Asiri, Musab Atif Alamri, Habib Hassine, Ali Ibrahim Aamry
Journal of Nuclear Medicine Technology Jun 2023, 51 (2) 162-163; DOI: 10.2967/jnmt.122.265142
Twitter logo Facebook logo LinkedIn logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Abstract
    • CASE REPORT
    • DISCUSSION
    • CONCLUSION
    • DISCLOSURE
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Cervical Ganglioneuroblastoma Diagnosed by 68Ga-DOTATOC PET/CT in a Child with Opsoclonus Myoclonus Syndrome
  • Utility of 18F-FDG PET/CT in Assessment of Disease Extent and Response to Treatment in Xanthoma Disseminatum
  • The Role of [99mTc]Tc-Sestamibi in Functional Imaging of the Iodine-Loaded Thyroid Gland
Show more Teaching Case Study

Similar Articles

Keywords

  • Meckel diverticulum
  • GI bleeding
  • 99mTc-pertechnetate
SNMMI

© 2025 SNMMI

Powered by HighWire