Clipboard, Search History, and several other advanced features are temporarily unavailable. Meckel's diverticulum. In the study of 119 patients, technetium Tc 99m (99m Tc) scan, also known as Meckel's scan, was positive in 3 of 4 patients. J Pediatr Surg 1999;34:760-765. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Role of the technetium scan in the diagnosis of Meckel's diverticulum. A technetium-99 scan was performed in an 18-year-old man with abdominal pain, vomiting and rectal bleeding to confirm the presence of a Meckel's diverticulum which was not diagnosed laparoscopically elsewhere. Methods of arriving at the diagnosis preoperatively are reviewed. Eight patients with a false negative scan were found to have Meckel’s diverticuli containing ectopic gastric mucosa at surgery. SPECT improves anatomic resolution by enhancing the contrast between focal, vascular, and soft tissue uptake of the pertechnetate.  |  Role of the Technetium Scan in the Diagnosis of Meckers Diverticulum By Carolyn R. Wine, David L. Nahrwold, and John A. Waldhausen T HE DEVELOPMENT of a complication of Meckel's diverticulum in in- fants and children is often a life-threatening situation for which early surgical intervention is mandatory. 1. NLM The relatively low negative predictive value of the Meckel’s scan may result in a need to consider surgery, despite a negative scan result. However, the addition of single photon emission computed tomography (SPECT) imaging may further increase the detection of a small Meckel’s diverticulum by precisely depicting the radionuclide distribution within a small volume of tissue.2 SPECT is analogous to CT and MR in that multiplanar imaging is obtained and displayed as thin sections. Both clinical and radiologic examinations are often nondiagnostic. Das Meckel-Divertikel (auch Meckelsches Divertikel, lateinisch Diverticulum ilei) – benannt nach dem deutschen Anatom Johann Friedrich Meckel (1781–1833) – ist eine Ausstülpung des Leerdarms bzw.Krummdarms (), das einen Rest des embryonalen Dottergangs (Ductus omphaloentericus, die Verbindung zum Dottersack) darstellt.Beim menschlichen Neugeborenen ist dieses Divertikel ca. Get the latest research from NIH: https://www.nih.gov/coronavirus. Hematochezia and the false negative Meckel's scan: a continued need for barium studies. The aim of the present study was to assess the use of technetium (Tc) 99m pertechnetate scintigraphy (Meckel’s scan) in the diagnostic workup of the pediatric patient with GI bleeding and a suspected Meckel’s diverticulum.  |  However, in symptomatic patients who present with lower GI bleeding or bowel obstruction, the diagnosis is often made after much difficulty. The technetium-99 scan was positive and a diagnostic laparoscopy was re-performed which revealed a Meckel's diverticulum that was subsequently resected. Yamaguchi M, et al. Source: Swaniker F, et al. Please enable it to take advantage of the complete set of features! Miller KB, Naimark A, O'Connor JF, Bouras L. Gastrointest Radiol. HHS You must have JavaScript enabled to enjoy a limited number of articles over the next 360 days. Daher führen wir in unserer Klinik keine Szintigraphie zur Diagnose eines Meckel Divertikels durch. Therefore, they advocate the addition of "minimally invasive laparoscopy," or exploratory laparotomy, instead of nuclear medicine imaging, to the diagnostic algorithm of identifying the presence of a bleeding Meckel’s diverticulum in the evaluation of pediatric patients with clinically significant GI bleeding and a high index of suspicion for a bleeding Meckel’s diverticulum. COVID-19 is an emerging, rapidly evolving situation. The high incidence of ectopic gastric tissue within symptomatic Meckel's diverticula, particularly in children, makes this scan a useful diagnostic tool. When planar scintigraphic imaging is used, it is generally accepted that gastric mucosa of 1 cm2 is required for proper identification.  |  Copyright © 2020 Elsevier B.V. or its licensors or contributors. 2. Meckel's diverticulum: imaging diagnosis. Swaniker et al conclude that the scan has a high positive and negative predictive value for all patients with a suspected Meckel’s diverticulum, but that the negative predictive value for this important subclass of patients was too low at 0.74 and, therefore, the use of the scan in such patients is compromised. NIH 7 Although use of 99m Tc scan has demonstrated diagnostic accuracy, the false-negative rate can be high, especially in adults. Technetium Scans and Meckel’s Diverticulum. [Scintiscanning with technetium-99m pertechnetate in the diagnosis of Meckel's diverticulum]. A technetium-99m pertechnetate scan, also called Meckel scan, is the investigation of choice to diagnose Meckel's diverticula in children. A subclass of patients—those with lower GI bleeding and a hemoglobin level of less than 11.0 g/dL who underwent a Meckel’s scan—were assessed for use of the scan. Thus, the probability that a child who presents with lower GI bleeding and a hemoglobin less than 11.0 gm/dL will have a Meckel’s diverticulum despite a negative scan is 26%. J Nucl Med 1998;39:1458-1459. a. have a low positive predictive value in the diagnosis of a bleeding Meckel’s diverticulum. Mott Children’s Hospital of the University of Michigan Medical Center conducted a 22-year retrospective study that evaluated the records of 235 consecutive pediatric patients who had either a Meckel’s scan (n = 165) or had a discharge diagnosis of Meckel’s diverticulum (n = 70). This scan detects gastric mucosa ; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them, [22] this is displayed as a spot on the scan distant from the stomach itself. The best tool for diagnosing Meckel's diverticulum in children is scintigraphy using [99m Tc] pertechnetate, an isotope taken up by mucus-secreting cells of the gastric mucosa and ectopic gastric tissue within a Meckel's diverticulum. Fresca swaniker and associates from the Department of Surgery of the C.S. 1985 Oct;80(10):781-3. Although some of the negative scans in the present study were repeated following the addition of pentagastrin alone, the false negative rate did not change significantly. This study is performed retrospectively over a 22-year period. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Until recently there have been no reliable diagnostic aids which are specific … Methods of arriving at the diagnosis preoperatively are reviewed. A case of a Meckel's diverticulum is described in a young man presenting with abdominal pain and gastrointestinal bleeding. d. when negative, operative intervention is unnecessary. 1981;6(3):209-15. doi: 10.1007/BF01890251. Georgacopulo P, Feggi LM, Franchella A, Bighi S. Gebarski KS, Byrne WJ, Gebarski SS, Wesley JR, Coran AG. Copyright © 1974 Published by Elsevier Inc. https://doi.org/10.1016/S0022-3468(74)80226-5. In one series, only 6% of patients were diagnosed preoperatively.1. Synopsis: Technetium-99 "Meckel’s scans" have a relatively low predictive value and may result in the need for operative evaluation despite negative scan results. In general, the diagnosis of Meckel’s diverticulum with ectopic gastric mucosa continues to be a difficult one, often only established after the exclusion of other entities. Am J Gastroenterol. Twenty-two patients underwent laparotomy and 12 had Meckel's diverticulum with ectopic gastric mucosa. The factors influencing technetium uptake by a Meckel's diverticulum are reviewed. (Dr. Schwartz is Associate Professor of Diagnostic Radiology [Pediatrics] at the Yale University School of Medicine.). Get the latest public health information from CDC: https://www.coronavirus.gov. ABSTRACT & COMMENTARY Synopsis: Technetium-99 "Meckel’s scans" have a relatively low predictive value and may result in the need for operative evaluation despite negative scan results. Meckel’s diverticulum: Investigation of heterotopic gastric mucosa with technitium 99m pertechnate SPECT. From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pa. We use cookies to help provide and enhance our service and tailor content and ads. Meckel's diverticulum: pitfalls in scintigraphic detection in the adult. These findings suggest that surgical exploration may be indicated instead of scintigraphic scanning in the assessment of the anemic pediatric patient with lower GI bleeding, especially in patients in whom there is high clinical suspicion for a bleeding Meckel’s diverticulum. In all patients, the Meckel’s scan had a positive and negative predictive value of 0.93. Swaniker et al do not describe the sizes of the lesions resected in the present cases; perhaps only the smaller lesions were missed. Please click here to continue without javascript.. Pediatric Adolescent Medicine Reports Archives, Technetium Scans and Meckel’s Diverticulum, Ehrlichia Ewingii — Another Human Ehrlichia Identified, Surgical Management of Inguinal Hernia: Exploration of the Contralateral Side. Rossi P, Gourtsoyiannis N, Bezzi M, Raptopoulos V, Massa R, Capanna G, Pedicini V, Coe M. AJR Am J Roentgenol. The utility of technetium 99m pertechnetate scintigraphy in the evaluation of patients with Meckel’s diverticulum. b. according to the literature, their sensitivity may be increased with the use of pentagastrin. Smith FR, Rheingold OJ, Kanner R, Rogers AI. 1996 Mar;166(3):567-73. doi: 10.2214/ajr.166.3.8623629. When clinically indicated, however, an operative procedure may be necessary to identify a small, bleeding diverticulum. A false-negative as well as a true-positive small bowel series and technetium scan were obtained in this case. Am J Surg 1978;136:247-248. c. can regularly detect intradiverticular gastric mucosa less than 1 cm in diameter. Diese hat jedoch nur eine geringe Treffsicherheit und hilft uns bei der Entscheidung, ob wir eine Bauchspiegelung durchführen müssen, nicht weiter. … In most instances, Meckel’s diverticuli are asymptomatic and incidentally found at surgery or autopsy. ReliasMedia_AR@reliasmedia.com, Do Not Sell My Personal Information  Privacy Policy  Terms of Use  Contact Us  Reprints  Group Sales, For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, DPO@relias.com, Design, CMS, Hosting & Web Development :: ePublishing, Pediatric Adolescent Medicine Reports 1999-10-01, Radiology’s point of view: Work with us on CT scans, EMTALA: It’s here, it’s new, and it’s still prompting questions for risk managers, Don’t accept ED’s claim it’s too busy to benchmark. However, in patients with lower GI bleeding and a hemoglobin less than 11.0 gm/dL, the scan had a sensitivity of 0.60, a positive predictive value of 1.0, but only a negative predictive value of 0.74. „Meckel Scan") nachzuweisen. 1982 Oct;7(10):441-3. doi: 10.1097/00003072-198210000-00001. Am J Gastroenterol. 1984 Aug;79(8):611-8. Connolly J, et al. This study did take place over a relatively long period, given the rapidly evolving technology present in all branches of medicine. A case of a Meckel's diverticulum is described in a young man presenting with abdominal pain and gastrointestinal bleeding. The sensitivity and specificity of a Meckel’s scan may be increased by the use of pentagastrin stimulation and ranitidine (H2-receptor antagonist), used individually or together. Clinical impressions had a major effect on the decision-making process in these patients, despite the results of the scan. An additional dilemma in the diagnosis of Meckel’s diverticuli with ectopic gastric mucosa is related to the size of the diverticulum. It is unclear if SPECT is able to detect even smaller volumes. For most children, no anesthesia or sedation is required for nuclear medicine imaging as long as the child can be safely restrained for the duration of the study.

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