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A previously healthy 17-year-old male was admitted for pain in the right lower quadrant of the abdomen and emission of blood with stools. Abdominal angio-CT (computed tomography) was negative for active bleeding sources, esophagogastroduodenoscopy showed grade B esophagitis, two colonoscopies could not identify the source of hemorrhage. Bleeding continued during observation; hemoglobin dropped from 13 g/dl at admission at 10 g/dl at 48 h. Capsule endoscopy identified bleeding from the distal ileus. Technetium (Tc) 99-m pertechnetate scintigraphy demonstrated gastric and right lower quadrant enhanced uptake (Fig. 1A). A laparoscopic intervention removed the cause of bleeding (Fig. 1B).
Fig. 1(A) Technetium (Tc) 99-m pertechnetate scintigraphy demonstrated gastric and right lower quadrant enhanced uptake (arrow). (B) Surgical specimen.
Scintigraphy was suggestive for Meckel diverticulum (MD) (indicated with arrow in Fig. 1A). Laparoscopy confirmed the diagnosis after identifying a 4 cm length diverticulum proximal to the ileocecal valve (Fig. 1B; opened gross specimen of MD; arrow indicates intestinal mucosa, arrowhead indicates gastric mucosa).
MD is the most common congenital anomaly of the small bowel, due to an incomplete omphalomesenteric duct obliteration: it can be found in 2–4% of general population, with male prevalence, although symptomatic cases are 4–16% [
Nuclear scans with Technetium (Tc) 99-m pertechnetate may visualize the MD using the accumulation of the tracer in ectopic gastric tissues: specificity and sensibility are high in children, but lower in adults [
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