[99mTc pertechnetate scintigraphy and premedication for the search for ectopic gastric mucosa in Meckel's diverticulum].

Abstract

BACKGROUND:

Meckel's diverticulum (MD) is the most common anomaly of the large intestinal tract (1-3%) and is more frequent in children (62% < 2 years) and in males (66%). It often involves ectopic gastric mucosa which manifests through gastrointestinal bleeding in 50% of cases. 99m-Technetium scintigraphy (99mTcO4) is one of the procedures available for the non-invasive diagnosis of ectopic gastric mucosa.

METHODS:

Twenty-eight patients (11 females, 17 males), including 16 children and 12 adults, aged 8 months-80 years old, were included in the study. The patients were admitted to hospital for hematochezia and melena (22) associated with abdominal pain (5): 3 patients repeatedly presented occult blood in their stools. Two patients only suffered from abdominal cramps and one only anemia. Patients were studied using plain abdominal radiographs and ultrasound; 10 underwent gastroscopy and colonoscopy; radiological contrast studies were performed in 5 patients. All tests were inconclusive. All the patients were premedicated with oral cimetidine (20 mg/kg in pediatric patients and 300 mg q.i.d. for adults, 48 hours before the test) or with ranitidine i.v. (1 mg/kg, max 50 mg, in 20 minutes, one hour before the test); barium meals and colonoscopy were deferred for 2-3 days after examination. An intravenous injection of 37-180 Mbq of 99mTcO4 was given followed by a dynamic study of the abdomen in anterior projection. Images were acquired for one hour or until the visualisation of abnormal foci of intake: in this case, lateral and oblique images were acquired for a better localisation of the suspicious area. Some patients were administered furosemide i.v. (0.75 mg/kg). All underwent a follow-up period of 12 months.

RESULTS:

Pertechnetate scintigraphy was positive in 10 cases and the presence of ectopic gastric mucosa was confirmed by surgery. The study was negative in 18 cases: 3 of them were discharged with a diagnosis of Salmonella infection, polyp of the small bowel or ulcer of the large bowel respectively; the other 15 patients did not show symptoms of onset during follow-up.

CONCLUSIONS:

These results confirm the high diagnostic accuracy of pertechnetate scintigraphy to detect ectopic gastric mucosa if associated with H2-receptor-blocking agent premedication.

• Authors: L Rampin, D Donner, P Zucchetta, M Zuffante, P Faggin, F Bui, M Gregianin
• Journal: Minerva chirurgica (Minerva Chir) Vol. 53 Issue 11 Pg. 877-82 (Nov 1998) ISSN: 0026-4733 [Print] Italy
• Vernacular Title: Scintigrafia con 99mTc pertecnetato e "premedicazione" per la ricerca di mucosa gastrica ectopica nel diverticolo di Meckel.
• PMID: 9973790 (Publication Type: Journal Article)

Chemical References

• Histamine H2 Antagonists
• Radiopharmaceuticals
• Cimetidine
• Ranitidine
• Sodium Pertechnetate Tc 99m

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Child, Preschool
• Choristoma (diagnostic imaging)
• Cimetidine (therapeutic use)
• Diagnosis, Differential
• Female
• Gastric Mucosa
• Histamine H2 Antagonists (therapeutic use)
• Humans
• Ileal Diseases (diagnostic imaging)
• Infant
• Male
• Meckel Diverticulum (diagnostic imaging)
• Middle Aged
• Premedication
• Radionuclide Imaging
• Radiopharmaceuticals
• Ranitidine (therapeutic use)
• Retrospective Studies
• Sodium Pertechnetate Tc 99m