Case Author(s): Marc Montella, MD and Keith Fischer, MD , 6/28/00 . Rating: #D3, #Q4
Diagnosis: Jejunal Diverticulum with Ectopic Gastric Mucosa
Brief history:
78 year old male with melena
Images:
Tc-99m RBC Study
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View second image(gs).
Small Bowel Follow Through
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Spot Image from SBFT
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Tc-99m Pertechnetate Study
Full history/Diagnosis is available below
Diagnosis: Jejunal Diverticulum with Ectopic Gastric Mucosa
Full history:
79 yo. male with myelodysplastic syndrome. He has reduced platelets and presented with lower GI bleeding.
Radiopharmaceutical:
Tc-99m in vitro labeled RBC's for the GI bleed study and Tc-99m pertechnetate for the gastric mucosa study
Findings:
The GI bleed study demonstrated a small bowel source of bleeding thought to be in the left lower quadrant. NOte was made of spleenomegaly.
The gastric mucosa study performed two days later demonstrated a focus of abnormal uptake in the midline above the bladder thought to represent an area of ectopic gastric mucosa.
Followup:
The jejunal diverticulum identified on the SBFT was resected and found to have ectopic gastric mucosa within it. This was thought to account for the positive gastric mucosa study. The bleeding was secondary to the effect of the gastric acid on the jejunum with ulcer formation and bleeding.
Differential Diagnosis List
Positive gastric mucosal scans can be due to Meckel's diverticula containing ectopic gastric mucosa and duplication cysts. The inflamation around intersusceptions can give false positive finding simulating positive gastric mucosa scans.
ACR Codes and Keywords:
References and General Discussion of Meckel's Scintigraphy (Anatomic field:Gasterointestinal System, Category:Neoplasm, Neoplastic-like condition)
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Case number: ms005
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