Case Author(s): Akash Sharma, M.D. and Henry D. Royal, M.D. , . Rating: #D2, #Q3

Diagnosis: (Atypical location) Meckel's diverticulum

Brief history:

18 month old girl with history of gastrointestinal bleeding.


Sequential anterior images

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Full history/Diagnosis is available below

Diagnosis: (Atypical location) Meckel's diverticulum

Full history:

This patient is an 18 month old female who presented to an outside hospital witha history of a large maroon bowel movement. She was noted to have a hemoglobin of 4.0. She received a transfusion and transferred to St. Louis Children'sHospital. She had a two- to three-week history of intermittent non-biliousemesis and yellow-green phlegm, but no bloody or coffee-ground emesis.


1.8 mCi Tc-99m pertechnetate i.v.


Sequential abdominal images demonstrate an abnormal focus of increased activity in the right upper quadrant. This activity does not move and is not related to the collecting system of the kidney.


Although the location of the activity is somewhat higher than expected for the conventional location of a meckel's diverticulum, the temporal pattern is still suggestive for this diagnosis. Often with a mobile cecum, the terminal ileal segment, the region where majority of Meckel's diverticula are located may be mobile and project in the right upper quadrant.


Patient undwent surgery at Saint Louis Children's Hospital the next day:


POSTOPERATIVE DIAGNOSIS: bleeding meckel diverticulum.

References: 1. Adams BK, Abudia A, Awadh S. A moving Meckel's diverticulum on Tc-99m pertechnetate imaging in a patient with lower gastrointestinal bleeding. Clin Nucl Med. 2003 Nov;28(11):908-10.

2. Singh MV, Walsham AC, Bruce J, Wilson B, Shabani A. A fading Meckel's diverticulum: an unusual scintigraphic appearance in a child. Pediatr Radiol. 2004 Mar;34(3):274-6. Epub 2003 Oct 08.

3. Zellner C, Roorda AK. Images in clinical medicine. A bleeding Meckel's diverticulum. N Engl J Med. 2003 Aug 28;349(9):e9.

Differential Diagnosis List

Atypical location Meckel's diverticulum vs. ectopic gastric mucosa in duodenum vs. duplication cyst with functional gastric mucosal lining.

ACR Codes and Keywords:

References and General Discussion of Meckel's Scintigraphy (Anatomic field:Gasterointestinal System, Category:Normal, Technique, Congenital Anomaly)

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Case number: ms006

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