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Lower Gastrointestinal Bleed Playing Hide and Seek.

Aditi Khurana1, Shubha Gadde Ravindra1, Sumit Garg1

  • 1Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Indian Journal of Nuclear Medicine : IJNM : the Official Journal of the Society of Nuclear Medicine, India
|February 23, 2023
PubMed
Summary

A 13-year-old boy experienced recurrent painless rectal bleeding. Diagnostic imaging, including Tc-99m pertechnetate scintigraphy, was used to investigate potential Meckel's Diverticulum as the cause.

Keywords:
99mTc-pertechnetate scintigraphyMeckel's diverticulumectopic gastric mucosamelenasingle-photon emission computed tomography

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Area of Science:

  • Pediatric Gastroenterology
  • Nuclear Medicine Imaging
  • Surgical Diagnosis

Background:

  • Recurrent painless lower gastrointestinal (GI) bleeding in adolescents can be challenging to diagnose.
  • Common causes include Meckel's Diverticulum, inflammatory bowel disease, and vascular malformations.
  • Initial endoscopic evaluations (upper GI endoscopy and colonoscopy) may not identify the source of bleeding.

Purpose of the Study:

  • To investigate the cause of recurrent, painless lower GI bleeding in a 13-year-old male.
  • To evaluate the utility of Tc-99m pertechnetate scintigraphy in diagnosing Meckel's Diverticulum in this clinical context.

Main Methods:

  • Clinical presentation of a 13-year-old male with a history of five episodes of black, tarry stools mixed with fresh blood.
  • Physical examination revealed pallor; abdominal examination was unremarkable.
  • Laboratory investigations showed mild anemia (hemoglobin 102 g/L); clotting studies were normal.
  • Diagnostic procedures included upper GI endoscopy and colonoscopy, which revealed no abnormalities.
  • Tc-99m pertechnetate scintigraphy was performed to identify a potential Meckel's Diverticulum.

Main Results:

  • Despite negative upper GI endoscopy and colonoscopy, the patient presented with significant lower GI bleeding.
  • Tc-99m pertechnetate scintigraphy was employed as a key diagnostic tool for suspected Meckel's Diverticulum.

Conclusions:

  • Tc-99m pertechnetate scintigraphy is a valuable imaging modality for diagnosing Meckel's Diverticulum in cases of obscure GI bleeding.
  • This case highlights the importance of considering Meckel's Diverticulum in the differential diagnosis of recurrent, painless lower GI bleeding in pediatric patients, even after negative standard endoscopic evaluations.