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Ectopic "Ectopic" Gastric Mucosa
Adeel Haq1, Amin Haghighat Jahromi1
1Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA.
Abstract:
Meckel's diverticulum is a developmental GI anomaly. It is a remnant of the omphalomesenteric duct (vitelline duct) and the most common congenital anomaly found in the small intestine. It contains ectopic/heterotopic gastric mucosa in half of the cases. Imaging investigations for diagnosing Meckel's diverticulum may include a plain radiography; however, this has a very limited diagnostic value. A blind-ending fluid-filled structure can sometimes be seen with sonography, but again, this technique's diagnostic value is limited due to multiple factors. A CT scan may be helpful in localizing the bleeding diverticulum, which can be better visualized with CT enterography. Diverticula containing gastric mucosa can be diagnosed with a higher sensitivity with Tc-99 scintigraphy. The typical location of Meckel's diverticulum is within two feet of the ileocecal valve; thus, ectopic gastric mucosal uptake is typically seen in the lower right quadrant in scintigraphy. We present a rare case of Tc-99 pertechnetate scintigraphy showing ectopic gastric mucosa in the upper mid abdomen, which was surgically proven to be at the mid ileum. To our knowledge, there is no ectopic Meckel's diverticulum case published in the literature. Familiarity with this atypical imaging presentation of relatively common ectopic gastric mucosa may help the radiologists in the timely diagnosis and management of the patient.
Insights
Meckel's diverticulum, a common small intestine anomaly, typically presents with ectopic gastric mucosa near the ileocecal valve. This case highlights an unusual upper abdominal Tc-99 scintigraphy finding, emphasizing the need for awareness of atypical presentations.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Pediatric Surgery
Background:
- Meckel's diverticulum is the most common congenital anomaly of the small intestine, arising from the omphalomesenteric duct.
- Ectopic gastric mucosa is found in approximately half of Meckel's diverticulum cases, often leading to complications.
- Conventional imaging modalities like radiography and sonography have limited diagnostic value for Meckel's diverticulum.
Purpose of the Study:
- To report a rare case of Meckel's diverticulum with ectopic gastric mucosa presenting with an atypical location on Tc-99 scintigraphy.
- To increase radiologist awareness of unusual imaging findings for Meckel's diverticulum.
- To emphasize the importance of considering atypical presentations in diagnosing gastrointestinal anomalies.
Main Methods:
- Review of a case involving Tc-99 pertechnetate scintigraphy for suspected Meckel's diverticulum.
- Correlation of imaging findings with surgical confirmation.
- Literature review for similar atypical presentations of Meckel's diverticulum.
Main Results:
- Tc-99 scintigraphy revealed ectopic gastric mucosal uptake in the upper mid abdomen, an atypical location.
- Surgical exploration confirmed Meckel's diverticulum located in the mid ileum.
- This represents a rare instance of an ectopic Meckel's diverticulum with unusual scintigraphic localization.
Conclusions:
- Atypical presentations of Meckel's diverticulum, particularly with ectopic gastric mucosa, can occur.
- Radiologists should be aware of unusual Tc-99 scintigraphy findings to ensure timely diagnosis and management.
- Familiarity with rare imaging patterns aids in the diagnosis of common congenital GI anomalies.
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