Imaging

Meckel's Diverticulum

Preliminary Diagnosis: Meckel's Diverticulum

I. What imaging technique is first-line for this diagnosis

  • Radiopharmaceutical technetium-99m pertechnetate

II. Describe the advantages and disadvantages of this technique for diagnosis of Meckel's diverticulum.

Advantages

  • Meckel scan is a diagnostic evaluation with high specificity

Disadvantages

  • False negative results may be due to lack or minimal gastric mucosa in the diverticulum, rapid washout, or impaired blood supply.

  • False positive results may be due to ectopic gastric mucosa, inflammation, and vascular malformations.

  • Normal small bowel activity can be confused with a Meckel’s diverticulum.

  • Use of ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

  • Pregnancy is a relative contraindication with use of ionizing radiation.

IV. What alternative imaging techniques are available?

  • CT with oral contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Meckel's diverticulum.

CT with oral contrast

Advantages

  • Relatively quick imaging procedures that require minimal patient cooperation and are less susceptible to motion artifact

Disadvantages

  • A Meckel’s diverticulum suspected on CT is likely an incidental finding and may be confirmed with a Meckel scan if clinically indicated.

  • CT imaging is not a sensitive test to detect a Meckel’s diverticulum.

  • Findings may be confused with appendicitis.

  • For pregnant women, ultrasound is the first choice of imaging.

VI. What are the contraindications for the alternative imaging techniques?

CT with oral contrast

  • Contraindicated in pregnant women, especially within the first two trimesters

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