Meckel diverticulitis

Case contributed by Dr Michael P Hartung

Presentation

Right lower quadrant pain.

Patient Data

Age: 35
Gender: Male
CT

Presentation

Tubular structure projecting from the distal ileum with peripheral wall enhancement, low-attenuation thickening, and surrounding stranding/inflammation. The appendix is normal (second axial image). 

Nuclear medicine

Technetium 99m-pertechnetate study (Meckel's scan)

Normal uptake in the gastric mucosa. No abnormal uptake elsewhere to suggest ectopic gastric mucosa. 

Photo

Gross specimen

Surgical specimen of Meckel diverticulum. 

Case Discussion

Meckel diverticulum is a remnant of the omphalomesenteric duct. It often contains ectopic gastric or pancreatic tissue and can become inflamed, mimicking acute appendicitis.

Only about 50-60% have ectopic gastric mucosa, and therefore it is not excluded based on the negative T99m pertechnetate scan. In fact, one could argue whether it was even necessary based on the classic CT appearance with normal appendix (if it would go to the OR with a negative or positive scan, why did they do it?!). 

Surgery confirmed the Meckel diverticulum, which was removed. 

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Case information

rID: 59033
Published: 17th Mar 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: Ascension Healthcare

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