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What is Best investigation to diagnose Meckel's diverticulum? and explain in detail?
Ans. d (Tc 99m Pertectinate scan) (Ref. LB 25th/II59)An aphorism attributed to Dr Charles Mavo is: 'a Meckel's diverticulum is frequently suspected, often sought for and seldom foundMECKEL'S DIVERTICULUM# present in 2 per cent of the population; it is situated on the antimesenteric border of the small intestine, commonly 60 cm from the ileocaecal valve, and is usually 3-5cm long. Many variations occur (2 per cent- 2 feet - 2 inches).# In 20 per cent of cases the mucosa contains heterotopic epithelium, namely, gastric, colonic or sometimes pancreatic tissue.# Meckel's diverticulum can he very difficult to demonstrate by contrast radiology; small bowel enema would be the most accurate investigation.# Technetium-99m scanning# In cases of repeated gastrointestinal haemorrhage of unknown cause where a Meckel's diverticulum is suspected the abdomen is imaged with gamma camera after the injection of 30-100 mic Ci (111-370 x 1010 Bq) of 99''Tc-labelled pertechnetate intravenously. This may localise heterotopic gastric mucosa revealing the site of a Meckel's diverticulum in 90 per cent of cases.# Exceptionally a Meckel's diverticulum is found in an inguinal or a femoral hernia sac - Littre's hernia.RadiopharmaceuticalCritical organ/Disease (imaged)1. Salivary glandTc-99m pertectinate2. PET-sestamibi fusion scanTc99m-sestamibiTc99m-201 thaliumsubtraction scanParathyroid3. 1-131, 1-125, 1-123Thyroid4. Tc99m-MDPBone5. Tc-99m pertechnetateMeckel's diverticulum, gastric mucosa, intestine, thyroid, choroid plexus6. Tc-99m DTPA/MAG3Renal GFR7. Tc-99m DMSARenal cortical function8. Xe-127, Xe-133, Kr-81mLung (VP scan), trachea9. Tc-tagged RBCsSpleen, Gl bleeding10.Tc-99m HMPAOBrain scan11.Stress induced thalium-201Tc99m Stannous pyrophosphate >Reversible myocardial ischemia12.TetrafosminAcute myocardial infarction (heart)13. HIDA/DISIDABiliary scintigraphy14.Tc-99m sulfur colloidLiver pathologies15.67Ga/111lndium labeled WBCIntraabdominal abscess and inflammatory bowel disease16. DOPA-PET > MIBG/MRIExtraadrenal pheochromocytoma17.Selenium methioninePancreas18.SRS (Octreoscan)Pancreatic neuroendocrine tumors