Presentation
Right lower quadrant pain.
Patient Data
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).
Normal uptake in the gastric mucosa. No abnormal uptake elsewhere to suggest ectopic gastric mucosa.
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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