Which imaging investigation is most appropriate to confirm the diagnosis in a child with recurrent painless lower gastrointestinal bleeding suspected to arise from a Meckel's diverticulum?

• A CT enteroclysis
• B Technetium-99m pertechnetate scintigraphy ✓
• C Colonoscopy with terminal ileal intubation
• D Barium follow-through

Explanation

Technetium-99m pertechnetate is taken up by gastric parietal cells, so the scan demonstrates ectopic gastric mucosa within a Meckel's diverticulum, the tissue responsible for acid secretion and ulceration of adjacent ileal mucosa. Sensitivity is highest in children with active bleeding. Colonoscopy often cannot reach the lesion reliably, and barium studies have low sensitivity for a diverticulum this small. CT enterography does not specifically identify gastric mucosa.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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