A 2-year-old boy has three episodes of painless, brisk rectal bleeding with normal stool colour between bleeds. He is otherwise well and haemoglobin is 9 g/dl. Which investigation is most likely to establish the diagnosis?

• A Colonoscopy
• B CT angiography of the mesenteric circulation
• C Barium follow-through study
• D Technetium-99m pertechnetate radionuclide scan ✓

Explanation

Painless lower gastrointestinal bleeding in a young child suggests a Meckel diverticulum with ectopic gastric mucosa ulcerating the adjacent ileum. Technetium-99m pertechnetate is taken up by gastric parietal cells, so the scan localises ectopic gastric mucosa and is the diagnostic test of choice. Barium studies frequently miss the diverticulum, colonoscopy examines the wrong segment, and angiography is reserved for massive ongoing haemorrhage where other tests have failed.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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