A previously healthy 2-year-old boy presents with painless passage of large quantities of maroon-coloured stool and pallor. Colonoscopy is normal except for blood entering from the terminal ileum. Which investigation is most likely to establish the diagnosis?

• A Faecal calprotectin estimation
• B Mesenteric angiography
• C CT enterography
• D Technetium-99m pertechnetate radionuclide scan ✓

Explanation

Painless massive lower gastrointestinal bleeding in a young child with normal colonoscopy points to a Meckel diverticulum containing ectopic gastric mucosa. Technetium-99m pertechnetate is taken up by gastric mucosal cells, so the scan localises the diverticulum with high sensitivity in children. Angiography requires active bleeding rates too fast for this scenario and is rarely needed, while CT enterography and calprotectin add nothing to detecting ectopic mucosa.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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