Meckel's diverticulum diagnostic study of choice: Difference between revisions

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{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{Cherry}}
{{Duodenal atresia}}
{{Meckel's diverticulum}}
== Overview ==
== Overview ==
* The page name should be '''"[Disease name] diagnostic study of choice"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
[[Technetium-99|Technetium-99m pertechnetate radioisotope scanning]] or the [[Technetium-99m|Meckel scan]] is considered as the diagnostic study of choice in patients with a [[bleeding]] Meckel's diverticulum. This scan helps in the detection of the [[Ectopia|ectopic]] [[gastric mucosa]] within the diverticulum that leads to [[Ulcer|ulceration]] of the adjacent [[Intestine|intestinal]] [[Mucous membrane|mucosa]], leading to [[Symptom|symptoms]] of [[bleeding]] in [[Patient|patients]].
* '''Goal:'''
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
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* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


===== Template statements =====
'''Technetium-99m pertechnetate  radioisotope scanning'''
[[File:Mgiff.gif|500px|center|thumb|Radionuclide scan or Technetium-99m scan in patients with Meckel's diverticulum <br> Source: Wikimedia commons <ref name="urlFile:Meckels Diverticulum by Technetium-99m Pertechnetate Scan.jpg - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/wiki/File:Meckel%27s_Diverticulum_by_Technetium-99m_Pertechnetate_Scan.jpg |title=File:Meckel's Diverticulum by Technetium-99m Pertechnetate Scan.jpg - Wikimedia Commons |format= |work= |accessdate=}}</ref>]]
* September 2014: Guidelines for the [[Nuclear medicine|Scintigraphy]] for Meckel’s diverticulum were laid down by:<ref name="pmid24948825">{{cite journal |vauthors=Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M |title=SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0 |journal=J Nucl Med Technol |volume=42 |issue=3 |pages=163–9 |year=2014 |pmid=24948825 |doi=10.2967/jnmt.113.136242 |url=}}</ref>
** Society of Nuclear Medicine and Molecular Imaging (SNMMI)
** European Association for Nuclear Medicine (EANM)
* [[Technetium-99m|Technetium-99m pertechnetate scanning]] helps in the detection of a symptomatic [[bleeding]] Meckel’s diverticulum.
* It is preferred as the investigation of choice for the diagnosis of Meckel's diverticula in children due to the following features:<ref name="urlFundamentals of Pediatric Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=-AAD9WiIZLAC&pg=PA773&lpg=PA773&dq=Mattei,+P.+(2011).+Fundamentals+of+Pediatric+Surgery.+New+York,+NY:+Springer+Science%2BBusiness+Media,+LLC.&source=bl&ots=VWeSV7HsOo&sig=p2LET6NVySpB-ANSdF3G1YmAzw8&hl=en&sa=X&ved=0ahUKEwip4uPoya3YAhUG_IMKHUn8ABIQ6AEIQTAD#v=onepage&q=Mattei%2C%20P.%20(2011).%20Fundamentals%20of%20Pediatric%20Surgery.%20New%20York%2C%20NY%3A%20Springer%20Science%2BBusiness%20Media%2C%20LLC.&f=false |title=Fundamentals of Pediatric Surgery - Google Books |format= |work= |accessdate=}}</ref>
** High accuracy
** [[Non-invasive (medical)|Noninvasive]] nature
** 95% [[Specificity (tests)|specificity]]
** 85% [[Sensitivity (tests)|sensitivity]]
** Approximately 50% of symptomatic Meckel's diverticula have [[Ectopia|ectopic]] [[Stomach|gastric]] or [[Pancreas|pancreatic cells]] contained within them<ref name="pmid10706156">{{cite journal |vauthors=Martin JP, Connor PD, Charles K |title=Meckel's diverticulum |journal=Am Fam Physician |volume=61 |issue=4 |pages=1037–42, 1044 |year=2000 |pmid=10706156 |doi= |url=}}</ref>
* [[Technetium-99m|Technetium-99m pertechnetate scanning]] is not preferred in adults as [[Type I and type II errors|false negative]] rates are high with [[Specificity (tests)|specificity]] of 9% and [[Sensitivity (tests)|sensitivity]] of 62%.
* Indications of Meckel's scan:<ref name="pmid12540005">{{cite journal |vauthors=Lin S, Suhocki PV, Ludwig KA, Shetzline MA |title=Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan |journal=South. Med. J. |volume=95 |issue=11 |pages=1338–41 |year=2002 |pmid=12540005 |doi= |url=}}</ref><ref name="pmid23417523">{{cite journal |vauthors=Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, Biassoni L |title=Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years |journal=Pediatr. Surg. Int. |volume=29 |issue=5 |pages=511–7 |year=2013 |pmid=23417523 |doi=10.1007/s00383-013-3270-3 |url=}}</ref>
** Patients with intermittent or less severe GI [[Bleeding|bleed]]
** High suspicion of Meckel’s diverticulum
** Failure to identify source of [[Bleeding|bleed]]
* [[Type I and type II errors|False-positives]] are seen in the following conditions:
** [[Intussusception]]
** [[Volvulus]]
** [[Obstruction]] of the [[small intestine]]
** [[Appendicitis|Acute appendicitis]]
** [[Carcinoid Tumor|Carcinoid]] of the [[Vermiform appendix|appendix]]
** [[Carcinoma]] of the [[cecum]]
* On [[Intravenous therapy|intravenous]] administration, the [[Technetium-99m|Technetium-99m pertechnate radioisotope]] is taken up by the [[gastric mucosa]].<ref name="pmid15241619">{{cite journal |vauthors=Rerksuppaphol S, Hutson JM, Oliver MR |title=Ranitidine-enhanced 99mtechnetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum |journal=Pediatr. Surg. Int. |volume=20 |issue=5 |pages=323–5 |year=2004 |pmid=15241619 |doi=10.1007/s00383-004-1189-4 |url=}}</ref>
* In order to obtain a positive result, at least 1.8 cm2 of [[Ectopia|ectopic]] [[gastric mucosa]] in Meckel's diverticulum is required.
* A Meckel's diverticulum containing [[gastric mucosa]] manifests as a small rounded area of increased activity in the right lower quadrant.
* Normal activity simultaneously appears in the [[stomach]].
* [[Technetium-99m|Technetium-99m pertechnetate scanning]] requires 30 images, taken at 1-minute intervals to demonstrate [[terminal ileum]] activity.
* The use of [[Pentagastrin]] in [[Technetium-99m|Technetium-99m pertechnetate scanning]] has a synergistic effect:
* Role of [[Pentagastrin]]:
** [[Histamine receptor|Histamine-2 (H2) receptor blocker]]
** Enhances radioisotope uptake by the [[Cell (biology)|cells]]:
*** Promotes [[isotope]] retention
*** Blocks intraluminal release of [[isotope]]
*** Minimizes [[Type I and type II errors|false negative]] results
* Agents promoting retention of [[Technetium-99|99m technetium pertechnetate]]:<ref name="pmid729309">{{cite journal |vauthors=Petrokubi RJ, Baum S, Rohrer GV |title=Cimetidine administration resulting in improved pertechnetate imaging of Meckel's diverticulum |journal=Clin Nucl Med |volume=3 |issue=10 |pages=385–8 |year=1978 |pmid=729309 |doi= |url=}}</ref>
** [[Aluminium hydroxide|Aluminum hydroxide]]
** [[Ranitidine]], Cimetidine


=== Gold standard/Study of choice: ===
==References==
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
{{Reflist|2}}
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
[[Category:Needs overview]]
{|
[[Category:Surgery]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
[[Category:Gastroenterology]]
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
[[Category:Emergency medicine]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
{{WikiDoc Help Menu}}
The following result of [investigation name] is confirmatory of [disease name]:
{{WikiDoc Sources}}
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].
 
 
==References==
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
* For information on how to add references into your page, click [[Adding References to Articles|here]].

Latest revision as of 15:38, 11 January 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

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Overview

Technetium-99m pertechnetate radioisotope scanning or the Meckel scan is considered as the diagnostic study of choice in patients with a bleeding Meckel's diverticulum. This scan helps in the detection of the ectopic gastric mucosa within the diverticulum that leads to ulceration of the adjacent intestinal mucosa, leading to symptoms of bleeding in patients.

Diagnostic Study of Choice

Technetium-99m pertechnetate radioisotope scanning

Radionuclide scan or Technetium-99m scan in patients with Meckel's diverticulum
Source: Wikimedia commons [1]

References

  1. ↑ "File:Meckel's Diverticulum by Technetium-99m Pertechnetate Scan.jpg - Wikimedia Commons".
  2. ↑ Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M (2014). "SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0". J Nucl Med Technol. 42 (3): 163–9. doi:10.2967/jnmt.113.136242. PMID 24948825.
  3. ↑ "Fundamentals of Pediatric Surgery - Google Books".
  4. ↑ Martin JP, Connor PD, Charles K (2000). "Meckel's diverticulum". Am Fam Physician. 61 (4): 1037–42, 1044. PMID 10706156.
  5. ↑ Lin S, Suhocki PV, Ludwig KA, Shetzline MA (2002). "Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan". South. Med. J. 95 (11): 1338–41. PMID 12540005.
  6. ↑ Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, Biassoni L (2013). "Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years". Pediatr. Surg. Int. 29 (5): 511–7. doi:10.1007/s00383-013-3270-3. PMID 23417523.
  7. ↑ Rerksuppaphol S, Hutson JM, Oliver MR (2004). "Ranitidine-enhanced 99mtechnetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum". Pediatr. Surg. Int. 20 (5): 323–5. doi:10.1007/s00383-004-1189-4. PMID 15241619.
  8. ↑ Petrokubi RJ, Baum S, Rohrer GV (1978). "Cimetidine administration resulting in improved pertechnetate imaging of Meckel's diverticulum". Clin Nucl Med. 3 (10): 385–8. PMID 729309.


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