Ectopic “Ectopic” Gastric Mucosa

Abstract

Meckel’s diverticulum is a developmental GI anomaly. It is a remnant of the omphalomesenteric duct (vitelline duct) and the most common congenital anomaly found in the small intestine. It contains ectopic/heterotopic gastric mucosa in half of the cases. Imaging investigations for diagnosing Meckel’s diverticulum may include a plain radiography; however, this has a very limited diagnostic value. A blind-ending fluid-filled structure can sometimes be seen with sonography, but again, this technique’s diagnostic value is limited due to multiple factors. A CT scan may be helpful in localizing the bleeding diverticulum, which can be better visualized with CT enterography. Diverticula containing gastric mucosa can be diagnosed with a higher sensitivity with Tc-99 scintigraphy. The typical location of Meckel’s diverticulum is within two feet of the ileocecal valve; thus, ectopic gastric mucosal uptake is typically seen in the lower right quadrant in scintigraphy. We present a rare case of Tc-99 pertechnetate scintigraphy showing ectopic gastric mucosa in the upper mid abdomen, which was surgically proven to be at the mid ileum. To our knowledge, there is no ectopic Meckel’s diverticulum case published in the literature. Familiarity with this atypical imaging presentation of relatively common ectopic gastric mucosa may help the radiologists in the timely diagnosis and management of the patient.