Delayed Imaging of Meckelʼs Diverticulum: Observation of a Quadrantal Shift

A 10-year-old male with no significant medical history presented to the emergency room with 2 episodes of painless bright red rectal bleeding within the previous 24 hours. A Meckelʼs scan utilizing 5.12 mCi of Tc-99m pertechnetate injected intravenously was performed. Continuous anterior images of the abdomen were obtained for 60 minutes. Postvoid images at 1 and 3 hours were also obtained. Coincident with the appearance and progressive intensity of gastric mucosal uptake, a focal accumulation of Tc-99m pertechnetate was observed in the right lower quadrant, just superior to, and separate from the urinary bladder. This finding was consistent with a Meckel diverticulum (MD). Notably, the 3-hour delayed image demonstrated a shift in position of this focus to the left lower quadrant, again just superior to the urinary bladder. A MD was confirmed surgically. As this case illustrates, a scan-positive MD may change in position during imaging and can be differentiated from active gastrointestinal bleeding by the absence of characteristic radiotracer transit through the gut.