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Features of Meckel's diverticulum on imaging studies

Features of Meckel's diverticulum on imaging studies
Modality Features and caveats
Plain abdominal film
  • May demonstrate nonspecific signs of intestinal obstruction
  • An enterolith may be seen in the lower abdomen but cannot be definitively localized to the Meckel's as opposed to the appendix
Ultrasonography
  • An obstructed Meckel's diverticulum may be identified as a fluid-filled pouch off the distal small intestine
  • Ultrasound findings are nonspecific and easily confused with appendicitis
  • Intussusception can be diagnosed with ultrasound, but attributing the lead point to be a Meckel's diverticulum cannot be determined with any certainty
Computed tomography
  • Asymptomatic or bleeding diverticula are rarely or infrequently identified with computed tomography
  • A distinction between a Meckel's diverticulum and normal small intestinal loops is virtually impossible in the absence of associated inflammation
  • Acutely inflamed diverticula can be identified as a blind pouch off the distal small intestine and are typically with associated bowel wall thickening of the peridiverticular fat
Upper gastrointestinal series
  • Small bowel series have demonstrated Meckel's diverticulum but are unreliable even using enteroclysis in experienced hands
  • False negative rates are high due to:
    • Rapid emptying of contrast from the diverticulum
    • Obscured visualization of the diverticulum due to overlying contrast-filled small bowel loops
    • Poor filling of the diverticulum (occlusion or narrowing of the entrance)
Mesenteric arteriography
  • A diagnosis of Meckel's is based upon the finding of an anomalous superior mesenteric artery branch feeding the diverticulum; active contrast extravasation may be seen in patients with ongoing hemorrhage
Meckel's scan
  • Identifies areas of ectopic gastric mucosa, if present
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