Long segment jejuno-ileal duplication cyst with ectopic gastric mucosa detected on 99mTc-pertechnetate scintigraphy
A 6-year-old male child operated for exstrophy of the urinary bladder 4 years back presented with a 10 days history of fever, vomiting, abdominal pain and hematochezia. At presentation, hemoglobin was 10 g/100 ml and total leucocyte count 10,200/mm3 with normal coagulation parameters. Suspecting a Meckel's diverticulum, dynamic abdominal scintigraphy was performed under a gamma camera for 20 min after intravenous injection of 37 MBq (1 mCi) of 99mTcO4 (pertechnetate). Tracer uptake was seen in the central abdomen, corresponding to the shape of the small intestinal loops. The intensity was seen to increase simultaneously with that of the stomach, indicative of extensive ectopic functioning gastric mucosa []. USG showed a large well defined bean-shaped cystic lesion in the left lumbar region with a positive gut signature and internal debris and echoes, suggestive of an infected EDC. Exploratory laparotomy was performed and a 150 cm long tubular jejuno-ileal duplication cyst communicating with the ileal lumen was excised [Figures and ]. Presence of EGM in the cyst was confirmed on histopathology, which showed hyperplastic gastric lining epithelium, with viliform transformation at places [] and marked edema and vascular congestion in the submucosa. However, the patient's condition deteriorated post-operatively, and the child died of septicemia 9 days after surgery.