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Failure to detect a huge Meckel's diverticulum with abundant ectopic gastric mucosa on gastric mucosal scintigraphy with Tc-99m pertechnetate.

Ectopic gastric mucosal scintigraphy with Tc-99m pertechnetate failed to detect a huge Meckel's diverticulum that measured 17 cm x 1.5 to 4 cm in a 25-year-old woman whose condition was complicated by repeated melena with severe anemia. Pathologic analysis of the specimen, resected by a laparoscopic procedure, revealed the presence of abundant ectopic gastric tissue with a tiny ulcer scar in the wall of the diverticulum, but the gastric tissue consisted of only pyloric gland components. Tc-99m pertechnetate does not accumulate in Meckel's diverticula without ectopic gastric mucosa. This case emphasizes that failure of abnormal accumulation can occur despite the presence of ectopic gastric mucosa if the lesion lacks fundic gland tissue with parietal cells.