o 2 t T : ,.ti - Prof. Dr. İbrahim ULMAN

I
EgeOnivccital T9 Fek0ltai Ocryid Oh:28, Sryt: l, 1989
I ILETANISI
M€CKELOIVTRTIKOLONON
RAOYOIZOTOP
SINTIGRAf
(8lR OLGU)
M.ONLO...
l. gur|Aperor
E 8AL|K..""
H.OzKlLlC.
C. YAMAN..
M. TUNCY0REK""'
.o 2 t T
Ntcltl
dfuedl\ii0i omfolomcz
nuhoto
lutrih
Nicnleri
catclil
lhtiw cdcr. Pcttclntot
tool\trd.an
latulm
blt Lolmtst obp, lcncfiliLb cltopi\
iyonu (Tc99-mO" ) t3'ltrit
6zcl olat:o'l- tutuAulutdon
Neclcl
mu*ozonrn mu'.otd
diwdihii/lldi
g6rintiilcmc\
miinlJndib.
&r grhgnudr 1,5 yegtnd: McclcJ divcrtikirlE bir crtck hrruyr ebdornin:l pcrrek.
ncot tintigr.fisi yrprldr. 3 mG lik Tc-jcrtckncot
intrncndz yolle heruy: vcrildi vc
cnikriyond:n 15 d.likr rcnre dntignml:r clde cdildi. Srt rlt kdanda kilg0k, y.rverhk bir ektivite u.rtulugunpandl. 8u bulgu pozitif ohaft deterlcndirildi. *lest: daha
tonn op€yccdildi vc histopetobiik incclcnr divcrti&fl igindeektopik tanrik mukozr
olduluru do!rulrdr. Bu tcknik, bezr gnrdem:lrrr olnrune kergrnMeckeldivenikiilijn[n invzzivolmey:n lmrsnda gok defedkJir.
:
Mec*el divertildlii crnbriyonun ornfrlomcrentcrik kenelnrn kehnttcr olup, rkhkle
ilarnx.rn dirtil
100 cm lik bitlijmOnde lokrlirc olur- Gcnel populesyonun % l-3
buluru.rr vc Mcckel divertik0tE olgulann % 25-40
t t.O-T.F.
"
rrr
r'r'
\ r.a.
Nijklctr Trp Anabilim
| rmptom
iinde
verir. Stmp(om verm
Dalr Ogrerim Oyesi
F.O.T.F. NJkler
Trp Anabilinr l):lr Llzmznr
-lrir
l ( _ l . TF I ' i r ! . l a - r
Analrili'r. I)alr {r:,,r.rnjrl i)1,,;q1i1;
f (l T.F
f,ocut. Crrr":hiri An:5illm
i)
{l:n:rlr'..
F f , ) T F p ; r . , | < , i iA e : . l . i l i , r O a l r f 1 i ; c l i r
I r I I
{ , . , . 1 t ( ' a . r . , i , : r i . 1 : : r l , i l , , : :3
O!rcniiri
l11q1i
iJgrr:i;;; U; cri
,.ti
lllcckcl divertildllcrinin % 57 sindcekropik gerrrik m.rkor: mcvcuttur. E&topikgasrrik
rnrkorenrn 6mmll mikrerhn veren hidroklorik lir vc peprin ckroyonu biriliktckl
Opereryon ronnr
ebcnn midc mukoxr,
rnrctiyrr picsinin petoloiik ferkikindc lcryon, Mcckel divcnikijb,
pcptik 0lrr olerek deferlmdirildi
intcstinel m.rkoann 0lrcresyonune
yol egrr. Etgha komplikrsyonrckul krnenudr.
Nedircnobtr0krlyonvc'z pcrforxyon olebilir (7).
TARTtSMA
Pcnckncut
Mcckel divcrtlHll0 tlnrrrnd: brryumlu lontrett ctAyogru;fiv. r.lckraf rncriojafi
6o[ ka begrnrz q)nuglrntr. Tr 99m-pcrtekm0r ilc yeprbn ebdominrlrinrigrefitcrilc
Meckcl divcrtikiil8 olgulen 9690 orenrndt trnr koynu olrnrlr verdrr (20). Pcrrehncut
.nyotil trtrrlk mrkorenrn m.rkoidtr6crtlcrindcrclektif obrek rt ekrif bir mckenirru
ilc birikir vc drlu ronn brrek $rntninc clrkrttc cdilir (2). Bu y{hdcn Mcclcl divcrrild}
(Renm 2).
iyoru ih (Tc99m6a
fonkriyonu dclertcrrdirnrdc
) ebdorrfnel imrjl:nu
vc 3rnrcktomi
rcknifi llkdnccleri3esrrik
rcnresr rcridijcl 3enrik dokuyrr 6(rncdc
&ulbnrlmrl vc oldukqe rrnrrlrbir tulhnrm ehnr lgindc kelmrllr (10). 1967 dc Hrrdcn
vc ertld:1lert bu rrdyoriiklidi ilt kcr Mec&cl divcrtikiilij unrrrndr kullenmrllerdr (8).
8u trrihtcn rcnre ydnrcm klinik parige drhil cdilmig vc klinik 6ncminl wrjuhyen
pck
g o k g e h l m : y r p r l m r l t r r ( 3 , J , I l , | 2 , | 3 . I 5 . 1 6 ,1 t , 2 5 ) .
Sndehi ektoplk rnrkoredr mukur relgrhytn liicrclcr verrr bu b6lgcninebdomin:lrio
lignmlerle jbr0ntiilcnmcriniimki,in?0r.Anctk cktopik trnrik lrUkotr yrlnrra Meclct
divertikiililncdr olmtyrp, kinler. cnterik duplikeryonhr,duplik^rsyonkinlcri vcyr normrl incc brrnfn hcrhengibir ycrirdc bulun:bilir (21). Ayncr McckcldiveniHlE llc
ilgili olm:krrm lnorrur.priyon, intcninel ob;triikriyon, rqlonel cnlerit, cnflrnuryo.l
3ibi 9ok gelitll durumlrrdr pcrtllncur gthgnuhn ile poritif rcnrg rlrn$itir. 8u yud:
Pcrtckncut iyocrn:n
eltrndr Mcclel divcrtiliiliin0n irwerivolrruyen trntJtnd: 1.99 m -pcrt krEul ile irnei-
rkrtryonu
ckrc
ultnfiltrrfi
olulturufi'rrten mlkoid tilcre ekreryomna
gestrik nukou
drhil olur vc pcrtcknctrlt urtrn
tiicrclerinin 6iiriintiilenrr*rinc ohruk verir (1,2). Atktlm cvmrn
tponun olmekh birlikrc br.rr dm3hr vc hormonrl rtim.rlurlerdtn ctkilcnir.
8u iirellik dikkzt
elrrurek drhe iyi bir 3briintT cldc cdcbilnrck ,cin pcntrgrnrin. rimc-
ridin vc afuk4ond:n
yzrttlznrlrr. Penr-t:rtrin direkt ohrek rckrtsyoru rnr.
ll9,2l
nr. Kuwetfi bir herumin H2 -<egti5r:nt'gonisti
ohn drnetidin pctt krEutrn brrrrk
OLGU
goork. $oark Gcrrehiri prot No:498
Anemncrinde 2 ay dncoinc
tctkil odcr. Meckcl divenildlihdcki
vc d:he ronrr bune nokur il:ve odilereh pH t 7,61 yc tyerlenrr. Pcrt kncur pl.urru
cktolk
Y.U. 1,5 pSrndr cttct
mukore Hjcrclerindc &onrrntre odilnr 6rclll{i Mec-
plk 3urrik mukouye dt rrukoid lijcrtlcr rrpkr 3rnrik mukor:deki
3ibi etkrlcn bir rrvr
€ktkrclc eder. Eu rlkelcn rvr iyon bilelimi beJrrnunden plrrnu uhnfiltr.trnr
bcruct
Mcclel divcnikiilii oldufu prtoloiik incclerrrlcdc krnrrlenrrrl bir olgununopcnrryon
dnccrindekirbdominel icrteknd:t irnejlenneeit bulgller vcrilmig vc lircntiiriin rgrlr
lerru tckni!i gdrdengcAirilmistir.
grtrik
krl divcnikiilijriin rinri3refik t nrrnrn 6'qnr
bnrcninc slgrlanmernr
rit 6 gin dircn rcktel kanam: 6yldsii ver. 8ol mikundr
hem:toclrczir'n olrnesr nedeniyle f 0TF $ocuk €crrehid Anrbilim Drhnr yatrnldr. Her
inhibc cder. Gtubgon
|r
inrcrtin:l perirt:ttizmi dnleyerck
Iimen igindeki elrivitenin diliiryonunu ijnler. Pcrkloret ayonu pcrteknchtrn lok:liras
y o n u r x J6 n l e d i g i n d c n g a t r 5 m ai i n c c t i n d e k u l l e n r l m e g k o n r r c n d i k c d i r -
tr .anemik, hafif dercccde dehidntc idi. Rektel rrr.raycrrede r: miktarda bol kanh fcaes
rcspit cdildi, Hcnutokrit %midi.
Diler ristcrn murycncleri norrneldi.
Deneyscl galrSnular ekropik gastril mukor:ntn
cn tz I cm2
lik bir elenr iggal ameri
( 19 ) vc mutl2La mukoid hiioe talrmasr halindc ( I ), Mcckel divertikiil0nih sintigrafih
Sintigrafik incclcme igin 3 mG Tc
di. Eniksiyondan
pcrtekntat
15 dekika ronrr im.rihmrya
cdildi. 30. dekikayr ait sintigramda q!
rady'orktivitc birikimi
intraveniiz yolle hastayaveril-
ba5landr ve l5 cr dakikr er:hrle danm
ah kedranda ki4iik yrn.arlak birodak halindc
irlendi. Bu gorlnol
Meckel divcrtikllij
olarak de!crlcndirildi
( R c s i ml ) .
olarak saptarubilecciini ortaya koynukradrr. Ekropik ga.Jtrikmukoza gastrojenik kistferde ( l4 ), entcrik duplibsyonlarda (9,24
ckropik x3strik mukoz: ile
i l g i l i o l m a k s r ur n d a d r v e r t i k i j l i l l e r ,i n t e s r i n a l o b s t r O k s i y o n ,i u v e n i l p o l i p l c r . h e m a i i o m a ,
leiomyosarkom, normel utertrs ( 7 ), intususscpsiyon ( 4 ), inflanutuvar lezyonlar { 6 )
a r ( c r i o r e n i i z r r o l { o r s q 1 y o q l a ,( l l
l l : s l a n r ' . g c n c l d u r u n r u t J r i r c l t i l r l rllo
) , d u p l i b s y o n k i s t l c r i n d e( 2 6 ) v e n o r m a l
ince barsairn hertungi bir yerinde ( I ) bulunabilir. Ay'ra
r { } n r a c l * s p l o r ; r r i r l a ; . a r a t o m i; , a p r l t 1 r| r 1 r c i . c t
d j r c : , i l i r \ t l , : ; r y j r D i r c t l ' i L t c i . l ' r r n r r, c ; . i t ; ) . r n , f , r l l 1 1 ( , t i . , (t i \ f , i j l t n a " tI ' { } r : , ) ; r r . 2 ' . r \ f
'I
()
' '1:
t r;i!Tr l.an rcrilili l..o,rr;.lrl;*on
i.
5clilrrr\cn tr.rti;
6r:r 1i1: ilt ulr.rr. .
) , i r l r e r l r r( I ) r ' t h a r r t r a r r r ! .r l r : r , r l e 1 ( 1 7 ) , u r i
n e r t r a l l u s a n o r m a l l i [ . l e r id e n o n s p r s i f i l . o l a r : l ' . f r e r t c l . n ( t ; t r t { , ! r r F l , rr u : r d t ' na l . d r i c r ,
rui fxrl.lrrrlrl
q a l r 5 n u b r r M e r f . e l< j r r r t i L u l u r r u ni n r a r i v o l n . : r ' z r ru n r r r n d z o n t n r l i c l
m a k l : h i r l r l ' . i :1 ' a n l r ;J r o z i t i f l r i er r r l . : 1 a n i , , , . i i ' , ! i a , , nd i k t : t l r r i c i c r l r n d i r i l m c r is a r l r r r
Bit g:hSrnryr g6rc ( 20 ) ndyoriiklid
3ulenn t6 ti
rcrniklcrlc Mc<kcl divtrrikiilii oldutu r6ylencn ol-
inin Mcckcl divcrtik0lii oldulu
divertikOli,i olnudrfr
oruye konmrl
( rcnsirivirc 9685 ), Mcckct
rdylcncn oljuterde irc 96 5 onnrnde Meckcl divcrtikijli.i saptinmrt.
rrr. Eune gikc rpesifirc 96 9J tir. Tcnin gcf ctlilifii 190 olenk hcrepbnrr. Tclnilin
&cmmclleltirilnrsi
vc yorumlerrn dikkrtli
mii-
yeprlnnsr ilc bu or-erunrrtnusr mi,imLi.inrdii.
SUMMARY
OIAGNOSIS OF MICKEL'5 OIVTRIICUTUM 8Y R,AOIOISOTOPI
SCANN|NG ( A CASI RTFORT )
Mc<kcl'r dlvcrticulum
contrinr
rr,ucoid ccllr of 3rrric
Rcsln - I
.t
In lhc pr:lcnt
i lbdornlnal Tc99t-per..< rretst
Ok)a 1;arot edllen -,l5edel:l
ir r remnem of rhc omphelomocntc.ic
ducl rnd it often
Gctoplc Astric mucoril. PcrtcchrrUte
rnion lr rclectirtly eccumuletcd by thc
rynr(rrrr, ro it an bc dcrccrcd by tnrglng. ;
riudy. pcrtechncotc
rbdomirul
rcinti3rern ves pcrformed on e 1r5
yczr old boy with Meckel'r divcrtlculum. The p:tient wrs 3ittn 3 mCl of 1.99!o-tcchncutc intnvcnously end t .nr
wcrc obr:ined 15 mintnc rfta
Inicoion- A rm:ll rnd
tutulugu Meckel'dlvertlktJliJne
.lt8t tSlundekl ekt 1v1tc nldeyd
roundcd .rca of upoke wes identified in fhc righi-lowcr riudrent. Thus xinrigremr
alttakl
wcrc interprctcd es poritivc- Thc pttient wrj opcr.red on conrcqucntly end hisropetho.
aktlvlte
'
lse neaarieye
1-'
rA
{*2
logir cr.rmimtion
confirmed thc prernct
Although, tfiis tchnique
'fl{,',
of ectopic tzJtric nrrcore in ihc divcrtjculum.
tre5 clrtein limiutions h is of r jrerr'nlue in the noninvusivr'
diagnosisof Meckel's divmiculum.
KAYNAKLAR
Berquist TH, Nobn NG, Stephenr DH, Cerlrcn C : Spccificity o1 l69nlpcrtechneute in rintigraphic
1t1-\
diagnosis of Meckel'r diverticulum. Rcvic'wof 100 cascs-J N M
1l :465469.1976.
Chaudhuri TK : Cellu lar sire of Tc$nQsccrction
in the rtomach. J N M 1 7 : 756-
7s1,1976.
C c i o p r cM
r : D i a g n o s i so f t r l c c l e l d i v e r r i c u l u m b y s o d i u m p c r t e r h n r u r c l . 9 t ! . r n .
I A ['l A 1f5 :1411
1 4 1 ?. 1 9 ] 6
O u s uv n r l i O C ) .A n t h o n c R
r-..' 1r';:' r 11;, :
,.,iil:O:a:l
,
/ f.i
r
I;.
f : I
.
t r \ r - r a 1a( 'n d : b d o m r n a l \ r r n n r ( ) f A n r I R o r n r g e ' r r rllO 9
I
j
i'.:'l.'l:r.r,-
f r j u r r : l i n l u s r , r qr r - . t i ( )dr . n p n 1 1 r z l c llj. \
I '
,.1 .
-1 qltl'
,
72q l Jl lal{)
6",
t.
FeggiLM, EiSftiSM : Technicrfnot6 for 5cinrigraphyof Mcckcl'sdivcniculum.f .
Nucl.Mcd,20 :888J89, 1979.
5.
Gclf:nd Mf, Silbcctcin fB, Cox f : Diegnosiso{ Meckcl.t divcniculumby rinrignphy : Clinicalerd perholo3icel
corrcbrion. .f N M l7 : 553, 1976"
7. Hrrbcn f, Dr Roch: AF : Tcxtbookof Nucle.rrMcdicincVol tt : Clinial Apptiorions,SccondEd. 1984LtA end Febi3er,Philedclphies :225-278
8.
Her&n R McG, Alcxrndcr WD, Kcnncdy'l , trorop. upukc rnd r<:nningof io
rrucfi in rnenwith l.9mpcrrcchncutc. Ltn<cr. : t 105-1307, 1967.
9.
Ho f t, Gkercn WA, Thomprcnf S : Thc expendingrp.ctrum of dirar dcrnonltrrblc by Tc-9*rpcrrcchncarcrMomin:l irruging., N M l9 :691 1978.
10. lrvinc Wf , SrewenAG. Mc lo,u3frlin
GP : Apprzis:l qf rpptic.tion of Tc99tL escrmcnr of larric funcrion.Lznc42:648-553, 1967.
ll.
A, Lcvy LM : Prcopcrerivcdie3noritof btcrdingMeckcl'rdif eror R, S<hursheim
(cchncriurn
vrriculum uriliring
99 m-pmcchncarc rinrilnuging. f . pcdieu.82 :
4s-49,1973.
vrti(ulum :nd othcr ebcrrelionsby rintijrephy. ll. Indicztionslrd rncrhodr-A l0- yar cxpcricncc., N M 22 :732-738, l98l
22. 9gzr V V, PicconcI M : Thc gaJui( uptrkc rnd rccrclionof Tc-99m p€rtcchncrrtc.ftcr H2 rcccptorblobgcin do6. I NM 2l :57, 1980.
23" SrddrqurA, Ryo UY, PinsLy5M : ArrcrbvcnouJflulfornution rimuhting Mcckcl'r
divertuculumon TcSm -;rrtcchrrutc rMomin:l rcintiSr.phy.R:diotogy122 :
1 7 31 1 4 .1 9 7 724. Wilron JP, Wcnrcl WW,C:mpbcll J8 : fcchrrtium lc:nl in thc dcrccrion of grrtrolntcsrinelhcmorrhege.Preopcrrrivediegrrcrlrof cntcric duplicrtlon In en infrnt.
I A M A L37 :265-266, 1911.
25. t{inc C R, Nrhrword DL, Weldheurn I A : Rolc of thc rcchnctiumtctn ln rhc dir3,
norirof Mcckel'rdivcrticulum.l. PcdLtr.Sory.9 : E85J88, 1974.
25. lfintcr P F : Sodium pcrlechndrrc Tc-99 m r:nning of rhc eMon*n. Di4norir
o f : n i l q l d u p l i a t l o nc y n . , A M A 2 3 7 : 1 3 5 2 - 1 3 5 3 ,1 9 7 7 .
12. Jcwcn TC, Durry.nrti DO, Alhn JE : The vistreliz:rionof Mcckcl.rdiva-ticulum
with 99 m Tc-pcrtcchncure,Surgery6E :567-570, 1970.
13. Kilprtrid 7]1, Allyq CR : Redioirotopcdctcaion of Meckcl't diwrticulum czuring rcutr rccat hcnprrhege.N Eng., Mcd. 287 :65j-554,197?.
14. Merk R, Yourts L, Fcqurcn C : Dignoris of en inrethoocic ;rtrogtnic cyn r.lsing
Tc99m pcr-rccfirratc.Rrdiotosy109 :137-138 ,1913. .
'
15. Martin Gl, Kutncr FR, MoscsL : Di4nosis of Meckcl';divcr1is11tg6
by ndioirctop. tcannint.Pcdietria57 :11-12,191616. Muroff LR, Cr.erelleWf, JohnsonPM jPreoperativediagrrosis
of Meckel'sdiverticulum. Ar€iogrephicend r:dionuclidciudies in an edult. , A M A 729 .. lgOO1902,197411. PolgaJP,Srrgcntf , DickinsonP : Positiveintesrinalscancau:cdby orcinoid rumor
J N M l5 :365-36'6,1974.
18. Roscntlull L, Henry JN, Murphy DA : Rrdiopertechnctrteimagingof the Meckcl's
divcrriculum.Rediology105 : 371 -37 3, 1972
19. Sf:hi:nekis Gf
AndcrsonGF, King DR, Boles T : The effecr of garuoinresrinal
,
hormonc on the pcrterhneuteimagingof ectopic gastricmucrsa in exprerimental
Meckcl's
diverticulum_
J N M 22 :678-683, lglil-
20 S{akian:kis
Gn, Conw:y' I | : Dcrecrionof ctropir g:stric mucosain Mt: Lel'<di
vrniculumrnd in odrcr:bcnationsby scintigr:pl:1| f'arhophl,rioloql,
anrl l0
21
_\tartlrn,ul crtxtrcrxr
'-o,
1,i:l*:rnairi:L. i:,
,,,!\{'
I f . i f . 1? ? : 6 . 1 1 - 6 i 4 ,
l,_l5l
way .| | : Detcction ol t<loJrrr gasul( .nurola in Mr
L,.!s di.
l_(
'l