Background <p>Beyond the duodenum, aside from Meckel’s diverticulum (MD) and intestinal duplication, heterotopic gastric mucosa (HGM) is rarely found in the rest of the intestines. The lesion can have clinical and radiologic characteristics that are also usual for MD, leading to misdiagnosis and inadequate treatment.&#xa0;Technetium-99m pertechnetate&#xa0;Single-Photon Emission Computed Tomography combined with Computed Tomography (SPECT CT) scan was utilized in a patient with massive GI bleeding and guided the conduct of surgery. This is the first reported use of the modality for the preoperative assessment of solitary ileal HGM.</p> Case presentation <p>An 11-year-old male was admitted for dizziness and vomiting. He previously had surgery for intussusception at 2&#xa0;years of age, and no pathologic lead point (PLP) was identified then. While confined, he had massive hematochezia. A Meckel’s scan was done, which showed isotope uptake at the right hemiabdomen. A SPECT CT localized the area in the ileum. On laparotomy, a dilated ileal segment was found and resected. A polyp was present and determined to be HGM on histologic examination.</p> Conclusion <p>SPECT CT was a useful adjunct in the preoperative evaluation of a pediatric patient with massive GI bleeding from ileal HGM.</p>