Advertisement

Meckel diverticulum in the pediatric population: Patient presentation and performance of imaging in prospective diagnosis

      Highlights

      • Most children with symptomatic Meckel diverticulum present with nonspecific abdominal symptomatology and without gastrointestinal bleeding.
      • Computed tomography is insensitive for the prospective imaging diagnosis of a Meckel diverticulum, even when symptomatic.
      • In the absence of prior surgery and imaging findings of appendicitis or inguinal hernia, a Meckel diverticulum should usually be in the differential diagnosis as a cause of pediatric small bowel obstruction.
      • Nuclear medicine Meckel scans are positive when the Meckel diverticulum contains gastric mucosa.

      Abstract

      Purpose

      To determine the most common presentations of Meckel diverticulum (MD) in children and the performance of imaging modalities in prospective diagnosis.

      Materials and methods

      A 28-year retrospective review was performed of children under 18 years of age with MD listed as a diagnosis on pathology and/or surgical reports. The medical record was reviewed to determine presenting clinical scenarios. All imaging performed for each case was reviewed.

      Results

      Seventy-six patients met inclusion criteria. Of the surgically removed MD, most presented with abdominal symptoms (n = 31, 41%); gastrointestinal (GI) bleeding (n = 15, 20%), or both abdominal symptoms and GI bleeding (n = 7, 9%). Twenty-nine percent of MD were discovered incidentally at surgery performed for other reasons. Of the symptomatic MD, only 31% were prospectively diagnosed. For patients with abdominal symptoms, CT had a sensitivity of 13% (3/24) while nuclear medicine (NM) scan had a sensitivity of 0% (0/2). For patients with GI bleed, CT had a sensitivity of 29% (2/7) and NM scan had a sensitivity of 71% (10/14). For patients with both abdominal symptoms and GI bleed, CT was 0% (0/2) and NM scan 75% (3/4) sensitive.

      Conclusion

      MD as a cause of abdominal symptoms and gastrointestinal bleeding may be difficult to diagnose due to nonspecific presentations and nonspecific findings. Most prospectively diagnosed MD are on NM scan in patients with GI bleed with abdominal pain (sensitivity of >70%). CT is relatively insensitive for MD in all symptomatology groups (0 to 29%).

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hansen C.C.
        • Soreide K.
        Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century.
        Medicine (Baltimore). 2018; 97e12154
        • Clark J.K.
        • Paz D.A.
        • Ghahremani G.G.
        Imaging of Meckel's diverticulum in adults: pictorial essay.
        Clin Imaging. 2014; 38: 557-564
        • Levy A.D.
        • Hobbs C.M.
        From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic correlation.
        Radiographics. 2004; 24: 565-587
        • Sagar J.
        • Kumar V.
        • Shah D.K.
        Meckel's diverticulum: a systematic review.
        J R Soc Med. 2006; 99: 501-505
        • Park J.J.
        • et al.
        Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950–2002).
        Ann Surg. 2005; 241: 529-533
        • Saremi F.
        • Jadvar H.
        • Siegel M.E.
        Pharmacologic interventions in nuclear radiology: indications, imaging protocols, and clinical results.
        Radiographics. 2002; 22: 477-490
        • Elsayes K.M.
        • et al.
        Imaging manifestations of Meckel's diverticulum.
        Am J Roentgenol. 2007; 188
        • Kotecha M.
        • et al.
        Multimodality imaging manifestations of the meckel diverticulum in children.
        Pediatr Radiol. 2012; 42: 95-103
        • Kotha V.K.
        • et al.
        Radiologist's perspective for the Meckel's diverticulum and its complications.
        Br J Radiol. 2014; 87: 20130743
        • Rerksuppaphol S.
        • Hutson J.M.
        • Oliver M.R.
        Ranitidine-enhanced 99mtechnetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum.
        Pediatr Surg Int. 2004; 20: 323-325
        • Kotecha M.
        • et al.
        Multimodality imaging manifestations of the meckel diverticulum in children.
        Pediatr Radiol. 2012; 42: 95-103
        • Olson D.E.
        • Kim Y.-W.
        • Donnelly L.F.
        CT findings in children with meckel diverticulum.
        Pediatr Radiol. 2009; 39: 659-663
        • Bennett G.L.
        • Birnbaum B.A.
        • Balthazar E.J.
        CT of Meckel's diverticulitis in 11 patients.
        Am J Roentgenol. 2004; 182: 625-629
        • Kawamoto S.
        • et al.
        CT detection of symptomatic and asymptomatic meckel diverticulum.
        Am J Roentgenol. 2015; 205: 281-291
        • Poulsen K.A.
        • Qvist N.
        Sodium pertechnetate scintigraphy in detection of Meckel's diverticulum: is it usable?.
        Eur J Pediatr Surg. 2000; 10: 228-231