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
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References
- Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century.Medicine (Baltimore). 2018; 97e12154
- Imaging of Meckel's diverticulum in adults: pictorial essay.Clin Imaging. 2014; 38: 557-564
- From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic correlation.Radiographics. 2004; 24: 565-587
- Meckel's diverticulum: a systematic review.J R Soc Med. 2006; 99: 501-505
- Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950–2002).Ann Surg. 2005; 241: 529-533
- Pharmacologic interventions in nuclear radiology: indications, imaging protocols, and clinical results.Radiographics. 2002; 22: 477-490
- Imaging manifestations of Meckel's diverticulum.Am J Roentgenol. 2007; 188
- Multimodality imaging manifestations of the meckel diverticulum in children.Pediatr Radiol. 2012; 42: 95-103
- Radiologist's perspective for the Meckel's diverticulum and its complications.Br J Radiol. 2014; 87: 20130743
- 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
- Multimodality imaging manifestations of the meckel diverticulum in children.Pediatr Radiol. 2012; 42: 95-103
- CT findings in children with meckel diverticulum.Pediatr Radiol. 2009; 39: 659-663
- CT of Meckel's diverticulitis in 11 patients.Am J Roentgenol. 2004; 182: 625-629
- CT detection of symptomatic and asymptomatic meckel diverticulum.Am J Roentgenol. 2015; 205: 281-291
- Sodium pertechnetate scintigraphy in detection of Meckel's diverticulum: is it usable?.Eur J Pediatr Surg. 2000; 10: 228-231
Article Info
Publication History
Accepted:
July 25,
2022
Received in revised form:
July 15,
2022
Received:
May 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
