Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis

Abstract

PurposeMeckel's diverticulum (MD) has various clinical manifestations, and diagnosis or selectection of proper diagnostic tools is not easy. This study was conducted in order to assess the clinical differences of MD diagnosed by scintigraphic and non-scintigraphic methods and to find the proper diagnostic tools.MethodsWe conducted a retrospective review ofthe clinical, surgical, radiologic, and pathologic findings of 34 children with symptomatic MD, who were admitted to Gachon University Gil Medical Center, Inha University Hospital, and The Catholic University of Korea, Incheon St. Mary's Hospital between January 2000 and December 2012. The patients were evaluated according to scintigraphic (12 cases; group 1) and non-scintigraphic (22 cases; group 2) diagnosis.ResultsThe male to female ratio was 7.5 : 1. The most frequent chief complaint was lower gastrointestinal (GI) bleeding in group 1 and nonspecific abdominal pain in group 2, respectively. The most frequent pre-operative diagnosis was MD in both groups. Red blood cell (RBC) index was significantly lower in group 1. MD was located at 7 cm to 85 cm from the ileocecal valve. Four patients in group 1 had ectopic gastric tissues causing lower GI bleeding. The most frequent treatment modality was diverticulectomy in group 1 and ileal resection in group 2, respectively.ConclusionTo diagnose MD might be delayed unless proper diagnostic tools are considered. It is important to understand indications of scintigraphic and non-scintigraphic methods according to clinical and hematologic features of MD. Scintigraphy would be weighed in patients with anemia as well as GI symptoms.

Perforation of Meckel`s diverticulum in a very low birth weight neonate with severe pneumoperitoneum and review of literature

“…Although patients born with MD could develop complications at any age, the dominate types differ between children and adults. Pediatric patients tend to present with painless intestinal hemorrhage 3,4,6 , whereas diverticulitis and intestinal obstruction are more common in adult patients. 4 Perforation is a rare complication of MD, evident in approximately 3-10% of patients who have symptoms.…”

“…1 It is a true diverticulum consisting of all three layers of the normal bowel wall, and may contain ectopic tissues such as gastric, pancreatic, and duodenal mucosa. [2][3][4] The majority of patients with MD are asymptomatic, and those who develop complications could present with various manifestations. According to previous studies, the peak incidence of complicated MD was observed to be in childhood.…”

Diverse Presentation of Meckel’s Diverticulum in Pediatric Patients

“…5 According to Rho et al, the chief complaints were GI bleeding and nonspecific abdominal symptoms whereas some study mentions intestinal obstruction as the major presentation. [6][7][8] It is seen that bleeding and intussusception due to MD were more frequent in children under two years of age, whereas symptoms of intestinal obstruction occur more often after two years. 9 Rattan et al, mentioned intestinal obstruction (86%) was the most common presentation for MD.…”

Recurrent abdominal pain in children: a clinical approach

“…It can present in various ways, including RAP and intestinal haemorrhage, and can also be the lead point for intussusceptions. When it presents as abdominal pain, (15,16) inflammation or ulceration of the ectopic gastric mucosa is the usual cause. Pain is often localised at the right iliac fossa.…”