Symptomatic Meckel’s diverticulum in children: a 16-year review

Abstract

Meckel's diverticulum (MD) has varied presentations and often becomes a diagnostic challenge. The purpose of this study was to review the various presentations of symptomatic MD and to assess the sensitivity of the Meckel's scan as a diagnostic tool in patients with bleeding MD. The hospital records of 71 consecutive patients with a diagnosis of MD from 1990 to 2005 were retrospectively reviewed. The data was assessed for age at presentation, sex, clinical features, investigations performed, surgical intervention and histopathological findings. There were 71 patients with a diagnosis of MD (age 2 days-14 years). In eight patients, MD was an incidental finding at laparotomy. The remaining 63 patients were symptomatic and presented with various clinical features. Ten patients (15.8%) had clinical features of peritonitis; of these, six had perforated MD and four had Meckel's diverticulitis at laparotomy. Nine patients (14.2%) were diagnosed as intestinal obstruction, and at laparotomy, a Meckel's band was found to be the cause of the obstruction. Nine patients (14.2%) had a patent vitello-intestinal duct and presented with umbilical discharge. Thirty-five patients (55.5%) presented with episodes of bleeding per rectum or malaena. Ultrasound scans revealed intussusception in six patients requiring open reduction. Of the remaining 29 patients with bleeding per rectum, 27 underwent a Meckel's Tc99 scan that showed a positive tracer in 18 patients (66.6%) and negative in 9 (33.3%). All patients with a symptomatic MD underwent resection of the diverticulum. Histology revealed ectopic gastric mucosa in 43 patients (68.3%). MD has various presentations and can be easily misdiagnosed. It is necessary to maintain a high index of suspicion in the paediatric age group. The Meckel's scan has a poor positive predictive value and cannot be relied upon for a diagnosis in cases of bleeding MD if Tc99 scan is negative.

Enterocutaneous Fistula Formation of Meckel's Diverticulum via the Urachal Cyst in an Adult Patient: A Case Report and Literature Review

“…Meckel's diverticulum is a remnant of omphalomesenteric or vitelline duct and it connects the growing embryo's midgut to the yolk sac during early development (17). Normally, the allantois and upper portion of the bladder become obliterated during the sixth to eighth weeks of gestation and are postnatally represented as a thick fibrous band (ie.…”

Perforated Meckel’s Diverticulum- A Rare Case Presentation

“…The most common presentation in the pediatric age group is painless rectal bleeding. In a retrospective study of 71 pediatric patients with diagnosed MD, 55.5% of the patients initially presented with rectal bleeding 5 ; however, this number varies among studies 6,7,8 . In a study of 776 patients, Kusumoto et al found that an accurate preoperative diagnosis was made only in 11% of patients presenting with symptoms other than bleeding, compared to 88% in bleeding patients 9 .…”

Semptomatik Meckel Divertikülleri ve Tecrübelerimiz

“…Toplumun %2-3'ünün MD'ne sahip olduğu tahmin edilmektedir (1). Hayat boyu semptom verme insidansı %6 olup, erkeklerde daha sıklıkla görülmektedir (2).…”