Systematic review of Meckel's diverticulum in pregnancy

Abstract

Introduction: Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future. Materials and Methods: The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed. Results: Twenty-seven cases were included. Average age = 26.9 years. Average gestation = 25.1 weeks. Occurrence: first trimester = 3.7%; second trimester = 48.1% and third trimester = 48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms = 3.4 days. Diagnostic imaging modalities utilised: ultrasound = 40.7%; CT = 25.9%; MRI = 14.8%; abdominal X-ray = 11.1% and endoscopy = 7.4%. All cases required definite surgical management: laparotomy = 65.4%; laparoscopy = 15.4%; C-section = 19.2% and unreported = 3.8%. Main intra-operative findings: perforated MD = 40.7%; intussusception with MD as a lead point = 11.1%; bleeding MD = 11.1%, inflamed MD = 11.1%; small bowel obstruction = 11.1%; gangrenous MD = 3.7%; volvulus = 3.7% and unspecified = 7.4%. Mean length from ileocolic junction = 51.7 cm. Average length of stay was 7.1 days. T-test (p-value = 0.12) when comparing management strategy. Three maternal complications and two foetal mortalities. Conclusion: MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.

Meckel’s Diverticulum: The “Great Mimic” but Often a Forgotten Cause of Acute Abdomen during Pregnancy

“…Symptomatic Meckel's diverticulum during pregnancy is an extremely rare event. There are only 38 cases reported so far since 1949 [ 3 – 6 ] and 21 cases describing perforation of Meckel's diverticulum [ 5 , 6 ].…”

“…Obstruction is more frequent amongst adults, whereas bleeding is most commonly observed in children due to ulceration caused by acid secretion by ectopic gastric mucosa [ 9 ]. Rarely, fistulae and malignancy can occur with carcinoid tumor being the most frequent [ 6 , 7 ]. MD can be discovered incidentally during abdominal exploration or diagnostic imaging.…”

“…Ultrasound is often the first and most used diagnostic modality [ 6 ]. It is fast, noninvasive and involves no radiation; however, its sensibility is very limited as it is operator dependent and has limited field of view due to pregnant uterus.…”

“…Computer tomography (CT) is usually the gold standard for diagnosis of several abdominal pathologies and can be utilized in pregnant women. Nevertheless, in a recent systematic review, CT had a very low diagnostic value (14.7%) [ 6 ] and exposes the fetus to radiation. MRI without gadolinium, if available, is a good alternative to CT because of its higher sensitivity and no radiation exposure [ 6 , 14 ].…”

“…Nevertheless, in a recent systematic review, CT had a very low diagnostic value (14.7%) [ 6 ] and exposes the fetus to radiation. MRI without gadolinium, if available, is a good alternative to CT because of its higher sensitivity and no radiation exposure [ 6 , 14 ]. Technetium-99m (99mTc) pertechnetate, also known as a Meckel's scan, is a modality used to diagnose MD with good results, particularly in children.…”