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Symptomatic paediatric Meckel's diverticulum: stratified diagnostic indicators and accuracy of Meckel's scan
Mazin Al Janabi1, Madan Samuel, Andrea Kahlenberg
1Departments of aNuclear Medicine bPaediatric Surgery cAnaesthesia, Mediclinic City Hospital, Dubai Health Care City, Dubai, UAE dQueen Mary University of London, London, UK.
Insights
Technetium-99m scintigraphy has limited value for diagnosing symptomatic Meckel
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Meckel's diverticulum (MD) is a congenital anomaly that can cause significant gastrointestinal issues in children.
- Symptomatic MD often presents with rectal bleeding or other complications, necessitating accurate diagnosis.
- Ectopic gastric mucosa is a common finding in symptomatic MD.
Purpose of the Study:
- To identify diagnostic indicators for symptomatic Meckel's diverticulum (MD) in children.
- To evaluate the diagnostic accuracy of technetium-99m (Tc)-pertechnetate scintigraphy for MD.
Main Methods:
- A 5-year prospective observational study of 73 children with symptomatic MD.
- Analysis of clinical presentation, laboratory results, and imaging findings.
- Stepwise multiple logistic regression to identify diagnostic markers.
- Assessment of Tc-pertechnetate scintigraphy sensitivity and specificity.
Main Results:
- 44% of MD cases presented with complications.
- Rectal bleeding correlated with ectopic gastric mucosa (r=0.94).
- Tc-pertechnetate scintigraphy showed 84% sensitivity but only 22% specificity.
Conclusions:
- Tc-pertechnetate scintigraphy has poor predictive value and limited clinical utility for MD diagnosis.
- Clinical suspicion should be high for children with hematochezia and hemoglobin drop.
- Laparoscopy is an effective diagnostic and therapeutic option for MD.
Purpose:
The aim of the study was to delineate stratified diagnostic indicants and evaluate the diagnostic accuracy of technetium-99m (Tc)-pertechnetate scintigraphy in children with symptomatic Meckel's diverticulum (MD).
Materials And Methods:
This was a prospective linear observational study conducted over a period of 5 years on 73 children with a diagnosis of symptomatic MD. The independent variables assessed were age, sex, weight-for-age z-scores, clinical presentation, complications of MD, laparoscopic findings, haematologic and biochemical results, radiological results, and histological findings. Stepwise multiple logistic regression analysis was performed to determine the diagnostic markers. The sensitivity and specificity of Tc-pertechnetate scintigraphy were assessed.
Results:
The incidence of MD with complications was 44%. The prevalence of ectopic gastric mucosa in histological specimens was 84%. There was a good correlation between rectal bleeding and the presence of ectopic gastric mucosa [r=0.94; 95% confidence interval (CI): 0.77-0.98]. Haematochezia associated with a drop in haemoglobin (>2 g/dl) was diagnostic of MD with ectopic gastric mucosa in children (n=42, 58%; P=0.006; odds ratio 1.99; 95% CI: 1.14-2.42). Bilious vomiting was diagnostic of complicated MD (n=12, 16%; P=0.007; odds ratio 1.89; 95% CI: 1.12-3.22). The sensitivity of Tc-pertechnetate scintigraphy was 84% and specificity was 22%. The positive predictive value was 0.64 and the negative predictive value was 0.22. The sensitivity and specificity of Tc-pertechnetate scintigraphy were dependent on the quantity and functional quality of the heterotopic gastric mucosa. The preoperative median z-score was -1.4 and the postoperative median z-score was -1.2.
Conclusion:
Tc-pertechnetate scintigraphy had a truncated predictive value. Its contribution in clinical decision making was poor. Clinical suspicion of MD should be high in children presenting with haematochezia associated with a drop in haemoglobin by more than 2 g/dl. Laparoscopy is an effective diagnostic and therapeutic tool.
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