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Meckel diverticulum in children: Evaluation of macroscopic appearance for guidance in subsequent surgery
Hasan Özkan Gezer1, Abdulkerim Temiz1, Emine İnce1
1Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Turkey.
Background:
The treatment of incidentally encountered asymptomatic Meckel diverticulum (MD) is controversial. We evaluated whether the macroscopic appearance correlates with clinical features, histopathological findings, future complications, and management decisions.
Methods:
Patients who underwent MD resection at a single institution from 2000 to 2012 were retrospectively analyzed in terms of age, sex, clinical features, laboratory data, perioperative findings (diverticulum length, diameter, depth, thickening, and height-to diameter ratio [HDR]), pathology, and postoperative follow-up.
Results:
Fifty children were enrolled. Sixteen percent of the resected MDs were found incidentally. Of 42 complicated MDs, 17 (40%) were long (HDR ≥2), 14 (33%) were thickened, and 29 (70%) exhibited base widening. Histopathologically, ectopic mucosa was found in 32 (64%) of all MDs and in 5 (62%) of incidentally removed MDs. There was no statistical difference between the macroscopic appearance and clinical signs, sex, or presence of ectopic tissue based on palpation.
Conclusion:
The macroscopic appearance of MD does not indicate the presence or absence of HGM and cannot be used to guide subsequent surgery. Additionally, 40% of symptomatic patients in our study had life-threatening complications requiring prompt fluid resuscitation. We consider that incidentally detected MD should be removed regardless of its macroscopic appearance.
Insights
Asymptomatic Meckel diverticulum (MD) macroscopic appearance does not predict complications. Incidental MDs should be surgically removed, irrespective of their visual characteristics, to prevent potential life-threatening issues.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Surgical Pathology
Background:
- The management of asymptomatic Meckel diverticulum (MD) remains a clinical dilemma.
- Evaluating the correlation between macroscopic appearance and clinical/histopathological findings is crucial for informed treatment decisions.
Purpose of the Study:
- To determine if the macroscopic appearance of Meckel diverticulum (MD) correlates with clinical features, histopathological findings, and potential complications.
- To assess the impact of macroscopic features on surgical management decisions for incidentally found MDs.
Main Methods:
- Retrospective analysis of 50 children who underwent Meckel diverticulum (MD) resection between 2000 and 2012.
- Data collected included patient demographics, clinical presentation, perioperative findings (diverticulum dimensions, thickness, HDR), pathology, and follow-up outcomes.
Main Results:
- Of the resected MDs, 16% were incidental findings. Ectopic mucosa was present in 64% of all MDs.
- Macroscopic features like length (HDR ≥2), thickness, and base widening were noted in complicated MDs.
- No statistically significant correlation was found between macroscopic appearance and clinical signs, sex, or presence of ectopic tissue.
Conclusions:
- The macroscopic appearance of Meckel diverticulum (MD) is unreliable for predicting ectopic gastric mucosa (EGM) or guiding surgical intervention.
- A significant proportion (40%) of symptomatic MDs presented with severe complications.
- The study recommends surgical resection of incidentally detected MDs, regardless of their macroscopic characteristics, to mitigate risks of future complications.
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