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Published on: November 30, 2010
Complicated Meckel's Diverticulum in Children: Clinical Presentation, Diagnostic Work-Out, Surgical Approach and
Susan Vaabengaard1, Line Andersen1, Niels Qvist1
1Surgical Department, Odense University Hospital, Odense, DNK.
Abstract:
Introduction Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of cases are asymptomatic and in cases with complications, the diagnosis may be a challenge and the surgical approach is not obvious. The primary aim of the present study was to evaluate the diagnostic process and surgical approach in relation to clinical presentation. The secondary aim was to evaluate the severity of postoperative complications. Methods A two-center, retrospective analysis of all children below the age of 15 years, operated for complications to MD during the period from January 2003 to December 2016. Results A total of 58 patients were included. In the 40 patients presenting with an acute abdomen an average of 2.3 preoperative diagnostic investigations was performed. In only five cases an MD was recognized preoperatively. In the 18 patients presenting with rectal bleeding or melaena an average of 3.2 preoperative investigations were performed and in only one case the MD was recognized preoperatively. Laparoscopy was the surgical approach in 36 patients (62%) with a conversion in 8. Postoperative complications were seen in two patients (Clavien-Dindo II and IIIb). Conclusion Despite extensive diagnostic work-out an MD was recognized in only a few patients preoperatively. Laparoscopy was the surgical approach in two-thirds of the patients.
Insights
Diagnosing Meckel
Area of Science:
- Pediatric Surgery
- Gastrointestinal Anomalies
Background:
- Meckel's diverticulum (MD) is the most common congenital gastrointestinal anomaly.
- Complicated MD often presents diagnostic challenges and unclear surgical strategies.
Purpose of the Study:
- To assess the diagnostic process for Meckel's diverticulum complications in children.
- To evaluate surgical approaches and postoperative complication severity.
Main Methods:
- Retrospective analysis of 58 pediatric patients (<15 years) operated for MD complications.
- Data collected from January 2003 to December 2016 across two centers.
Main Results:
- Preoperative diagnosis of MD was infrequent, even with multiple investigations.
- Laparoscopy was used in 62% of cases, with 8 conversions.
- Postoperative complications occurred in only two patients (Clavien-Dindo II and IIIb).
Conclusions:
- Preoperative diagnosis of Meckel's diverticulum remains challenging despite extensive workup.
- Laparoscopic surgery is a feasible approach for a majority of pediatric MD complications.
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