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Meckel diverticulum in the pediatric population: Patient presentation and performance of imaging in prospective
Jennifer S McDonald1, Kelly K Horst1, Paul G Thacker1
1Mayo Clinic, Department of Radiology, 200 First Street SW, Rochester, MN 55902, United States of America.
Purpose:
To determine the most common presentations of Meckel diverticulum (MD) in children and the performance of imaging modalities in prospective diagnosis.
Materials And Methods:
A 28-year retrospective review was performed of children under 18 years of age with MD listed as a diagnosis on pathology and/or surgical reports. The medical record was reviewed to determine presenting clinical scenarios. All imaging performed for each case was reviewed.
Results:
Seventy-six patients met inclusion criteria. Of the surgically removed MD, most presented with abdominal symptoms (n = 31, 41%); gastrointestinal (GI) bleeding (n = 15, 20%), or both abdominal symptoms and GI bleeding (n = 7, 9%). Twenty-nine percent of MD were discovered incidentally at surgery performed for other reasons. Of the symptomatic MD, only 31% were prospectively diagnosed. For patients with abdominal symptoms, CT had a sensitivity of 13% (3/24) while nuclear medicine (NM) scan had a sensitivity of 0% (0/2). For patients with GI bleed, CT had a sensitivity of 29% (2/7) and NM scan had a sensitivity of 71% (10/14). For patients with both abdominal symptoms and GI bleed, CT was 0% (0/2) and NM scan 75% (3/4) sensitive.
Conclusion:
MD as a cause of abdominal symptoms and gastrointestinal bleeding may be difficult to diagnose due to nonspecific presentations and nonspecific findings. Most prospectively diagnosed MD are on NM scan in patients with GI bleed with abdominal pain (sensitivity of >70%). CT is relatively insensitive for MD in all symptomatology groups (0 to 29%).
Insights
Diagnosing Meckel diverticulum (MD) in children is challenging. Nuclear medicine scans are more effective than CT scans for identifying MD, especially in cases of gastrointestinal bleeding.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Meckel diverticulum (MD) is a congenital anomaly that can cause significant morbidity in children.
- Clinical presentations of MD are often nonspecific, complicating diagnosis.
- Accurate and timely diagnosis is crucial for effective management and preventing complications.
Purpose of the Study:
- To identify the most frequent clinical presentations of Meckel diverticulum in pediatric patients.
- To evaluate the diagnostic performance of various imaging modalities for Meckel diverticulum.
Main Methods:
- A 28-year retrospective review of pediatric patients (<18 years) with a confirmed Meckel diverticulum diagnosis.
- Analysis of clinical presentations, including abdominal symptoms and gastrointestinal bleeding.
- Review of all imaging studies (CT, nuclear medicine scans) performed for prospective diagnosis.
Main Results:
- Seventy-six pediatric patients met the inclusion criteria.
- Abdominal symptoms (41%) and gastrointestinal bleeding (20%) were the most common presentations of symptomatic Meckel diverticulum.
- Overall prospective diagnostic yield was low (31%); nuclear medicine scans showed higher sensitivity (71%) for gastrointestinal bleeding compared to CT (29%).
Conclusions:
- Meckel diverticulum diagnosis in children is often delayed due to nonspecific symptoms and imaging findings.
- Nuclear medicine scans demonstrate superior sensitivity for diagnosing Meckel diverticulum, particularly in cases of gastrointestinal bleeding.
- CT scans exhibit limited sensitivity across all symptomatic presentations of Meckel diverticulum.
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