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Reevaluating the rule of two's: Age and epidemiological variations in Meckel's diverticulum
Ashley Polachek1,2, Megha S Mehta1,2, Ahmed Shalaby3
1Division of Pediatric Gastroenterology, UT Southwestern Medical Center, Dallas, Texas, USA.
Insights
Over half of pediatric Meckel's diverticulum (MD) cases are diagnosed after age five. Clinical presentation and diagnostic imaging for MD significantly vary by patient age.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Diagnostics
Background:
- Meckel's diverticulum (MD) is a congenital anomaly of the small intestine.
- Delayed diagnosis of MD can lead to complications such as obstruction, intussusception, or bleeding.
Purpose of the Study:
- To analyze the clinical characteristics and diagnostic approaches for Meckel's diverticulum (MD) in pediatric patients.
- To investigate age-related variations in the presentation and diagnosis of MD.
Main Methods:
- Utilized the Kids' Inpatient Database (KID) for 2016 and 2019 to identify pediatric patients with MD.
- Conducted a retrospective review of 147 patients diagnosed with MD at a single institution over 20 years.
- Confirmed diagnoses through surgical findings and pathological examination.
Main Results:
- Over 60% of pediatric patients in both datasets were diagnosed with MD after the age of five.
- Younger children (≤5 years) more frequently presented with painless rectal bleeding and underwent Meckel's scintigraphy.
- Older children (>5 years) were more likely to exhibit abdominal pain or vomiting and undergo CT scans, with longer hospital stays observed in younger age groups.
Conclusions:
- A significant proportion of pediatric Meckel's diverticulum (MD) cases are diagnosed later in childhood.
- Age-specific clinical presentations and diagnostic imaging preferences are evident in pediatric MD cases.
- Diagnostic strategies for MD should consider age-related variations in symptoms and imaging findings.
Objective:
To evaluate the clinical characteristics, diagnostic modalities, and age-related variation of Meckel's diverticulum (MD) using data from a nationwide pediatric inpatient database and a single-center institutional cohort.
Methods:
The Kids' Inpatient Database (KID) for 2016 and 2019 was queried for patients with a principal diagnosis of MD. We additionally conducted a retrospective review of patients hospitalized with a primary diagnosis of MD at our institution over a 20-year period (January 1, 2005-May 1, 2025). Diagnosis was confirmed by surgical findings and pathology.
Results:
A total of 1004 patients with a primary diagnosis of MD were identified in KID. More than half were diagnosed after 5 years of age (n = 648, 64.8%). Similarly, among 147 patients identified in the single-center cohort, 63.2% (n = 93) were diagnosed after 5 years of age. Within this single-center cohort, patients ≤5 years more commonly presented with painless rectal bleeding (38.9%, p = 0.017) and underwent Meckel's scintigraphy more frequently (48.1%, p < 0.005). In contrast, patients >5 years more often presented with abdominal pain (61.3%) or vomiting (54.8%) and were more likely to undergo abdominal computed tomography (68.9%, p < 0.0001). Length of stay (LOS) was longer in patients <5 years and shortest in those >15 years (p = 0.04).
Conclusion:
More than half of pediatric patients with MD are diagnosed after 5 years of age. Presentation, LOS, and imaging patterns vary by age, with younger children more often presenting with bleeding and older children with obstructive symptoms and greater CT detection.
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