Diagnosis of Bleeding Meckel's Diverticulum in Adults.

Sung Noh Hong,Eun Ran Kim,Byong Duk Ye,Jae Myung Cha,Soo Jung Park,Hyun Joo Jang,Jong Pil Im,Dong Kyung Chang,Seong-Eun Kim,Seong Ran Jeon,John Green

doi:10.1371/journal.pone.0162615

Abstract

Background and AimsVarious modalities have been used to diagnose Meckel's diverticulum (MD) in practice, but with their diagnostic accuracy deemed to be unsatisfactory for clinical practice. Moreover, the usefulness of these modalities has not been evaluated for the diagnosis of bleeding MD in adults, due to the relative rarity of this condition. Therefore, the aim of our multicenter study was to determine the most accurate modality for the preoperative diagnosis of bleeding MD in adults.MethodsWe conducted a retrospective analysis of the diagnostic accuracy for small bowel bleeding associated with MD of different modalities in patients ≥18 years old who underwent assessment for MD, with confirmation at the time of explorative surgery. Diagnostic accuracy of the different modalities was evaluated against the diagnosis obtained using technetium-99m pertechnetate scintigraphy (also known as Meckel's scan), considered to be the gold standard for the diagnosis of bleeding MD in pediatrics.ResultsThirty-five adults were identified with bleeding in MD over the study period, between 2005 and 2012. Among these patients, only 24 (68.6%) were diagnosed with MD preoperatively. The mean (95% confidence interval) diagnostic accuracy of selected modalities was as follows: Meckel’s scan, 21.4% (5.7%-51.2%); capsule endoscopy, 35.7% (14.0%-64.4%); balloon-assisted enteroscopy (BAE), 85.0% (61.1%-96.0%); angiography, 0.0% (0.0%-80.2%); computed tomography, 31.8% (14.7%-54.9%); and small-bowel follow-through, 62.5% (25.9%-90.0%). The diagnostic accuracy was significantly higher for BAE than for Meckel’s scan (P = 0.001).ConclusionsAmong available diagnostic modalities, BAE provides the highest accuracy for the diagnosis of bleeding MD in adults and, therefore, should be considered as the preferred modality for preoperative diagnosis.

Highlights

Meckel’s diverticulum (MD) forms part of the differential diagnosis of small bowel bleeding
SBFT, small bowel follow-through; RBC scan, Technetium-99m red blood cell scintigraphy; 95% CI, 95% confidence intervals; H2, histamine type-2
The diagnostic accuracy was significantly higher for balloon-assisted enteroscopy (BAE) than for Meckel’s scan (P = 0.001)

Summary

Introduction

Meckel’s diverticulum (MD) forms part of the differential diagnosis of small bowel bleeding. Technetium-99m pertechnetate scintigraphy, commonly known as Meckel’s scan, is considered as the modality of choice to evaluate patients with suspected MD, based on its diagnostic accuracy of approximately 90% in pediatric patients [3]. Various modalities have been adopted for the diagnosis of MD in adults, with the diagnostic accuracy often considered to be unsatisfactory for clinical practice. The diagnostic yield and accuracy of these modalities for the diagnosis of bleeding MD, a relatively rare condition, have not been comprehensively evaluated. Various modalities have been used to diagnose Meckel's diverticulum (MD) in practice, but with their diagnostic accuracy deemed to be unsatisfactory for clinical practice. The usefulness of these modalities has not been evaluated for the diagnosis of bleeding MD in adults, due to the relative rarity of this condition. The aim of our multicenter study was to determine the most accurate modality for the preoperative diagnosis of bleeding MD in adults

Methods

Results

Conclusion