Meckel's Diverticulum in Children: A Monocentric Experience and Mini-Review of Literature.

Matthias Nissen,Volker Sander,Ralf-Bodo Tröbs,Mohamad Alrefai,Phillip Rogge

doi:10.3390/children9010035

Matthias Nissen, Volker Sander + Show 3 more

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https://doi.org/10.3390/children9010035

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Journal: Children	Publication Date: Jan 1, 2022
Citations: 1	License type: CC BY 4.0

Affiliation: Marien Hospital Witten, St.-Johannes-Hospital Dortmund

Abstract

Vitelline duct anomalies (VDA, including Meckel’s diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic versus asymptomatic VDA, analyzing clinico-laboratory data from 73 children, aged 1 day to 17 years, treated at a tertiary Pediatric Surgery Institution from 2002–2017. A male preponderance was obtained (ratio 3.6:1). MD accounted for 85% of VDA. Incidence of symptomatic VDA decreased with older age. Leading symptoms were intestinal obstruction and hemorrhage. Mucosal heterotopia (present in 39% of symptomatic MD) was associated with anemia and lowered CRP-levels. On ROC-analysis, hemoglobin < 8.6 g/dL, CRP < 0.6 mg/dL and MD distance to ileocecal valve >40 cm were predictors of ectopic tissue in symptomatic MD. Our data confirmed known characteristics as male preponderance, declined incidence of symptomatic cases with age and predominance of gastric ectopia in symptomatic MD. Moreover, anemia and prolonged distance of MD to ileocecal valve were predictors of ectopic mucosa in symptomatic MD.

Highlights

Failure in obliteration of the vitelline duct, that connects the yolk sac to the embryonic midgut by the seventh to eighth gestational week, results in various forms of vitelline duct anomalies (VDA) [1,2]
WBC White blood cell count, CRP C-reactive protein, MD Meckel’s diverticulum, OMD Omphalomesenteric duct; VDA Vitelline duct anomaly, † Obstruction versus bleeding group. n/a not applicable; Categorical variables were presented as frequencies and percentages and compared by Fisher’s exact test; p ≤ 0.05 was defined significant
Hemoglobin < 8.6 g/dL (AUC 0.837 ± 0.101; p = 0.014; sensitivity 72%; specificity 93%; positive predictive value (PPV) 83%; negative predictive value (NPV) 87%; odds ratio (OR) 32.5), CRP < 0.6 mg/dL (AUC 0.854 ± 0.095; (0.67–1.04); p = 0.017; sensitivity 83%; specificity 58%; PPV 50%; NPV 88%; OR 7 (0.61–79.9)) and distance of MD diverticulum from ileocecal valve >40 cm (AUC 0.889 ± 0.111 (0.67–1.11); p = 0.009; sensitivity 86%; specificity 89%; PPV 86%; NPV 89%; OR 48 (2.5–932.9)) were of predictive value for presence of ectopic tissue

Summary

Introduction

Failure in obliteration of the vitelline (or omphalomesenteric; OMD) duct, that connects the yolk sac to the embryonic midgut by the seventh to eighth gestational week, results in various forms of vitelline duct anomalies (VDA) [1,2]. Depending on the extent and site of disintegration and absorption, several anomalies may result including patent. OMD, fibrous cords from umbilicus to ileum, omphalomesenteric (umbilical) duct sinus or cyst in case of its distal persistence. Its proximal part persistence constitutes the most commonly observed representative of VDA, known as Meckel’s diverticulum (MD) [2,3]. In the majority of cases, MD is clinically silent, only incidentally identified by radiographic imaging, endoscopy or surgery for another reason [2]. MD usually presents a normal small bowel wall architecture, lined by ileal mucosa

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