Value of sonographic pseudogestational sac sign in the diagnosis of Meckel diverticulum in children presenting with bleeding per rectum: a 15-year prospective study

Samar M El-Maadawy,Vassil N Zefov,Nesreen Alaaeldin

doi:10.1186/s43055-021-00575-1

Samar M El-Maadawy, Vassil N Zefov + Show 1 more

Open Access

https://doi.org/10.1186/s43055-021-00575-1

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Abstract

BackgroundMeckel diverticulum is the most common congenital abnormality of the gastrointestinal tract. Gastrointestinal bleeding is the most common complication of Meckel diverticulum in the paediatric population; the bleeding mostly occurs in the first 2 years of life. Because the diverticulum is seldom seen in clinical practice, misdiagnosis and delayed diagnosis are not uncommon. CT and nuclear studies are the most used diagnostic tools in clinical practice. However, radiation and sensitivity concerns remain an issue. Ultrasound has been suggested as an alternative diagnostic tool in diagnosing Meckel diverticulum with mixed results. The aim of our study is to assess the value of using a new sonographic sign, the pseudogestational sac sign in diagnosing Meckel diverticulum in children presenting with bleeding per rectum. Ultrasound was performed for all children. Results were correlated with nuclear studies, histopathology and clinical follow-up findings.ResultsSeventy-three children were included in our study. The pseudogestational sac sign was present in 46 (63%) and absent in 27 (37%) cases. Forty-five children were ultimately diagnosed as Meckel diverticulum. The age ranged from 2 months to 9 years with a mean of 2.3 years. The boy-to-girl ratio was 4.6:1 with 60% of children presenting during their first 2 years of life. The ultrasound performance using the pseudogestational sac sign revealed a sensitivity of 91.1%, specificity of 82.1%, positive predictive value of 89.1%, negative predictive value of 85.2%, positive likelihood ratio of 5.1, negative likelihood ratio of 0.11 and accuracy of 87.7%.ConclusionThe sonographic pseudogestational sac sign is a reliable diagnostic tool for diagnosing Meckel diverticulum in children presenting with bleeding per rectum. The sonographic diagnosis of Meckel diverticulum complies with the international standards of “Image Gently”.

Highlights

Meckel diverticulum is the most common congenital abnormality of the gastrointestinal tract
Despite the fact that Meckel diverticulum is the most common congenital gastrointestinal abnormality, the condition is rarely seen in clinical practice; delayed diagnosis or misdiagnosis is not uncommon adding burdens on children and their parents [2,3,4]
Inclusion criteria included all children with suspected Meckel diverticulum who are willing to perform ultrasound followed by laparoscopy if required

Summary

Introduction

Meckel diverticulum is the most common congenital abnormality of the gastrointestinal tract. Gas‐ trointestinal bleeding is the most common complication of Meckel diverticulum in the paediatric population; the bleeding mostly occurs in the first 2 years of life. CT and nuclear studies are the most used diagnostic tools in clinical practice. Meckel diverticulum is a congenital intestinal deformity attributable to incomplete embryonic degeneration of the yolk tube. It takes place in approximately 2% of the population. Since Meckel diverticulum has all three layers of Despite the fact that Meckel diverticulum is the most common congenital gastrointestinal abnormality, the condition is rarely seen in clinical practice; delayed diagnosis or misdiagnosis is not uncommon adding burdens on children and their parents [2,3,4]. The second most common complication is intestinal obstruction; adult population are more prone to experience such complication [6]

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