Diagnosis Of Meckel's Diverticulum Research Articles

Application of small bowel capsule endoscopy in children with Meckel's diverticulum.

Meckel diverticulum (MD) is an important cause of gastrointestinal bleeding in children. Small bowel capsule endoscopy (SBCE) is a first-line examination method applied to patients with obscure gastrointestinal bleeding, but there are few studies on its application in children with MD. This article aims to provide evidence in favor of the auxiliary diagnosis of MD in children by analyzing its characteristics using SBCE. We retrospectively collected the clinical data of patients with suspected MD. A total of 58 children were included in this study. All 58 children presented overt gastrointestinal bleeding (bloody stool or melena). Capsule endoscopy identified protruding lesions in 2 cases, double-lumen changes in 30 cases (all considered as MD), vascular lesions in 7 cases, intestinal mucosal inflammatory lesions in 3 cases, ulcers or erosion in 3 cases, and no obvious abnormalities in SBCE in 12 cases. Both SBCE and technetium-99 scans were performed for 24 cases, 22 of which were diagnosed MD by their combined results, giving a diagnostic coincidence rate of 91.7%. Eight cases were highly suspected as MD but were negative for the technetium-99 scan and positive for SBCE. SBCE has high accuracy in the diagnosis of MD in children, especially when performed in combination with a technetium-99 scan, which can greatly improve the diagnostic rate of MD in children.

Meckel’s diverticulum mimicking acute appendicitis in children: a retrospective cohort study

BackgroundThe aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children.Materials and methodsWe retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel’s diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded.ResultsA total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1–13 years). Perforated Meckel’s diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix.ConclusionsThe most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.

99mTc-Pertechnetate in Diagnosis of Meckel Diverticulum in an Adult.

One of the most common malformations of the gastrointestinal tract is Meckel diverticulum (MD). MD complications can range from minor to major, such as intestinal obstruction, intussusception, hemorrhage, ulceration, vesicodiverticular fistulae, and tumors. Bleeding from ectopic gastric mucosa is more common in children than in adults. In the current case, MD in a 25-y-old man was diagnosed by 99mTc-pertechnetate scanning. 99mTc-pertechnetate scanning helps to diagnose MD noninvasively and has a potential role in the evaluation of MD even in adults.

Bilateral peritonsillar abscess-developed ruptured Meckel's diverticulum: A case report

Peritonsillar abscess (PTA) is an accumulation of pus between the fibrous capsule of the palatine tonsils and the superior pharyngeal constrictor muscle. Bilateral PTA (BPTA) is a rare disease. Meckel's diverticulum (MD) is a congenital abnormality of the distal ileum associated with failed vitelline duct closure. Spontaneous MD rupture during the management of PTA never happened before. In this article, the authors present a case of BPTA-developed MD rupture. We present a case involving an 18-year-old male who presented to the emergency department (ED) for a 2-day history of worsening sore throat, trismus, fever, and odynophagia; a diagnosis of bilateral severe PTA was made. During the management of the BPTA, the patient developed severe acute abdominal pain which was diagnosed later as a case of MD rupture. In ED, the patient underwent computerized tomography (CT) scan of the neck that showed bilateral hypodense masses, consistent with BPTA. Conservative management was started on IV antibiotics, IV fluids, and IV analgesia at the time of diagnosis in the ED. The patient then underwent two attempts of needle aspiration using 18-gauge needles that showed evidence of aspirated pus. Later on, the patient developed severe abdominal pain, which is evaluated by the general surgery department (GS), and underwent ultrasonography (US) and CT scan; then, the diagnosis of rupture MD was made. The patient underwent diagnostic laparoscopy performed by the GS team and improved thereafter. In this article, the authors present a case of BPTA-developed MD rupture.

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

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”.

Imaging Findings of Acute Abdomen due to Complications of Meckel Diverticulum.

Meckel diverticulum is the most common and well-known congenital anomaly of the digestive system. Although most cases are asymptomatic, Meckel diverticulum can have a variety of complications, including gastrointestinal bleeding as a result of peptic ulceration, diverticulitis, and small bowel obstruction. Although the radiologic findings of these complications have been reported, they are difficult to diagnose preoperatively because Meckel diverticulum is a small entity. Computed tomography and scintigraphy play an important role in the diagnosis of Meckel diverticulum and its complications. It is important to be familiar with the radiologic features of acute abdomen due to complications of Meckel diverticulum to be able to manage the condition appropriately.

Complications of Meckel's diverticulum in children: about 18 cases

Le diverticule de Meckel (DM) est une persistance du canal omphalo-mésentérique. Il est souvent asymptomatique, mais peut être responsable de complications diverses avec des tableaux cliniques variables notamment chez l'enfant. Nous avons réalisé une étude rétrospective au Service de Chirurgie Pédiatrique du CHU Hassan II de Fès (Maroc), sur les DM compliqués chez l'enfant dans le but de décrire les aspects cliniques, radiologiques et thérapeutiques. Sur une période de 10 ans (janvier 2009- décembre 2018), 18 enfants (15 garçons et 3 filles) âgés de 1 jour à 15 ans (âge moyen de 5 ans) ont été opérés pour une complication du DM. L'invagination intestinale aigue et l'occlusion intestinale étaient les complications les plus fréquentes. Les autres complications décrites sont l'infection du DM (1 cas) et l'hémorragie digestive (2 cas). Deux formes néonatales rares ont été décrites (occlusion néonatale et fistule sur omphalocèle). L'imagerie basée sur la radiographie de l'abdomen sans préparation (ASP), l'échographie et la tomodensitométrie (TDM) abdominale n'ont objectivé le DM en aucun cas. La scintigraphie a été réalisée pour les 2 cas ayant une rectorragie et elle a permis de faire le diagnostic du DM dans un cas. Trois patients ont été opérés par laparoscopie avec résection du DM avec anastomose intestinale par out-laparoscopie. Les autres patients ont été opérés par laparotomie. L'iléostomie a été réalisée dans un cas suivi d'un rétablissement secondaire. L'évolution était bonne pour tous les patients hormis un cas de lâchage d'anastomose. Sur le plan anatomo-pathologique, deux cas d'hétérotopie ont été notés.

Diagnosis of a Bleeding Meckelʼs in an Adult with a Negative Meckelʼs Scan

Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract, occurring in 2% of the general population. Most diagnosis of MD are made in childhood. However, some patients may remain asymptomatic through adulthood or present later in life with complications such as anemia due to ileal ulceration. Strictures occur in MD due to secretion of hydrochloric acid and pepsin by heterotopic gastric tissue. We describe a case of an adult male presenting with abdominal pain and anemia who was diagnosed initially with small bowel ulceration consistent with Crohn's disease. However, he was eventually diagnosed with MD after surgical exploration. This case illustrates the difficulty in diagnosing MD in adults by standard imaging or endoscopy. A 45 year-old South Asian man without significant PMH presented to clinic with a one-year history of progressive anemia associated with fatigue and abdominal pain. Initial evaluation included an upper endoscopy and colonoscopy. A video capsule endoscopy (VCE) study revealed an inflammatory stricture in the distal ileum concerning for IBD. Retrograde DBE defined two ulcerated stenotic strictures located in the mid-ileum immediately adjacent to a diverticulum. Biopsies of the two strictures and diverticulum were suggestive of Crohn's disease. A Meckel's scan was performed and negative. Surgical resection of the diseased segment of bowel was consistent with a MD which was confirmed by histology. Meckel's diverticulum (MD) is primary diagnosed in childhood by 99mTc nuclear imaging or Meckel's scan (MS). The sensitivity and specificity of this scan in children is 85% and 95%, respectively, but falls to 62.5% and 9% in adults. This discrepancy may be related to a decline in heterotopic gastric mucosa with age in symptomatic MD. A case series evaluating an incidental MD in 311 patients found no presence of heterotrophic (ie. gastric and pancreatic) mucosa. One retrospective case-series found that DBE had a significantly higher diagnostic accuracy 85.0% (61.1%-96.0%) for MD than MS 21.4% (5.7%-51.2%) in the adult population with a (P = 0.001). However, DBE is not available in all centers. This same study also reported the diagnostic accuracy of other modalities for MD including small-bowel follow through (63%),VCE (36%),CT (32%), and angiography (0%). In cases in which a MD is suspected but evaluation by imaging and VCE are inconclusive, referral for DBE should be considered.1986_A Figure 1. Mid-ileum Stricture1986_B Figure 2. Stricture adjacent to Large Diverticulum1986_C Figure 3. Histopathology adapted from Fujita, Naoyuki

Balloon‐assisted enteroscopy for symptomatic Meckel's diverticulum: High diagnostic accuracy and possible endoscopic intervention

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, with reported prevalence of 1% to 3% and male predominance. As MD is usually asymptomatic and discovered incidentally, the true prevalence and characteristics are still unclear. Most MD patients are identified with the onset of complications, including bleeding, intussusception, diverticulitis, or bowel obstruction. Bleeding is the most common complication.1 MD is also the most common cause of obscure gastrointestinal bleeding in children and young adults. Diagnosis is challenging because no standardized diagnostic criteria are available. Before the introduction of balloon-assisted enteroscopy (BAE), the diagnostic accuracy of conventional modalities (computed tomography, small-bowel follow-through, angiography, or Technetium-99 m pertechnetate scintigraphy) was limited. Technetium-99 m pertechnetate scintigraphy (Meckel's scan) is a well-established tool for the diagnosis of MD, with high accuracy in children.2, 3 However, accuracy is not as high (less than 50%) in adults,4 because some MD patients may have little or no ectopic gastric tissue within the diverticulum. Capsule endoscopy is recommended as a first-line diagnostic tool for suspected small bowel bleeding in patients without bowel stenosis, but it has a limited role in MD because the bowel lumen cannot be inflated and good visibility of the distal small bowel is required.5 The development of BAE (including single-balloon and double-balloon enteroscopy) has provided a new diagnostic tool with high accuracy for MD.6 BAE also provides the possibility of treatment. Selected MD patients have reportedly been treated with endoscopic intervention.7-9 One recent study showed that BAE has the highest accuracy for diagnosis of a bleeding MD in adults, with diagnostic accuracy higher than that of a Meckel's scan (85.0% vs 21.4%, P < 0.001).5 When MD is suspected but conventional modalities provide no definite conclusion, retrograde BAE could be an alternative tool for confirmation of the diagnosis with high accuracy. Although the accuracy of BAE in patients with MD is high, some challenges persist in clinical practice. First, BAE is an invasive procedure and requires bowel preparation. Second, MD may be overlooked when the orifice is small or hidden by a mucosal-fold. To date, reports of BAE for MD have mostly employed double-balloon enteroscopy, while single-balloon enteroscopy has rarely been reported.10, 11 In this issue of the journal, Wei et al reported the clinical experience with single-balloon enteroscopy for diagnosis of adult MD in a single medical center in Taiwan. Compared to double-balloon enteroscopy, single-balloon enteroscopy is easier to perform and less time-consuming, and a previous meta-analysis found that the diagnostic rate is similar in patients with small bowel diseases.12 This technique could be considered as a first-line diagnostic tool in selected cases with strongly suspected MD. However, a conventional noninvasive modality (especially a Meckel's scan) should be performed first in children and young adults because retrograde BAE is a technical and invasive procedure and not available at some medical institutions. For symptomatic MD, surgical intervention is the standard method of treatment, and can prevent recurrent complications. BAE can be used for endoscopic intervention in selected patients with MD. Some cases with inverted MD were successfully resected with BAE.7, 8 As inverted MD can resemble a pedunculated polyp, careful manipulation during endoscopic intervention is necessary to prevent complications.11 Wei et al reported that some cases did not have recurrent bleeding on follow-up after endoscopic hemoclipping, but the possibility still exists because of the retained MD. Close follow-up is recommended. In conclusion, retrograde BAE could provide a reliable and useful modality with high diagnostic accuracy and the possibility of endoscopic intervention in selected patients with MD. The author declares no conflict of interest. The author transfers all copyright ownership of the above manuscript to the journal in the event the work is published.

Simple diverticulectomy is adequate for management of bleeding Meckel diverticulum

It is unclear whether simple diverticulectomy, rather than segmental bowel resection (SBR), is adequate treatment for gastrointestinal bleeding (GIB) secondary to Meckel diverticulum (MD). There is concern that ulcers in the adjacent bowel may continue to bleed if only the diverticulum is removed. This study seeks to determine if diverticulectomy is satisfactory treatment for bleeding MD. A multi-institution, retrospective review was performed for patients with a diagnosis of MD and GIB who underwent simple diverticulectomy or small bowel resection. Exclusion criteria were comorbid surgical conditions and other causes of GIB. The primary outcome was post-operative bleeding during the initial hospitalization. Secondary outcomes were bleeding after discharge, transfusion or additional procedure requirement, re-admission, and overall complications. There were 59 patients who met study criteria (42 diverticulectomy, 17 SBR). One patient in the SBR group had early post-operative bleeding (p = 0.288). There was one re-admission (p = 0.288) and three total complications in the SBR group (p = 0.021). There were no cases of bleeding or other complications in the diverticulectomy group. This study suggests that simple diverticulectomy is adequate for treatment of GIB caused by MD. Furthermore, diverticulectomy appears to have a lower overall complication rate.

Multifaceted behavior of Meckel's diverticulum in children.

Meckel's diverticulum (MD) is one of the most common congenital malformations of gastrointestinal tract in children. However, the nonspecific clinical manifestations of MD often cause a diagnostic as well as therapeutic challenge to pediatric surgeon. This study aimed to review our experience in managing this disease while evaluating the management strategies. We retrospectively analyzed the clinical data of all patients diagnosed with MD admitted to our center between January 2010 and December 2015. Factors documented including demographic criteria, clinical manifestations, preoperative examinations, surgical methods, histopathological characteristics, postoperative complications, and outcomes. The patients included 210 males and 76 females, aged from 1day to 15years. In fifty three patients, the MD was an incidental finding at laparotomy or laparoscopy. The remaining 233 patients were symptomatic and presented with various clinical features. Ninety nine patients presented with episodes of bleeding per rectum or melena. Fifty six patients demonstrated symptoms of diverticulitis or perforated MD. Forty patients were diagnosed as intestinal obstruction, and 35 patients with intussusception requiring surgical reduction. Two cases of Littre hernia and one case of foreign body trapped in MD were also observed in this group. Six patients misdiagnosed as appendicitis at another institution were reoperated in our department. Among the 99 patients with bleeding per rectum, 78 underwent a Tc-99m scan that showed a positive tracer in 55 patients and negative in 23. All patients underwent resection of the diverticulum, except for 2 cases of postponed resection. Histology revealed ectopic gastric mucosa or ectopic pancreatic tissue in 154 patients; significant differences were observed between the symptomatic group and the accidentally found group. One patient died of peritonitis and sepsis postoperatively; one case of anastomotic leak and one case of adhesive intestinal obstruction were reoperated. Meckel's diverticulum has various clinical presentations and it is difficult to make a precise diagnosis preoperatively. It is necessary to maintain a high suspicion of MD in the pediatric age group with symptoms of abdominal pain, gastrointestinal hemorrhage or intestinal obstruction. Heterotopic tissue is the main cause of complicated diverticulum, and it is safe and feasible to remove the incidentally found MD. Laparoscopy should become the first choice of methods in diagnosis and treatment of MD. Treatment study. Level IV.

Meckel's diverticulum in the adult

Meckel's diverticulum (MD) is the most common gastro-intestinal congenital malformation (approximately 2% in the overall population). The lifetime risk of related complications is estimated at 4%. These include gastro-intestinal bleeding, obstruction or diverticular inflammation. Diagnosis is difficult and rarely made, and imaging, especially in the case of complicated disease, is often not helpful; however exploratory laparoscopy is an important diagnostic tool. The probability of onset of complication decreases with age, and the diagnosis of MD in the adult is therefore often incidental. Resection is indicated in case of complications but remains debatable when MD is found incidentally. According to an analysis of large series in the literature, surgery is not indicated in the absence of risk factors for complications: these include male gender, age younger than 40, diverticulum longer than two centimetres and the presence of macroscopically mucosal alteration noted at surgery. Resection followed by anastomosis seems preferable to wedge resection or tangential mechanical stapling because of the risk of leaving behind abnormal heterotopic mucosa.

Reconsideration of the primary and secondary diagnostic criteria of Meckel's diverticulum scintigraphy. A study of 93 confirmed cases.

Meckel's diverticulum scintigraphy (MDS) is a common method for diagnosing ectopic gastric mucosa (EGM), but atypical images are difficult to diagnose. This study aimed to improve the understanding of the existing diagnostic criteria through a review of confirmed cases. A total of 352 patients underwent MDS. Among 120 patients with a positive diagnosis, 106 underwent surgery. This study analyzed the imaging presentation, surgical records, and pathological results. The existing diagnostic criteria included the location, shape, and radioactive appearance of the lesions. Data from surgical records with typical or atypical images were compared. One hundred cases (100/106) were surgically confirmed to be Meckel's diverticulum (MD). The remaining 6 were intestinal polyps, intestinal duplication, duodenal ulcer, non-Hodgkin's lymphoma (NHL) and hiatal hernia. Out of the 100 MD cases, 93 had complete operation records and 59/93 of the MDS 63.4% MD were located in the right lower quadrant, and 81.7% had a round shape in the scintiscan. The onset of the lesions activity in 96.8% (90/93) of the cases corresponded with the onset of the gastric activity. The radioactivity of 97.8% (91/93) of the lesions gradually increased during the examination. There were no significant differences between the typical and atypical scintiscan images: in the distance of MD from the ileocecal valve, in the MD length, and the basal diameter of MD for lesions at different scintiscans (P>0.05), or of different shapes (P>0.05). Location in the right lower quadrant and round shape of the lesions are not the primary diagnostic factors for Meckel's diverticulum. The establishment of the diagnosis of MD requires careful consideration of other imaging characteristics such as: a) The onset of lesions' radioactivity to correspond with the onset of the gastric activity and b) The lesions' radioactivity to gradually increase during the scan procedure.

Diagnosis of Bleeding Meckel's Diverticulum in Adults.

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.

Capsule Endoscopy detects Meckel’s Diverticulum in a Child with Recurrent Gastrointestinal Bleeding: Case Report and Review of the Literature

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract affecting about 2% of the populations. Gastrointestinal bleeding is a common presentation in pediatric and can be massive. The diagnosis of symptomatic MD is often difficult to make. We report on a 7-year-old boy who suffered from recurrent severe GI bleeding. He had normal upper and lower endoscopy and negative Meckel scan. Meckel's Diverticulum identification was achieved by wireless capsule endoscopy (WCE).

Symptomatic paediatric Meckel's diverticulum: stratified diagnostic indicators and accuracy of Meckel's scan.

The aim of the study was to delineate stratified diagnostic indicants and evaluate the diagnostic accuracy of technetium-99m (Tc)-pertechnetate scintigraphy in children with symptomatic Meckel's diverticulum (MD). This was a prospective linear observational study conducted over a period of 5 years on 73 children with a diagnosis of symptomatic MD. The independent variables assessed were age, sex, weight-for-age z-scores, clinical presentation, complications of MD, laparoscopic findings, haematologic and biochemical results, radiological results, and histological findings. Stepwise multiple logistic regression analysis was performed to determine the diagnostic markers. The sensitivity and specificity of Tc-pertechnetate scintigraphy were assessed. The incidence of MD with complications was 44%. The prevalence of ectopic gastric mucosa in histological specimens was 84%. There was a good correlation between rectal bleeding and the presence of ectopic gastric mucosa [r=0.94; 95% confidence interval (CI): 0.77-0.98]. Haematochezia associated with a drop in haemoglobin (>2 g/dl) was diagnostic of MD with ectopic gastric mucosa in children (n=42, 58%; P=0.006; odds ratio 1.99; 95% CI: 1.14-2.42). Bilious vomiting was diagnostic of complicated MD (n=12, 16%; P=0.007; odds ratio 1.89; 95% CI: 1.12-3.22). The sensitivity of Tc-pertechnetate scintigraphy was 84% and specificity was 22%. The positive predictive value was 0.64 and the negative predictive value was 0.22. The sensitivity and specificity of Tc-pertechnetate scintigraphy were dependent on the quantity and functional quality of the heterotopic gastric mucosa. The preoperative median z-score was -1.4 and the postoperative median z-score was -1.2. Tc-pertechnetate scintigraphy had a truncated predictive value. Its contribution in clinical decision making was poor. Clinical suspicion of MD should be high in children presenting with haematochezia associated with a drop in haemoglobin by more than 2 g/dl. Laparoscopy is an effective diagnostic and therapeutic tool.

Double-balloon enteroscopy for diagnosis of Meckel's diverticulum: Comparison with operative findings and capsule endoscopy

Meckel's diverticulum (MD) is one of the most common congenital gastrointestinal malformations. It is difficult to make a preoperative diagnosis of MD. To date, few data are available describing the diagnosis of MD by double-balloon enteroscopy (DBE) and capsule endoscopy (CE). To assess the value of DBE in the diagnosis of MD and comparatively evaluate the diagnostic yield of DBE and CE for MD. A single-center study was performed on patients with a confirmed diagnosis of MD by surgery and postoperative pathology between January 2003 and December 2011. Seventy-four patients (60 males) with a mean age of 29.0 ± 14.3 years were analyzed; 33 (55.0%) were between 21 and 40 years of age. Gastrointestinal bleeding was the major finding in 86.5% of the patients who were referred for DBE or CE examination. The mean duration of symptoms was 32.3 ± 48.7 months. In the 74 patients, the diagnostic yield of DBE for MD before surgery was 86.5% (64/74), and correct diagnoses were made in the majority of cases by retrograde DBE, with a few cases by antegrade DBE. In the 26 patients undergoing CE before DBE, the overall diagnostic yield of DBE was 84.6%, significantly greater than that of CE (7.7%, P < .000, McNemar's χ(2) test). Poor agreement was found between the 2 modalities (kappa = 0.03). For patients who are highly suspected of having MD, DBE provides a safe, effective, and reliable means of diagnosis before surgery.

Perforated Meckel’s diverticulitis on the mesenteric side: MDCT findings

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastro-intestinal tract (approximately 2% of population), and arises from improper closure and absorption of the omphalomesenteric duct. Very few cases of Meckel's diverticulitis on the mesenteric side have been reported in the surgical literature, and no reported cases have been documented on preoperative imaging. We report a 65-year-old woman presenting symptoms and signs of acute abdomen with an initial suspicion of acute appendicitis. MDCT imaging revealed a mesenteric abscess in the right lower quadrant at the level of the distal ileum as a complication of Meckel's diverticulitis on the mesenteric side. The patient recovered after a diverticulectomy without the need for a small bowel resection. This case demonstrates that MDCT is a fast imaging technique that may be helpful in the emergency setting for the preoperative diagnosis of an unusual complicated MD on the mesenteric side.

Intestinal obstruction caused by torsed gangrenous Meckel’s diverticulum encircling terminal ileum

Meckel's diverticulum (MD) is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage, obstruction, and inflammation. Obstruction of various types is the most common presenting symptom in the adult population. Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications. The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies. Delay in the diagnosis of a complicated MD can lead to significant morbidity and mortality. Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum. To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.

Meckel′s diverticulum in paediatric practice on Crete (Greece): A 10-year review

Although Meckel's diverticulum (MD) is the most prevalent congenital abnormality of the gastrointestinal tract, it has varied presentations and often becomes a diagnostic challenge. The purpose of this study was to review the diverse presentations of MD, record the epidemiologic features for Crete and review the detection techniques and the treatment options. This was a review of the records of all children who underwent surgery for MD in the department of Paediatric Surgery of the University Hospital of Crete (Greece) between January 1999 and January 2009. A total of 45 patients (32 male and 13 female) aged 1 to 13 years (median 10 years) with a diagnosis of MD were retrospectively reviewed. The collected data were analysed, looking at age, gender, clinical features, investigations, histopathological findings and surgical interventions. In 25 patients, MD was an incidental finding at laparotomy because of appendicitis. The remaining 20 patients were symptomatic and presented with various clinical features. Nine patients (19.9%) had clinical features of peritonitis; of these, three had perforated MD and six had Meckel's diverticulitis at laparotomy. Four patients were diagnosed with intestinal obstruction. Seven patients (15.5%) presented with lower gastrointestinal bleeding. Ultrasound scans revealed intussusception in three patients, requiring open reduction. The remaining four patients with bleeding per rectum underwent a Meckel's Tc99 scan that showed a positive tracer. All patients with MD underwent Meckel's diverticulectomy with appendicectomy. MD has an incidence of approximately 1 to 2% in our population. It is necessary to maintain a high index of suspicion in the diagnosis of MD paediatric age group because it can be easily misdiagnosed.