Meckel diverticulum in the pediatric population: Patient presentation and performance of imaging in prospective diagnosis

• Published in: Clinical imaging Vol. 91; pp. 37 - 44
• Main Authors: McDonald, Jennifer S., Horst, Kelly K., Thacker, Paul G., Thomas, Kristen B., Klinkner, Denise B., Kolbe, Amy B.
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01.11.2022; Elsevier Limited
• Subjects: Abdomen; Age; Asymptomatic; Autopsies; Bleeding; Computed tomography; Diagnosis; Diverticulum; Gastrointestinal bleeding; Intestinal obstruction; Meckel diverticulum; Medical imaging; Medical records; Nuclear medicine; Pain; Pain sensitivity; Pathology; Patients; Pediatrics; Population; Scintigraphy; Small bowel obstruction; Small intestine; Surgery; Small bowel obstruction; Computed tomography; Meckel diverticulum; Gastrointestinal bleeding
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2022.07.008

To determine the most common presentations of Meckel diverticulum (MD) in children and the performance of imaging modalities in prospective diagnosis. A 28-year retrospective review was performed of children under 18 years of age with MD listed as a diagnosis on pathology and/or surgical reports. The medical record was reviewed to determine presenting clinical scenarios. All imaging performed for each case was reviewed. Seventy-six patients met inclusion criteria. Of the surgically removed MD, most presented with abdominal symptoms (n = 31, 41%); gastrointestinal (GI) bleeding (n = 15, 20%), or both abdominal symptoms and GI bleeding (n = 7, 9%). Twenty-nine percent of MD were discovered incidentally at surgery performed for other reasons. Of the symptomatic MD, only 31% were prospectively diagnosed. For patients with abdominal symptoms, CT had a sensitivity of 13% (3/24) while nuclear medicine (NM) scan had a sensitivity of 0% (0/2). For patients with GI bleed, CT had a sensitivity of 29% (2/7) and NM scan had a sensitivity of 71% (10/14). For patients with both abdominal symptoms and GI bleed, CT was 0% (0/2) and NM scan 75% (3/4) sensitive. MD as a cause of abdominal symptoms and gastrointestinal bleeding may be difficult to diagnose due to nonspecific presentations and nonspecific findings. Most prospectively diagnosed MD are on NM scan in patients with GI bleed with abdominal pain (sensitivity of >70%). CT is relatively insensitive for MD in all symptomatology groups (0 to 29%). •Most children with symptomatic Meckel diverticulum present with nonspecific symptoms and without gastrointestinal bleeding.•Computed tomography is insensitive for the prospective imaging diagnosis of a Meckel diverticulum, even when symptomatic.•In the absence of surgery or visible cause, a Meckel's should be in the differential for pediatric small bowel obstruction.•Nuclear medicine Meckel scans are positive when the Meckel diverticulum contains gastric mucosa.