Can Meckel's diverticulum be diagnosed on sonography (ultrasound) of the abdomen?

Can Meckel's Diverticulum Be Diagnosed on Ultrasound?

Ultrasound can detect Meckel's diverticulum in some cases, particularly in children with complications like diverticulitis, but it is not the primary diagnostic modality and has significant limitations compared to nuclear medicine scintigraphy (Meckel scan) or CT enterography.

Primary Diagnostic Approach

The gold standard for diagnosing Meckel's diverticulum is nuclear medicine scintigraphy (Meckel scan), which involves intravenous administration of 99mTc pertechnetate that accumulates in ectopic gastric mucosa commonly found within symptomatic Meckel's diverticula 1. This technique is performed dynamically over 30-60 minutes to identify fixed abdominal regions of ectopic gastric mucosa 1.

Ultrasound Capabilities and Limitations

When Ultrasound May Be Useful

• In pediatric patients with complications: Ultrasound can demonstrate findings suggestive of inflamed Meckel's diverticulum, particularly in children presenting with diverticulitis 2.

• Specific sonographic features that may suggest Meckel's diverticulum include:

  • A tubular hyperechoic structure in patients with rectal bleeding due to diverticulitis 2
  • A cystic structure with irregular mucosal layer (more irregular than intestinal duplication) 2
  • Color Doppler may reveal anomalous vessels and inflammatory changes on the diverticulum wall 2

Critical Limitations

• Ultrasound findings often mimic other conditions, particularly acute appendicitis or intestinal duplication, making specific diagnosis difficult 2.

• The diagnosis of Meckel's diverticulum remains difficult even with modern imaging techniques, as small diverticula are often concealed by overlying small-bowel loops 3.

• Most symptomatic Meckel's diverticula occur in children and young adults, and the condition should be considered when other tests are negative 1.

Alternative Imaging Modalities

• CT enterography (CTE) has greater sensitivity for detecting small bowel masses and can help characterize abnormalities when Meckel's diverticulum presents with bleeding or obstruction 1.

• The radiological diagnosis is of paramount importance for proper patient management given the nonspecific clinical presentation (small-bowel obstruction, diverticulitis, perforation, gastrointestinal bleeding) 4.

Clinical Algorithm

1. For suspected Meckel's diverticulum (especially with GI bleeding in children/young adults): Obtain Meckel scan as first-line diagnostic test 1

2. If Meckel scan is negative but clinical suspicion remains high: Consider CT enterography to evaluate for anatomic abnormalities and complications 1

3. Ultrasound may be considered in pediatric patients presenting with acute abdominal pain when appendicitis is in the differential, as it may incidentally detect inflamed Meckel's diverticulum 2

4. Do not rely on ultrasound alone for definitive diagnosis, as the condition has myriad presentations and appearances across imaging modalities 5, 6