From the Guidelines
Meckel's diverticulum in children is typically characterized by gastrointestinal bleeding, often intermittent, and is usually diagnosed using a Meckel scan.
Key Features
- Gastrointestinal bleeding: Meckel's diverticulum is a common cause of gastrointestinal bleeding in children, often presenting with unexplained intermittent bleeding 1.
- Age: Most symptomatic Meckel diverticula are found in children and young adults, although they can occasionally be seen in older individuals 1.
- Diagnosis: A Meckel scan, which involves the intravenous administration of 99mTc pertechnetate, can be used to identify a Meckel diverticulum, especially in young patients with otherwise unexplained lower gastrointestinal bleeding 1.
- Imaging: The Meckel scan technique involves dynamic scintigraphy for 30-60 minutes to identify a fixed abdominal region of ectopic gastric mucosa, which is often found in a Meckel diverticulum 1.
Clinical Considerations
- Evaluation: A Meckel scan can be considered to identify the cause of unexplained intermittent GI bleeding in children and adolescents after negative endoscopic evaluation, including capsule endoscopy if available, and cross-sectional evaluation of the small bowel 1.
- Small bowel evaluation: In patients with gastrointestinal bleeding, an evaluation of the small bowel may be performed with push enteroscopy, video capsule endoscopy, or a radionuclide scan for a Meckel’s diverticulum, especially in young patients 1.
From the Research
Clinical Features of Meckel's Diverticulum in Children
- The most common clinical manifestations of Meckel's diverticulum in children include lower gastrointestinal bleeding, intussusception, and peritonitis 2, 3, 4, 5
- Intestinal obstruction is also a frequent complication, often caused by intussusception or volvulus 4, 5
- Abdominal pain and bloody stool are common symptoms, with some patients presenting with vomiting or other non-specific symptoms 3, 4, 5
Diagnostic Methods
- Technetium-99m pertechnetate imaging (Meckel's scan) is a useful diagnostic tool, particularly in patients with gastrointestinal bleeding 2, 3, 6
- The sensitivity and specificity of Meckel's scan vary depending on the presentation, with higher sensitivity in patients with painless rectal bleeding 6
- False-positive and false-negative scans can occur, and other diagnostic methods such as laparoscopy may be necessary in some cases 6
Histological Findings
- Ectopic gastric mucosa is the most common type of heterotopic tissue found in Meckel's diverticulum, followed by ectopic pancreatic tissue 2, 3, 4, 5
- The presence of ectopic tissue is more prevalent in patients with non-obstructive symptoms, such as gastrointestinal bleeding 5
- The type of ectopic tissue can influence the clinical presentation and complications of Meckel's diverticulum 5
Treatment and Outcomes
- Surgical excision of the Meckel's diverticulum is a safe and effective treatment for symptomatic patients 2, 5
- Laparoscopic surgery is a widely used approach, particularly in patients with non-obstructive symptoms 5, 6
- The outcomes of treatment are generally good, with most patients recovering uneventfully 2, 5