Diagnosis of Bleeding Meckel's Diverticulum in Adults (original) (raw)
Related papers
Symptomatic Meckel’s diverticulum in children: a 16-year review
Pediatric Surgery International, 2008
Meckel’s diverticulum (MD) has varied presentations and often becomes a diagnostic challenge. The purpose of this study was to review the various presentations of symptomatic MD and to assess the sensitivity of the Meckel’s scan as a diagnostic tool in patients with bleeding MD. The hospital records of 71 consecutive patients with a diagnosis of MD from 1990 to 2005 were retrospectively reviewed. The data was assessed for age at presentation, sex, clinical features, investigations performed, surgical intervention and histopathological findings. There were 71 patients with a diagnosis of MD (age 2 days–14 years). In eight patients, MD was an incidental finding at laparotomy. The remaining 63 patients were symptomatic and presented with various clinical features. Ten patients (15.8%) had clinical features of peritonitis; of these, six had perforated MD and four had Meckel’s diverticulitis at laparotomy. Nine patients (14.2%) were diagnosed as intestinal obstruction, and at laparotomy, a Meckel’s band was found to be the cause of the obstruction. Nine patients (14.2%) had a patent vitello-intestinal duct and presented with umbilical discharge. Thirty-five patients (55.5%) presented with episodes of bleeding per rectum or malaena. Ultrasound scans revealed intussusception in six patients requiring open reduction. Of the remaining 29 patients with bleeding per rectum, 27 underwent a Meckel’s Tc99 scan that showed a positive tracer in 18 patients (66.6%) and negative in 9 (33.3%). All patients with a symptomatic MD underwent resection of the diverticulum. Histology revealed ectopic gastric mucosa in 43 patients (68.3%). MD has various presentations and can be easily misdiagnosed. It is necessary to maintain a high index of suspicion in the paediatric age group. The Meckel’s scan has a poor positive predictive value and cannot be relied upon for a diagnosis in cases of bleeding MD if Tc99 scan is negative.
The value of sodium pertechnetate Tc99m scans in the diagnosis of Meckel's diverticulum
Pediatric Surgery International, 1996
A retrospective study was conducted of our experience with sodium pertechnetate Tc99m scans for diagnosing suspected Meckel's diverticula. Seventy-seven cases scanned between 1979 and 1994 were reviewed. Eighty per cent of the group presented with bleeding per rectum, 12% with pain, and 6.5% with anaemia. Ten scans were positive with 7 true-positive and 3 false-positive. Of the 67 negative scans, 3 were false-negatives. There were six Meckel's diverticuli and four duplication cysts between the true-positive and false-negative groups. All presented with major gastrointestinal (GI) bleeding and gastric mucosa was identified on histology. The three false-positive cases had inappropriate laparotomies on the basis of scan results. The test sensitivity was 70% with a specificity of 95%, giving an overall accuracy of 92%. The Meckel's scan is a useful investigation for GI bleeding in children. Surgical intervention should be guided by the full clinical picture and the scan, rather than the scan result alone.
Meckel’s diverticulum: new solutions for an old problem?
Frontline Gastroenterology, 2015
Meckel's diverticulum (MD) is the most commonly encountered true diverticulum in the small bowel. Although overall a rare cause of gastrointestinal bleeding, it remains an important differential in a child/young adult presenting with lower gastrointestinal bleeding. We present two MD cases, one associated with brisk bleeding resulting in haemodynamic instability and the other in insidious blood loss causing symptoms of chronic iron deficiency. These cases illustrate the heterogeneous nature of the clinical picture associated with Meckel's diverticulae, a condition most gastroenterological and surgical units will encounter. We subsequently discuss the diagnostic and management dilemma Meckel's diverticulae pose and appraise the latest evidence and management strategies in this regard.
Meckel’s Diverticulum with Gastrointestinal Bleeding: Role of Computed Tomography in Diagnosis
Digestive Diseases and Sciences, 2010
A 26-year-old white male with a prior history of a benign cardiac arrhythmia and seasonal allergies presented with gastrointestinal bleeding and anemia. Two months prior to admission, he was seen in an urgent care clinic with intermittent, crampy left lower quadrant abdominal pain, worse 15-60 min after eating, and associated with alternating constipation and diarrhea. During that visit, a comprehensive metabolic panel, complete blood cell count and right upper quadrant ultrasound were normal. The patient was given the diagnosis of ''vigorous gastrocolic reflex'' and was successfully treated with MiralaxÒ.
Egyptian Journal of Radiology and Nuclear Medicine
Background Meckel 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. Results Seventy-three c...
An unsuspected bleeding Meckel\u27s diverticulum in an adult detected on mesenteric angiography
2013
Meckel\u27s diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from a Meckel\u27s diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel\u27s diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel\u27s diverticulum and correlation with other radiological imaging
CT Detection of Symptomatic and Asymptomatic Meckel Diverticulum
AJR. American journal of roentgenology, 2015
The objective of our study was to determine how often symptomatic Meckel diverticulum and asymptomatic Meckel diverticulum are detected on CT in patients with known Meckel diverticulum and to evaluate factors that influence detection. A total of 85 CT examinations of 40 patients (eight pediatric patients and 32 adult patients; 29 male patients and 11 female patients; average age, 46.2 ± 23.7 [SD] years) with a pathologic diagnosis of Meckel diverticulum were retrospectively evaluated. These patients included 26 adult patients with incidentally found asymptomatic Meckel diverticulum and 14 patients (eight pediatric and six adult patients) with symptomatic Meckel diverticulum. The CT technical factors and patients' morphologic factors were compared with the detection of Meckel diverticulum using mixed-effect logistic regression models. Meckel diverticulum was detected on at least one CT examination in eight of 14 (57.1%) symptomatic patients (two of four patients with bleeding, tw...
Symptomatic paediatric Meckel’s diverticulum
Nuclear Medicine Communications, 2014
Purpose The aim of the study was to delineate stratified diagnostic indicants and evaluate the diagnostic accuracy of technetium-99m (99m Tc)-pertechnetate scintigraphy in children with symptomatic Meckel's diverticulum (MD). Materials and methods 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-forage 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 99m Tc-pertechnetate scintigraphy were assessed. Results 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 99m 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 99m 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. Conclusion 99m 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.