Diverse presentations in pediatric Meckel's diverticulum: A review of 100 cases

Background: Our objective was to analyze demographics and characteristics of Meckels diverticulum with different manifestations in pediatric patients.

Methods: This is a retrospective study in children with symptomatic Meckels diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckels scan results, surgical and histological findings were analyzed.

Results: One hundred symptomatic Meckels diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckels scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckels diverticulum with non-obstructive symptoms (p < 0.001).

Conclusion: Diverse presentations in pediatric Meckels diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with nonobstructive symptoms.