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Hu Y, Wang X, Jia L, Wang Y, Xin Y. Diagnostic accuracy of high-frequency ultrasound in bleeding Meckel diverticulum in children. Pediatr Radiol 2020; 50:833-839. [PMID: 32076751 DOI: 10.1007/s00247-020-04628-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/03/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Meckel diverticulum is one of the most important causes of small bowel bleeding in children. Reports suggest that ultrasonography can be used as an alternative examination for children with negative radionuclide scanning results or children with atypical clinical manifestations. OBJECTIVE To evaluate the diagnostic accuracy of high-frequency ultrasound in children with bleeding Meckel diverticulum. MATERIALS AND METHODS We collected the data of children who were admitted to our hospital for the main symptom of bloody stool from February 2006 to December 2017. Ultrasonography was performed in all children. The final diagnosis was confirmed by pathological analysis or clinical follow-up observation. We evaluated the diagnostic performance of ultrasonography according to the final diagnosis. RESULTS A total of 784 eligible children were enrolled in the study. Presenting symptoms or findings included black and red stool in 528 (67.3%), bright red stool in 51 (6.5%) and obscure or occult bloody stool in 205 (26.1%). Anemia was diagnosed in 489 (62.4%). Ultrasonography diagnosed Meckel diverticulum with a sensitivity of 93.6% (95% confidence interval [CI] 91.0-95.6%) and a specificity of 98.1% (95% CI 95.9-99.3%). CONCLUSION High-frequency ultrasound diagnosis of Meckel diverticulum in children has high sensitivity and specificity.
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Affiliation(s)
- Yanxiu Hu
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Xiaoman Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China.
| | - Liqun Jia
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Yu Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Yue Xin
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
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Chen Q, Gao Z, Zhang L, Zhang Y, Pan T, Cai D, Xiong Q, Shu Q, Qian Y. Multifaceted behavior of Meckel's diverticulum in children. J Pediatr Surg 2018; 53:676-681. [PMID: 29331260 DOI: 10.1016/j.jpedsurg.2017.11.059] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE/BACKGROUND Meckel's diverticulum (MD) is one of the most common congenital malformations of gastrointestinal tract in children. However, the nonspecific clinical manifestations of MD often cause a diagnostic as well as therapeutic challenge to pediatric surgeon. This study aimed to review our experience in managing this disease while evaluating the management strategies. METHODS We retrospectively analyzed the clinical data of all patients diagnosed with MD admitted to our center between January 2010 and December 2015. Factors documented including demographic criteria, clinical manifestations, preoperative examinations, surgical methods, histopathological characteristics, postoperative complications, and outcomes. RESULTS The patients included 210 males and 76 females, aged from 1day to 15years. In fifty three patients, the MD was an incidental finding at laparotomy or laparoscopy. The remaining 233 patients were symptomatic and presented with various clinical features. Ninety nine patients presented with episodes of bleeding per rectum or melena. Fifty six patients demonstrated symptoms of diverticulitis or perforated MD. Forty patients were diagnosed as intestinal obstruction, and 35 patients with intussusception requiring surgical reduction. Two cases of Littre hernia and one case of foreign body trapped in MD were also observed in this group. Six patients misdiagnosed as appendicitis at another institution were reoperated in our department. Among the 99 patients with bleeding per rectum, 78 underwent a Tc-99m scan that showed a positive tracer in 55 patients and negative in 23. All patients underwent resection of the diverticulum, except for 2 cases of postponed resection. Histology revealed ectopic gastric mucosa or ectopic pancreatic tissue in 154 patients; significant differences were observed between the symptomatic group and the accidentally found group. One patient died of peritonitis and sepsis postoperatively; one case of anastomotic leak and one case of adhesive intestinal obstruction were reoperated. CONCLUSION Meckel's diverticulum has various clinical presentations and it is difficult to make a precise diagnosis preoperatively. It is necessary to maintain a high suspicion of MD in the pediatric age group with symptoms of abdominal pain, gastrointestinal hemorrhage or intestinal obstruction. Heterotopic tissue is the main cause of complicated diverticulum, and it is safe and feasible to remove the incidentally found MD. Laparoscopy should become the first choice of methods in diagnosis and treatment of MD. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Qingjiang Chen
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Zhigang Gao
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Lifeng Zhang
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Yuebin Zhang
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Tao Pan
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Duote Cai
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Qixing Xiong
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Qiang Shu
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000
| | - Yunzhong Qian
- Department of pediatric general surgery, Children's Hospital, Zhejiang University School of Medicine, No. 57 Zhugan Street, Xiacheng District, Hangzhou, P.R. China 310000.
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Bollegala N, Patel K, Mosko JD, Bernstein M, Brahmania M, Liu L, Steinhart AH, Silver SS, Bell CM, Nguyen GC, Weizman AV. Quality Improvement Primer Series: The Plan-Do-Study-Act Cycle and Data Display. Clin Gastroenterol Hepatol 2016; 14:1230-3. [PMID: 27211505 DOI: 10.1016/j.cgh.2016.04.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Natasha Bollegala
- Division of Gastroenterology, Department of Medicine, Women's College Hospital, University of Toronto, Ontario, Canada.
| | - Kalpesh Patel
- Section of Gastroenterology and Hepatology, Baylor School of Medicine, Houston, Texas
| | - Jeffrey D Mosko
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Michael Bernstein
- Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Mayur Brahmania
- Division of Gastroenterology, Department of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Louis Liu
- Division of Gastroenterology, Department of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - A Hillary Steinhart
- Department of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation University of Toronto, Ontario, Canada
| | - Samuel S Silver
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Chaim M Bell
- Institute of Health Policy, Management and Evaluation University of Toronto, Ontario, Canada; Division of Internal Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Department of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation University of Toronto, Ontario, Canada
| | - Adam V Weizman
- Department of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation University of Toronto, Ontario, Canada
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