Sections

Workup

Approach Considerations

The history and physical examination are of paramount importance for establishing a clinical diagnosis of Meckel diverticulum. Perform a rapid assessment of any child with significant bleeding or signs of small bowel obstruction, ischemia, or inflammation. Meckel diverticulum is a relatively uncommon etiology for any of these complications, but it must always be considered in the differential diagnosis.

Laboratory Studies

Routine laboratory findings, including a complete blood cell (CBC) count, electrolyte levels, glucose, blood urea nitrogen (BUN), creatinine levels, and coagulation screen results, are not helpful in establishing the diagnosis of Meckel diverticulum, but they are necessary to manage a patient with gastrointestinal bleeding along with a blood type and cross-match.

Hemoglobin and hematocrit levels are low in the setting of anemia or significant bleeding. In one series, 58% of children had average hemoglobin levels lower than 8.8 g/dL.

In a prospective linear observational study of 73 children with a diagnosis of symptomatic Meckel diverticulum that compared mean hemoglobin level before onset of symptoms and at presentation of rectal bleeding, there was a 58% correlation between Meckel diverticulum and hematochezia with a drop in hemoglobin of more than 2 g/dL.^[31]

Ongoing bleeding from a Meckel diverticulum can cause iron deficiency anemia. However, megaloblastic anemia can also be seen due to vitamin B₁₂ or folate deficiency. These can occur secondary to small bowel overgrowth if chronic dilatation and/or stasis related to the diverticulum is present. Low albumin and low ferritin levels may erroneously lead to a diagnosis of inflammatory bowel disease.

Imaging Studies

According to the Mayo Clinic, "Meckel's diverticulum is frequently suspected, often looked for, and seldom found."^[32]Preoperative diagnosis is difficult, especially if the presenting symptom is not gastrointestinal (GI) bleeding. In one series, patients often had a correct preoperative diagnosis if the presenting symptom was GI bleeding, but only 11% of preoperative diagnoses were correct if other symptoms predominated.^[32]

Imaging studies are performed to confirm a clinical suspicion of Meckel diverticulum.

Radiography

Plain radiography of the abdomen is of limited value. It may reveal evidence of nonbleeding complications, including enteroliths and signs of intestinal obstruction, such as air or air-fluid levels (see the image below), or perforation.

Pediatric Meckel Diverticulum. Anteroposterior view of an abdominal radiograph showing multiple dilated loops of a small bowel with air-fluid levels.

Barium studies have largely been replaced by other imaging techniques; however, if a barium study is indicated, it should never precede the technetium-99m scan (99m-Tc pertechnetate scintigraphy; Meckel scan) (see below), because barium may obscure the hot spot.

Traditional small-bowel series using barium have been unreliable in the detection of Meckel diverticulum. However, for patients who require a barium study to primarily look for other conditions, enteroclysis is more sensitive in detecting Meckel diverticulum. Enteroclysis involves using a continuous infusion of barium with adequate compression of the ileal loops and intermittent fluoroscopy to detect Meckel diverticulum. If the barium mixture is too dense and the fold pattern cannot be visualized, carboxymethylcellulose sodium can be used as the contrast medium.

On barium studies, Meckel diverticulum may appear as a blind-ending pouch on the antimesenteric side of the distal ileum. If filling defects are visualized, the diverticulum may contain a tumor. Characteristic radiologic signs for Meckel diverticulum include demonstration of a triradiate fold pattern or a mucosal triangular plateau. Occasionally, a gastric rugal pattern may also be found within the Meckel diverticulum.

A barium enema can be performed if intussusception is suspected. Some people have tried hydrostatic therapy to reduce intussusception, but this has not been found to be useful.

Meckel scan

When a patient has GI bleeding suggestive of Meckel diverticulum, the diagnostic evaluation should focus on the "Meckel scan," a 99m-Tc pertechnetate scintiscan (0.25 mCi/kg in children, up to the dosage used in adults; 8-12 mCi in adults).^[2]The Meckel scan is the preferred modality, because it is noninvasive, involves less radiation exposure, and is more accurate than an upper GI and small-bowel follow-through study. The pertechnetate is taken up by heterotopic gastric mucosa. Because bleeding from the Meckel diverticulum is related to acid-induced damage of mucosa adjacent to the parietal cell containing tissue, it is always included early in the work-up.^[33]

After intravenous injection of the isotope, a gamma camera is used to scan the abdomen. This procedure usually lasts approximately 30 minutes.^[2]Gastric mucosa secretes the radioactive isotope; thus, if the diverticulum contains this ectopic tissue, it is recognized as a hot spot.

Based on a retrospective review of Meckel scans performed from 1993-2011, the Meckel scan has a reported sensitivity of 94% and a specificity of 97% in children.^[34]In adults, in whom GI bleeding is a much less common presentation, the scan has a lower sensitivity (62.5%), a much lower specificity (9%), and a lower accuracy (46%).^[35]

Because the Meckel scan is specific for gastric mucosa (ie, in the stomach or ectopic) and not specifically diagnostic of Meckel diverticulum, false-positive results occur whenever ectopic gastric mucosa is present. Duodenal ulcer, small intestinal obstruction, some intestinal duplications, ureteric obstruction, aneurysm, and angiomas of the small intestine have yielded positive results. False-negative results can occur when gastric mucosa is very slight or absent in the diverticulum, if necrosis of the diverticulum has occurred, or if the Meckel diverticulum is superimposed on the bladder.^[36]

Accuracy of the scan may be enhanced with administration of cimetidine, glucagon, and pentagastrin. Cimetidine enhances the uptake and blocks the secretion of 99m-Tc pertechnetate from ectopic gastric mucosa,^[37] which helps to improve the lesion-to-background ratio in enhancing a Meckel scan. Pentagastrin also enhances uptake of the isotope but also increases peristalsis, attenuating its value. Glucagon is used to decrease peristalsis, thus allowing the signal to be taken up during a longer exposure time. One strategy uses both pentagastrin and glucagon. With newer imaging technology, false-positive and false-negative rates have declined.

Bleeding scan

A bleeding scan can be performed to identify the source if the patient is bleeding at 0.1 mL/min or more. The scan involves removing and labeling some of the patient's own red blood cells 99m-Tc, reinjecting them into the patient, and then scanning the abdomen for hot spots.^{[38, 39]}

A retrospective study demonstrated that a repeat Meckel scan can be diagnostic in patients with an equivocal or negative finding who continue to have bleeding and a high clinical suspicion for Meckel diverticulum.^[40]Following an equivocal scan, 58% of the repeat scans were found to be positive, and 85% of these had a Meckel diverticulum. For patients with a negative first scan with a persistent high suspicion for Meckel diverticulum, 14% were positive on repeat study, and 86% remained negative. A repeat scan can also be helpful to differentiate a false-positive result from a true Meckel diverticulum.^[40]

Arteriography

Selective arteriography may be helpful in patients in whom the results from scintigraphy and barium studies are negative. Usually, this occurs if the bleeding is either intermittent or has completely resolved.

When the rate of bleeding is greater than 1 mL/min, a superior mesenteric arteriogram can be helpful, but interpretation may be difficult due to overlying blood vessels. In these cases, selective catheterization of the distal ileal arteries may be needed.

Demonstration of abnormal arterial branches, dense capillary staining, or extravasation of the contrast medium confirms the presence of a Meckel diverticulum. However, a well-developed arterial supply may not always be present in the Meckel diverticulum; thus, these arteriographic signs are not very reliable.

Computed tomography (CT) scanning

Previously, abdominal CT scanning was not considered helpful, because differentiating Meckel diverticulum from the small-bowel loops is difficult. However, a blind-ending, fluid-filled, and/or gas-filled structure in continuity with small bowel may be visualized. CT scanning may also reveal an enterolith, intussusception, or diverticulitis. CT enterography advancements have increased the sensitivity in the diagnosis of Meckel diverticulum.^[33]

In a retrospective study to determine the frequency of detecting symptomatic and asymptomatic Meckel diverticulum in patients known to have the lesion, comprising a total of 85 CT examinations (23 on 14 symptomatic patients and 62 on 26 asymptomatic patients) after surgical resection of Meckel diverticulum, a Meckel diverticulum was detected in 34.1% of patients.^[41]In symptomatic patients, Meckel diverticulum could be seen in 57.1% of patients on at least one CT examination and in 56.5% of the total CT examinations. Among the 14 symptomatic patients with negative studies, 6 involved children with little peritoneal fat, which likely related to the failure to see the diverticulum. In asymptomatic patients, Meckel diverticulum was detected in 42.3% patients on at least one CT examination and 25.8% of the total CT examinations. The authors concluded that CT scanning was able to detect Meckel diverticulum in 47.5% of all patients. The highest rates of success were found in symptomatic patients and in those with adequate peritoneal fat.^[41]

Ultrasonography

Ultrasonography has been used in some cases of Meckel diverticulum. This modality tends to be helpful if the patient presents with anatomic rather than mucosal complications. A retrospective study that analyzed ultrasound characteristics of pathologically proven Meckel diverticulum concluded that this condition is difficult to detect by ultrasound (detection rate of 15.5%).^[42]However, the presence of complications such as intussusception (24%), intestinal obstruction (24%), and diverticulitis (15.5%) increased the rate of detection.

Capsule endoscopy

Capsule endoscopy is a relatively new technology that assists with imaging in the small intestine . Wireless capsule endoscopy has been successfully used to identify Meckel diverticulum in young children and adolescents^{[43, 44]} especially after endoscopy and colonoscopy failed to detect the site of bleeding. Features that are noted include two lumina, a thickened bridge, an ulcer and, occasionally, direct visualization of ectopic gastric mucosa. However, during active bleeding, the diverticulum itself may be missed, lowering its sensitivity in those circumstances. In adults, this same technique has been used to identify an inverted Meckel diverticulum that presented as GI bleeding.^[45]

Other imaging studies

Magnetic resonance imaging (MRI)

Newer imaging modalities have been used to diagnose Meckel diverticulum. Magnetic resonance (MR) enterography (MRE) was able to visualize a Meckel diverticulum in an adult who presented with GI bleeding after numerous other modalities had failed to reveal the source of bleeding. MRI of another case revealed a cystlike structure of the small intestine in the iliac fossa with high signal intensity.^[46]This cystlike structure had a tear drop shape in the nonenhanced T1-weighted spin-echo coronal image, suggesting that it was a blood-filled body.

MR imaging can also be used to detect inflamed Meckel diverticulum, which is especially attractive for pediatric patients due to the lack of ionizing radiation.^[46]

Multidetector-row CT (MDCT) scanning

In a retrospective study that used MDCT scanning evaluate a series of patients prior to surgery for small bowel obstruction for factors such visualization of Meckel diverticulum, complication type of Meckel diverticulum, location and grade of small bowel obstruction, and the identification of a normal appendix, the authors found that when the Meckel diverticulum was visualized on preoperative MDCT scanning, it could be considered the likely source of the obstruction.^[47]If the obstructive process was seen in the midline location, at the terminal branch of the superior mesenteric artery, then the Meckel diverticulum was possibly the cause of the obstruction. However, the preoperative diagnosis of Meckel could not be made if it was not noted in MDCT scanning; this is frequently the situation in children as the diverticulum is not as developed. Two children with obstruction, were noted to have congenital bands between the mesentery and Meckel diverticulum.^[47]

Single-photon emission tomography/CT (SPECT/CT) scanning

Ambiguous results of a Meckel scan have recently been clarified with hybrid SPECT/CT scanning. SPECT/CT scanning enhances the sensitivity of a Meckel scan by precisely localizing ectopic gastric mucosa at an abnormal anatomic structure, while decreasing the false-negative or false-positive results associated with a traditional Meckel scan. Because of increased radiation, its greatest value may be in complicated situations.

In a case report that employed SPECT/CT fusion imaging after a CT scan showed an irregular inflammatory lesion believed to be an abscess in the distal ileum with a normal appendix, 99m-Tc pertechnetate scintigraphy was performed after the intravenous injection of 370 MBq 99m-Tc pertechnetate.^[48] Dynamic (2 min/frame) and delayed (30 min, 60 min) images revealed the focal concentration to be under the liver, similar to the gastric uptake. SPECT/CT fusion imaging clarified that the focal concentration was in the distal ileum, surrounded by the inflammatory lesion.^[48]Thus, in the face of complications related to a Meckel diverticulum, SPECT/CT fusion imaging can enhance the preoperative findings.

A 3-year-old girl was diagnosed with Meckel diverticulum by planar scintigraphy; due to resolution of her symptoms and concomitant congenital heart disease, surgery was not performed at the time.^[49]She presented 7 years later with massive hematochezia; a repeat planar scintigraphy showed an uptake in the area of the kidney. Whether this was due to physiologic uptake by the kidney or by ectopic gastric mucosa is unclear. A SPECT/CT scan was able to confirm that the Meckel diverticulum was the exact anatomic site of the focal concentration.^[49]

Histologic Findings

The surgical and oncologic relevance of Meckel diverticulum comes from its pluripotent cell lining. In one study, heterotropic gastric mucosa was found in 62% of cases, pancreatic tissue was found in 6%, both pancreatic tissue and gastric mucosa were found in 5%, jejunal mucosa was found in 2%, Brunner tissue was found in 2%, and both gastric and duodenal mucosa were found in 2%.^[3]

Rarely, ectopic tissue may undergo malignant degeneration; consequently, because the wall of the diverticulum is thin, a small cancer can penetrate and widely metastasize within the peritoneal space. In a case report, the immunohistochemical profile of the tumor cells, along with the presence of gastric epithelial differentiation, favored its origin in ectopic gastric epithelium.^[50] Per the authors’ report at the time, this was the first patient with gastric cancer peritoneal metastases reported in the literature and successfully treated.

GISTs can coexist along with other tumors. Carcinoid, pancreatic, and gastrointestinal stromal tumors (GIST) have been found in resected specimen of perforated or symptomatic Meckel diverticulum. A case report described a case of perforated Meckel diverticulum in which histologic findings revealed a GIST within the Meckel diverticulum.^[51]The study concluded that segmental resection of the small bowel should be considered in cases of perforation due to the risks of a tumor within the diverticulum.

Helicobacter pylori is a gram-negative rod that has virulence factors, allowing them to survive in the mucus layer adherent to gastric epithelium. The presence of H pylori in a heterotopic gastric mucosa in a Meckel diverticulum has not been widely reported, and its actual prevalence may vary. In a review of the literature for both adult and pediatric cases, a 2% prevalence of H pylori was noted in heterotopic gastric mucosa.^[52]The authors thus proposed considering an addition to the “rule of twos” related to Meckel diverticulum. In contrast, a small series of 21 consecutive patients from Turkey using polymerase chain reaction (PCR) failed to identify 23S ribosomal RNA sequences from the organism in their 12 surgical specimens with heterotopic gastric mucosa.^[53]

Although the underlying mechanisms leading to the rarely described perforated Meckel diverticulum in neonates have not been fully elucidated, it is thought that ectopic mucosa appeared to have little association with the development of perforation in these patients. Previous studies suggested that bowel obstruction was the most common etiology resulting in perforated Meckel diverticulum in term infants. High pressure within a thin diverticulum was hypothesized to play a vital role in the development of perforation in the neonatal period.^{[54, 55]} However, a small case series describing five neonates with perforation in a Meckel diverticulum demonstrated extensive inflammation without ectopic mucosa and gangrenous inflammation.^[56]The authors of the series proposed that hypoxia, inadequate blood supply, intestinal permeability, and early use of postnatal steroid and indomethacin can increase the risk of spontaneous intestinal perforation.^[56]

Like the authors of the small series above who inferred that the perforation may be related to intestinal immaturity, the authors of this article agree that in premature infants and neonates, conditions could lead to a necrotizing enterocolitis event that is centered in the Meckel diverticulum in a vulnerable patient. Another small case series that described seven cases of neonatal perforated Meckel diverticulum found heterotopic mucosa in just two cases and no evidence of intrinsic bowel wall weakness.^[57]

In another case report, an inverted Meckel diverticulum contained several aberrant smooth muscle bundles.^[58] The investigators proposed that these muscle bundles may have produced abnormal peristaltic movement, acting as a lead point for the inversion and ileoileal intussusception.

A retrospective case study showed Meckel diverticulum with gastric heterotopia has an increased frequency of abdominal pain, vomiting/nausea, and rectal bleeding compared with Meckel diverticulum with pancreatic heterotopia or no heterotophic tissue.^[59]

Treatment & Management

Opitz JM, Schultka R, Göbbel L. Meckel on developmental pathology. Am J Med Genet A. 2006 Jan 15. 140 (2):115-28. [QxMD MEDLINE Link].
Farrell MB, Zimmerman J. Meckel's diverticulum imaging. J Nucl Med Technol. 2020 Sep. 48 (3):210-3. [QxMD MEDLINE Link]. [Full Text].
Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel's diverticulum. AJR Am J Roentgenol. 2007 Jul. 189 (1):81-8. [QxMD MEDLINE Link].
Garg D, Singh AP, Kothari S, Kumar A. Urachal cyst, Meckel's diverticulum and band, and urachus. APSP J Case Rep. 2017 Jan-Feb. 8 (1):8. [QxMD MEDLINE Link].
Anderson DJ. Carcinoid tumor in Meckel's diverticulum: laparoscopic treatment and review of the literature. J Am Osteopath Assoc. 2000 Jul. 100 (7):432-4. [QxMD MEDLINE Link].
Ghahremani GG. Radiology of Meckel's diverticulum. Crit Rev Diagn Imaging. 1986. 26 (1):1-43. [QxMD MEDLINE Link].
Ruscher KA, Fisher JN, Hughes CD, et al. National trends in the surgical management of Meckel's diverticulum. J Pediatr Surg. 2011 May. 46 (5):893-6. [QxMD MEDLINE Link].
Alemayehu H, Hall M, Desai AA, St Peter SD, Snyder CL. Demographic disparities of children presenting with symptomatic Meckel's diverticulum in children's hospitals. Pediatr Surg Int. 2014 Jun. 30 (6):649-53. [QxMD MEDLINE Link].
Zhao L, Feng S, Wu P, Lai XH, Lv C, Chen G. Clinical characteristics and surgical outcome in children with intussusceptions secondary to pathologic lead points: retrospective study in a single institution. Pediatr Surg Int. 2019 Jul. 35 (7):807-11. [QxMD MEDLINE Link].
Bertozzi M, Melissa B, Radicioni M, Magrini E, Appignani A. Symptomatic Meckel's diverticulum in newborn: two interesting additional cases and review of literature. Pediatr Emerg Care. 2013 Sep. 29 (9):1002-5. [QxMD MEDLINE Link].
Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ 3rd. Surgical management of Meckel's diverticulum. An epidemiologic, population-based study. Ann Surg. 1994 Oct. 220 (4):564-8; discussion 568-9. [QxMD MEDLINE Link]. [Full Text].
Pandove PK, Moudgil A, Pandove M, Chandrashekhar, Sharda D, Sharda VK. Meckel's diverticulum mesentery along with its band forming a hernial sac: A rare case of internal herniation. Int J Surg Case Rep. 2015. 10:17-9. [QxMD MEDLINE Link]. [Full Text].
Paun DL, Vija L, Stan E, Banica A, et al. Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion from a Meckel diverticulum neuroendocrine tumor: case report. BMC Endocr Disord. 2015 Nov 26. 15:72. [QxMD MEDLINE Link]. [Full Text].
St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H. Meckel's diverticulum in children: a 20-year review. J Pediatr Surg. 1991 Nov. 26 (11):1289-92. [QxMD MEDLINE Link].
Cserni G. Gastric pathology in Meckel's diverticulum. Review of cases resected between 1965 and 1995. Am J Clin Pathol. 1996 Dec. 106 (6):782-5. [QxMD MEDLINE Link].
Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK. Meckel diverticulum: ten-year experience in adults. South Med J. 2004 Nov. 97 (11):1038-41. [QxMD MEDLINE Link].
Rattan KN, Singh J, Dalal P, Rattan A. Meckel's diverticulum in children: our 12-year experience. Afr J Paediatr Surg. 2016 Oct-Dec. 13 (4):170-4. [QxMD MEDLINE Link].
DeBartolo HM Jr, van Heerden JA. Meckel's diverticulum. Ann Surg. 1976 Jan. 183 (1):30-3. [QxMD MEDLINE Link].
Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi K. Complications and diagnosis of Meckel's diverticulum in 776 patients. Am J Surg. 1992 Oct. 164 (4):382-3. [QxMD MEDLINE Link].
Yigiter M, Kiyici H, Yucesan S, Hicsonmez A. An unusual cause of acute abdominal pain in a child: an inverted Meckel diverticulum: report of a case. J Clin Ultrasound. 2010 Jul. 38 (6):314-6. [QxMD MEDLINE Link].
Tummers WS, van der Vorst JR, Swank DJ. Traumatic rupture of a Meckel's diverticulum due to blunt abdominal trauma in a soccer game: a case report. Int J Surg Case Rep. 2016. 19:8-10. [QxMD MEDLINE Link]. [Full Text].
Thirunavukarasu P, Sathaiah M, Sukumar S, et al. Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management. Ann Surg. 2011 Feb. 253 (2):223-30. [QxMD MEDLINE Link].
Calderale SM, Marchioni L, Malizia A, Riminucci M, Corsi A. Malignant stromal tumor consistent with fibrosarcoma arising from Meckel's diverticulum. Clinicopathological study of an incidentally discovered tumor and review of the literature. Tumori. 1997 May-Jun. 83 (3):703-8. [QxMD MEDLINE Link].
Nies C, Zielke A, Hasse C, Rüschoff J, Rothmund M. Carcinoid tumors of Meckel's diverticula. Report of two cases and review of the literature. Dis Colon Rectum. 1992 Jun. 35 (6):589-96. [QxMD MEDLINE Link].
Halverson JM, Butterman MK, Legier JF, Mann WJ Jr, Hoefer RA Jr. Perforation of a Meckel's diverticulum caused by ingestion of a coin. South Med J. 1994 Aug. 87 (8):823-4. [QxMD MEDLINE Link].
Nastos C, Giannoulopoulos D, Georgopoulos I, et al. Large enterolith complicating a Meckel diverticulum causing obstructive Ileus in an adolescent male patient. Case Rep Surg. 2017. 2017:1871434. [QxMD MEDLINE Link].
Hussein BA, Khammas A, Al-Ozaibi L, et al. Phytobezoar impaction in a Meckel's diverticulum: a rare cause of bowel obstruction: Case report and review of literature. Int J Surg Case Rep. 2017. 30:165-8. [QxMD MEDLINE Link].
Redmond P, Sawaya D, Nowicki M. Bowel obstruction due to multiple retained foreign bodies in a Meckel diverticulum. J Pediatr. 2014 Sep. 165 (3):639-639.e1. [QxMD MEDLINE Link].
Park JS, Lim CW, Park T, Cho JM, Seo JH, Youn HS. Suppurative meckel diiverticulum in a 3-year-old girl presenting with periumbilical cellulitis. Pediatr Gastroenterol Hepatol Nutr. 2015 Mar. 18 (1):66-70. [QxMD MEDLINE Link]. [Full Text].
Muakkassa FF, Abouchedid C. Littre's hernia. N J Med. 1987 Sep. 84 (9):653-5. [QxMD MEDLINE Link].
Al Janabi M, Samuel M, Kahlenberg A, Kumar S, Al-Janabi M. Symptomatic paediatric Meckel's diverticulum: stratified diagnostic indicators and accuracy of Meckel's scan. Nucl Med Commun. 2014 Nov. 35 (11):1162-6. [QxMD MEDLINE Link].
Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR. Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002). Ann Surg. 2005 Mar. 241 (3):529-33. [QxMD MEDLINE Link].
Connolly SA, Drubach LA, Connolly LP. Meckel's diverticulitis: diagnosis with computed tomography and Tc-99m pertechnetate scintigraphy. Clin Nucl Med. 2004 Dec. 29 (12):823-4. [QxMD MEDLINE Link].
Sinha CK, Pallewatte A, Easty M, et al. Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years. Pediatr Surg Int. 2013 May. 29 (5):511-7. [QxMD MEDLINE Link].
Rerksuppaphol S, Hutson JM, Oliver MR. Ranitidine-enhanced 99m-technetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum. Pediatr Surg Int. 2004 May. 20 (5):323-5. [QxMD MEDLINE Link].
Wilton G, Froelich JW. The "false-negative" Meckel's scan. Clin Nucl Med. 1982 Oct. 7 (10):441-3. [QxMD MEDLINE Link].
Petrokubi RJ, Baum S, Rohrer GV. Cimetidine administration resulting in improved pertechnetate imaging of Meckel's diverticulum. Clin Nucl Med. 1978 Oct. 3 (10):385-8. [QxMD MEDLINE Link].
Rossi P, Gourtsoyiannis N, Bezzi M, et al. Meckel's diverticulum: imaging diagnosis. AJR Am J Roentgenol. 1996 Mar. 166 (3):567-73. [QxMD MEDLINE Link].
Sagar J, Kumar V, Shah DK. Meckel's diverticulum: a systematic review. J R Soc Med. 2006 Oct. 99 (10):501-5. [QxMD MEDLINE Link].
Vali R, Daneman A, McQuattie S, Shammas A. The value of repeat scintigraphy in patients with a high clinical suspicion for Meckel diverticulum after a negative or equivocal first Meckel scan. Pediatr Radiol. 2015 Sep. 45 (10):1506-14. [QxMD MEDLINE Link].
Kawamoto S, Raman SP, Blackford A, Hruban RH, Fishman EK. CT Detection of symptomatic and asymptomatic Meckel diverticulum. AJR Am J Roentgenol. 2015 Aug. 205 (2):281-91. [QxMD MEDLINE Link]. [Full Text].
Zhang M, Zhuang H, Luo Y. [Retrospective analysis of ultrasound imaging characteristics of 58 patients with Meckel's diverticulum disease] [Chinese]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2014 Aug. 31 (4):875-80. [QxMD MEDLINE Link].
Fritscher-Ravens A, Scherbakov P, Bufler P, et al. The feasibility of wireless capsule endoscopy in detecting small intestinal pathology in children under the age of 8 years: a multicentre European study. Gut. 2009 Nov. 58 (11):1467-72. [QxMD MEDLINE Link].
Silva M, Cardoso H, Peixoto A, et al. The role of capsule endoscopy in urgent evaluation of obscure gastrointestinal bleeding: a case series of Meckel diverticulum. Arq Bras Cir Dig. 2018 Dec 6. 31(4):e1409. [QxMD MEDLINE Link]. [Full Text].
Yoshikawa T, Suzuki N, Kikuyama M, Watanabe M. Virtual enteroscopic images of inverted Meckel's diverticulum. Dig Liver Dis. 2011 Oct. 43 (10):834. [QxMD MEDLINE Link].
Epifanio M, Terrazas E, Spolidoro J, Bastos JC, Mattiello R, Baldisserotto M. Magnetic resonance findings of a Meckel diverticulum at 3 T. J Pediatr Gastroenterol Nutr. 2017 Jan. 64 (1):e13. [QxMD MEDLINE Link].
Won Y, Lee HW, Ku YM, et al. Multidetector-row computed tomography (MDCT) features of small bowel obstruction (SBO) caused by Meckel's diverticulum. Diagn Interv Imaging. 2016 Feb. 97 (2):227-32. [QxMD MEDLINE Link]. [Full Text].
Zhu Y, Dong M, Weng W, Yang J. Spontaneous perforation and intraabdominal abscess due to Meckel's diverticulum revealed on SPECT/CT with 99m-technetium pertechnetate: a case report. Medicine (Baltimore). 2018 Oct. 97 (43):e13004. [QxMD MEDLINE Link]. [Full Text].
Xie Q, Ma Q, Ji B, Gao S, Wen Q. Incremental value of SPECT/CT in detection of Meckel's diverticulum in a 10-year-old child. Springerplus. 2016. 5 (1):1270. [QxMD MEDLINE Link].
El Bahesh E, Abell BM, Sugarbaker PH, Finianos A, Baird-Howell M, Ahlgren JD. Peritoneal metastases from malignant degeneration of ectopic gastric epithelium in Meckel's diverticulum: A case report. Int J Surg Case Rep. 2019. 61:305-8. [QxMD MEDLINE Link]. [Full Text].
Miyata S, Bliss DW. A gastrointestinal stromal tumor found in perforated Meckel's diverticulum. Surg Case Rep. 2016 Dec. 2 (1):67. [QxMD MEDLINE Link]. [Full Text].
Suhardja TS, Kua H, Hrabovszky Z. Helicobacter pylori colonisation in heterotopic gastric mucosa in Meckel diverticulum: case report and review of the literature. Clin Med Insights Case Rep. 2019. 12:1179547619846088. [QxMD MEDLINE Link]. [Full Text].
Tuzun A, Polat Z, Kilciler G, et al. Evaluation for Helicobacter pylori in Meckel's diverticulum by using real-time PCR. Dig Dis Sci. 2010 Jul. 55 (7):1969-74. [QxMD MEDLINE Link].
Aguayo P, Fraser JD, St Peter SD, Ostlie DJ. Perforated Meckel's diverticulum in a micropremature infant and review of the literature. Pediatr Surg Int. 2009 Jun. 25 (6):539-41. [QxMD MEDLINE Link].
Frooghi M, Bahador A, Golchini A, Haghighat M, Ataollahi M, Javaherizadeh H. Perforated Meckel's diverticulum in a 3-day-old neonate: a case report. Middle East J Dig Dis. 2016 Oct. 8 (4):323-6. [QxMD MEDLINE Link]. [Full Text].
Wang YJ, Wang T, Xia SL, Zhang YC, Chen WB, Li B. Perforation of Meckel's diverticulum in a very low birth weight neonate with severe pneumoperitoneum and review of literature. Turk J Pediatr. 2019. 61 (3):460-5. [QxMD MEDLINE Link].
McKelvie M, Soares-Oliveira M, Wang-Koh Y, Trayers C, Aslam A. Beware the innocent presentation of a spontaneous perforated Meckel diverticulum: a rare case and review of the literature. Pediatr Emerg Care. 2019 Dec. 35 (12):881-3. [QxMD MEDLINE Link].
Lee S, Cho SW. Adult intussusception caused by inverted Meckel's diverticulum containing mesenteric heterotopic pancreas and smooth muscle bundles. J Pathol Transl Med. 2017 Jan. 51 (1):96-8. [QxMD MEDLINE Link].
Francis A, Kantarovich D, Khoshnam N, Alazraki AL, Patel B, Shehata BM. Pediatric Meckel's diverticulum: report of 208 cases and review of the literature. Fetal Pediatr Pathol. 2016. 35 (3):199-206. [QxMD MEDLINE Link]. [Full Text].
Steinwald PM, Trachiotis GD, Tannebaum IR. Intussusception in an adult secondary to an inverted Meckel's diverticulum. Am Surg. 1996 Nov. 62 (11):889-94. [QxMD MEDLINE Link].
Gunasekaran SS, Gunasekaran TS. An unusual case of right lower quadrant abdominal pain. J Pediatr. 2017 Feb. 181:323-323.e1. [QxMD MEDLINE Link].
DiGiacomo JC, Cottone FJ. Surgical treatment of Meckel's diverticulum. South Med J. 1993 Jun. 86 (6):671-5. [QxMD MEDLINE Link].
Glenn IC, El-Shafy IA, Bruns NE, et al. Simple diverticulectomy is adequate for management of bleeding Meckel diverticulum. Pediatr Surg Int. 2018 Apr. 34 (4):451-5. [QxMD MEDLINE Link].
Robinson JR, Correa H, Brinkman AS, Lovvorn HN 3rd. Optimizing surgical resection of the bleeding Meckel diverticulum in children. J Pediatr Surg. 2017 Oct. 52 (10):1610-5. [QxMD MEDLINE Link]. [Full Text].
Sanders LE. Laparoscopic treatment of Meckel's diverticulum. Obstruction and bleeding managed with minimal morbidity. Surg Endosc. 1995 Jun. 9 (6):724-7. [QxMD MEDLINE Link].
Shalaby RY, Soliman SM, Fawy M, Samaha A. Laparoscopic management of Meckel's diverticulum in children. J Pediatr Surg. 2005 Mar. 40 (3):562-7. [QxMD MEDLINE Link].
Palanivelu C, Jategaonkar PA, Rangarajan M. Complicated Meckel's diverticulum in pediatrics: role of laparoscopy-two rare cases. J Laparoendosc Adv Surg Tech A. 2009 Apr. 19 (2):245-8. [QxMD MEDLINE Link].
Jung HS, Park JH, Yoon SN, Kang BM, Oh BY, Kim JW. Clinical outcomes of minimally invasive surgery for Meckel diverticulum: a multicenter study. Ann Surg Treat Res. 2020 Oct. 99 (4):213-20. [QxMD MEDLINE Link]. [Full Text].
Masuko T, Tanaka Y, Kawashima H, Amano H. Diagnostic laparoscopy for neonatal perforated Meckel's diverticulum. J Minim Access Surg. 2016 Jan-Mar. 12 (1):71-2. [QxMD MEDLINE Link].
Qi S, Huang H, Wei D, Lv C, Yang Y. Diagnosis and minimally invasive surgical treatment of bleeding Meckel's diverticulum in children using double-balloon enteroscopy. J Pediatr Surg. 2015 Sep. 50 (9):1610-2. [QxMD MEDLINE Link].
Kawasaki Y, Shinozaki S, Yano T, et al. Intussusception due to an inverted Meckel's diverticulum diagnosed by double-balloon enteroscopy. Case Rep Gastroenterol. 2017 Sep-Dec. 11 (3):632-6. [QxMD MEDLINE Link]. [Full Text].
Mizutani Y, Nakamura M, Watanabe O, et al. Specific characteristics of hemorrhagic Meckel's diverticulum at double-balloon endoscopy. Endosc Int Open. 2017 Jan. 5 (1):E35-40. [QxMD MEDLINE Link].
Papparella A, Nino F, Noviello C, et al. Laparoscopic approach to Meckel's diverticulum. World J Gastroenterol. 2014 Jul 7. 20 (25):8173-8. [QxMD MEDLINE Link].
Soltero MJ, Bill AH. The natural history of Meckel's diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's diverticulum found in King County, Washington, over a fifteen year period. Am J Surg. 1976 Aug. 132 (2):168-73. [QxMD MEDLINE Link].
McKay R. High incidence of symptomatic Meckel's diverticulum in patients less than fifty years of age: an indication for resection. Am Surg. 2007 Mar. 73 (3):271-5. [QxMD MEDLINE Link].
Gezer HO, Temiz A, Ince E, Ezer SS, Hasbay B, Hicsonmez A. Meckel diverticulum in children: Evaluation of macroscopic appearance for guidance in subsequent surgery. J Pediatr Surg. 2016 Jul. 51 (7):1177-80. [QxMD MEDLINE Link].

Media Gallery

Pediatric Meckel Diverticulum. Anteroposterior view of an abdominal radiograph showing multiple dilated loops of a small bowel with air-fluid levels.

of 1

Author

Simon S Rabinowitz, MD, PhD, FAAP Professor of Clinical Pediatrics, Vice Chairman, Clinical Practice Development, Pediatric Gastroenterology, Hepatology, and Nutrition, State University of New York Downstate College of Medicine, The Children's Hospital at Downstate

Simon S Rabinowitz, MD, PhD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, New York Academy of Sciences, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Phi Beta Kappa, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Minoti Haribhai, MBChB Resident Physician, Department of Pediatrics, State University of New York Downstate College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Additional Contributors

Neha Ahuja, MD Fellow in Pediatric Gastroenterology, State University of New York Downstate College of Medicine

Neha Ahuja, MD is a member of the following medical societies: American Academy of Pediatrics, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Nonyelum Erica Ebigbo, MBBS Resident Physician, Department of Pediatrics, Richmond University Medical Center

Nonyelum Erica Ebigbo, MBBS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Prem Shukla, MD; Pauline Mills, MD; Madhavi Katturupalli, MD; and Hongye Li, MD, to the development and writing of this article. The authors would also like to thank Dori Harasek for her assistance in the preparation of this article.