Meckel’s Diverticulum Does not fit the Rule of Two: A Bicentric Experience

Abstract

Introduction: Meckel's Diverticulum (MD) is the most common gastro-intestinal congenital malformation. The Rule of Two is largely diffused to describe the characteristics of MD, but in a consistent number of cases, clinic and histology do not fit into the rules. The experience of two referral centers is reported. Methods:The Rule of Two includes: 2% prevalence, male/female ratio 2:1, <2 years of age, location within 2 feet (60 cm) from the Ileocecal Valve (ICV), 2 inches' length (5 cm), 2 types of ectopic mucosa. Patients with MD admitted between 2010 and February 2022 were analyzed. Appendectomies, performed in the same period, were considered as the reference population. Data on prevalence, gender, age, position along the intestine, MD length, histology were analyzed.Results: Seventy-three patients were identified, of whom 43 symptomatic (59%). Appendectomies were 2289, the prevalence was 2.9%. Male/female ratio was 2.65; 8.5 in case of gastrointestinal bleeding. Mean age at onset 5.48 ± 4.34 years (range 0.08-14): 60.5%>2-year-old. Mean distance from IVC 45.10 ± 16.66 cm: 11% were >2 feet. Mean MD length 3.13cm ± 1.49. Ectopic tissues, found in 19, were all gastric mucosa except for 1 case of gastric-pancreatic mucosa. Conclusions:The diagnosis of MD should be included throughout all the pediatric age and the intestinal examination extended until 100 cm from IVC, especially in older children. According to our results, the Rule of Two seems too limited to describe the characteristics of MD.