Value of sonographic pseudogestational sac sign in the diagnosis of Meckel diverticulum in children presenting with bleeding per rectum: a 15-year prospective study

Abstract

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 children were included in our study. The pseudogestational sac sign was present in 46 (63%) and absent in 27 (37%) cases. Forty-five children were ultimately diagnosed as Meckel diverticulum. The age ranged from 2 months to 9 years with a mean of 2.3 years. The boy-to-girl ratio was 4.6:1 with 60% of children presenting during their first 2 years of life. The ultrasound performance using the pseudogestational sac sign revealed a sensitivity of 91.1%, specificity of 82.1%, positive predictive value of 89.1%, negative predictive value of 85.2%, positive likelihood ratio of 5.1, negative likelihood ratio of 0.11 and accuracy of 87.7%. Conclusion The sonographic pseudogestational sac sign is a reliable diagnostic tool for diagnosing Meckel diverticulum in children presenting with bleeding per rectum. The sonographic diagnosis of Meckel diverticulum complies with the international standards of “Image Gently”.

Perforation of Meckel's diverticulum by an unusual foreign body: A case report and a review of literature

“…Recent studies have showed high sensitivity and specificity in diagnosis of bleeding MD in pediatric patients. 11 , 12 Scintigraphy, using Technetium‐99m (Tc‐99m) pertechnetate, is preferred in pediatric patients with lower gastrointestinal bleeding due to its high sensitivity and specificity of 0.80 (95% CI 0.73–0.86) and 0.95 (95% CI 0.86–0.98) for detecting ectopic gastric tissue within MD in children. 13 In adults, however, its diagnostic accuracy is lower (20%–60%).…”