Skip to main content

Correlation of gastric heterotopia and Meckel’s diverticular bleeding in children: a unique association

Abstract

Purpose

Meckel’s diverticular bleeding is the commonest cause of major gastrointestinal (GI) haemorrhage in children. We hypothesise that gastric heterotopia (GH) is associated with increased risk of bleeding and, therefore, may affect initial management.

Methods

Paediatric patients with histological diagnosis of Meckel’s diverticulum (MD) following diverticulectomy from 1995 to 2011 were reviewed retrospectively, focusing on histological correlation to bleeding. GH identified on histology was regarded as GH+, and where GH was not found was regarded as GH−. Two-tailed Chi-square test and Fisher’s exact test were used, p < 0.05 was statistically significant.

Results

Thirty-nine patients underwent Meckel’s diverticulectomy. The number of patients with GH+, GH−, and bowel necrosis were 21, 15, and 3. Eighteen children with MD had GI bleeding. GI bleeding was more commonly associated with GH+ (14/21) than GH− (4/15) (67 vs 27 %, p = 0.02). Further analysis revealed all four GH− bleeding originated from other sources than the MD. GH+ had no significant association with other presentations. GH+ was present in 8/8 (100 %) positive Meckel’s scans and 2/5 (40 %) negative scans. Meckel’s scan had a sensitivity of 8/10 (80 %), and specificity of 3/3 (100 %).

Conclusion

This study confirmed that GH positive MD is a unique entity presenting typically with GI bleeding.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Sadler TW (2006) Chapter 14: digestive system. Langman’s medical embryology, 10th edn. Lippincott Williams & Wilkins, USA, pp 217–222

    Google Scholar 

  2. Sagar J, Kumar V, Shah DK (2006) Meckel’s diverticulum: a systematic review. J R Soc Med 99(10):501–505

    Article  PubMed Central  PubMed  Google Scholar 

  3. Menezes M, Tareen F, Saeed A, Khan N, Puri P (2008) Symptomatic Meckel’s diverticulum in children: a 16-year review. Pediatr Surg Int 24(5):575–577

    Article  PubMed  Google Scholar 

  4. Meckel J (1809) Uber die divertikel am darmkanal. Arch Physiol 9:421–453

    Google Scholar 

  5. Swaniker F, Soldes O, Hirschl RB (1999) The utility of technetium 99m pertechnetate scintigraphy in the evaluation of patients with Meckel’s diverticulum. J Pediatr Surg 34(5):760–764 Discussion 765

    Article  CAS  PubMed  Google Scholar 

  6. Tseng YY, Yang YJ (2009) Clinical and diagnostic relevance of Meckel’s diverticulum in children. Eur J Pediatr 168(12):1519–1523

    Article  PubMed  Google Scholar 

  7. Chan KW, Lee KH, Mou JWC, Cheung ST, Tam YH (2008) Laparoscopic management of complicated Meckel’s diverticulum in children: a 10-year review. Surg Endosc 22(6):1509–1512

    Article  CAS  PubMed  Google Scholar 

  8. Artigas V, Calabuig R, Badia F, Rius X, Allende L, Jover J (1986) Meckel’s diverticulum: value of ectopic tissue. Am J Surg 151(5):631–634

    Article  CAS  PubMed  Google Scholar 

  9. Brophy C, Seashore J (1989) Meckel’s diverticulum in the pediatric surgical population. Conn Med 53(4):203–205

    CAS  PubMed  Google Scholar 

  10. Vane DW, West KW, Grosfeld JL (1987) Vitelline duct anomalies. Experience with 217 childhood cases. Arch Surg 122(5):542–547

    Article  CAS  PubMed  Google Scholar 

  11. Collins JC Jr (1980) Hemorrhage from a Meckel’s diverticulum: one case with heterotopic gastric mucosa treated with cimetidine. Arch Surg 115(1):83–84

    Article  PubMed  Google Scholar 

  12. Kirkpatrick RA (1978) Cimetidine and Meckel’s diverticulum. Ann Intern Med 88(6):846–847

    Article  CAS  PubMed  Google Scholar 

  13. Minchom PE, Wheeler MH, Sibert JR (1980) Cimetidine and peptic ulceration in a Meckel’s diverticulum. Arch Dis Child 55(4):321

    Article  CAS  PubMed  Google Scholar 

  14. Volpato M, Marchetto R, Tacchetti G, Ori ML, Ciccia B (1989) Selective therapy with ranitidine in a case of bleeding Meckel’s diverticulum. Minerva Dietol Gastroenterol 35(1):61–63

    CAS  PubMed  Google Scholar 

  15. Dahshan A (2007) Bleeding Meckel diverticulum responds to intravenous pantoprazole. South Med J 100(3):334

    Article  PubMed  Google Scholar 

  16. Laine L, Jensen DM (2012) Management of patients with ulcer bleeding. Am J Gastroenterol 107(3):345–360 Quiz 361

    Article  CAS  PubMed  Google Scholar 

  17. Manning RJ (1987) Failure of H2 blocker therapy in a case of hemorrhage from a Meckel’s diverticulum. J Clin Gastroenterol 9(2):242

    Article  CAS  PubMed  Google Scholar 

  18. Ford PV, Bartold SP, Fink-Bennett DM, Jolles PR, Lull RJ, Maurer AH et al (1999) Procedure guideline for gastrointestinal bleeding and Meckel’s diverticulum scintigraphy. Society of Nuclear Medicine. J Nucl Med 40(7):1226–1232

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge and are grateful to Mr. M Kulkarni, Mr. AB Mathur and Mr. A Minocha who contributed patients to this study; and Dr. X Tyler for providing pathology review.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Bandi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bandi, A., Tan, Y.W. & Tsang, T. Correlation of gastric heterotopia and Meckel’s diverticular bleeding in children: a unique association. Pediatr Surg Int 30, 313–316 (2014). https://doi.org/10.1007/s00383-013-3441-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-013-3441-2

Keywords

  • Meckel’s diverticulum
  • Histology
  • Paediatric
  • Bleeding