title: Symptomatic paediatric Meckel's diverticulum: stratified diagnostic indicators and accuracy of Meckel's scan.
abstract: OBJECTIVE
  The aim of the study was to delineate stratified diagnostic indicants and evaluate the diagnostic accuracy of technetium-99m (Tc)-pertechnetate scintigraphy in children with symptomatic Meckel's diverticulum (MD).
  
  
  METHODS
  This was a prospective linear observational study conducted over a period of 5 years on 73 children with a diagnosis of symptomatic MD. The independent variables assessed were age, sex, weight-for-age z-scores, clinical presentation, complications of MD, laparoscopic findings, haematologic and biochemical results, radiological results, and histological findings. Stepwise multiple logistic regression analysis was performed to determine the diagnostic markers. The sensitivity and specificity of Tc-pertechnetate scintigraphy were assessed.
  
  
  RESULTS
  The incidence of MD with complications was 44%. The prevalence of ectopic gastric mucosa in histological specimens was 84%. There was a good correlation between rectal bleeding and the presence of ectopic gastric mucosa [r=0.94; 95% confidence interval (CI): 0.77-0.98]. Haematochezia associated with a drop in haemoglobin (>2 g/dl) was diagnostic of MD with ectopic gastric mucosa in children (n=42, 58%; P=0.006; odds ratio 1.99; 95% CI: 1.14-2.42). Bilious vomiting was diagnostic of complicated MD (n=12, 16%; P=0.007; odds ratio 1.89; 95% CI: 1.12-3.22). The sensitivity of Tc-pertechnetate scintigraphy was 84% and specificity was 22%. The positive predictive value was 0.64 and the negative predictive value was 0.22. The sensitivity and specificity of Tc-pertechnetate scintigraphy were dependent on the quantity and functional quality of the heterotopic gastric mucosa. The preoperative median z-score was -1.4 and the postoperative median z-score was -1.2.
  
  
  CONCLUSIONS
  Tc-pertechnetate scintigraphy had a truncated predictive value. Its contribution in clinical decision making was poor. Clinical suspicion of MD should be high in children presenting with haematochezia associated with a drop in haemoglobin by more than 2 g/dl. Laparoscopy is an effective diagnostic and therapeutic tool.
authors.affiliation: Departments of aNuclear Medicine bPaediatric Surgery cAnaesthesia, Mediclinic City Hospital, Dubai Health Care City, Dubai, UAE dQueen Mary University of London, London, UK.
authors.forename: Mazin
authors.initials: M
authors.lastname: Al Janabi
authors.forename: Madan
authors.initials: M
authors.lastname: Samuel
authors.forename: Andrea
authors.initials: A
authors.lastname: Kahlenberg
authors.forename: Sujith
authors.initials: S
authors.lastname: Kumar
authors.forename: Mina
authors.initials: M
authors.lastname: Al-Janabi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D008467:Meckel Diverticulum / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m
chemical_list: D013670:Sodium Pertechnetate Tc 99m