Table 1.
1 | Age, sex | 7‐year‐old male |
Presenting symptoms | Blood in stool, acute anemia | |
Time to diagnosis | 6 months | |
Pertinent lab results | Hgb ≥ 12, albumin > 4.0, fecal calprotectin 40 μg/g, CRP < 0.9, ESR < 20 | |
Imaging findings | Meckel's scan positive, CT abdomen, and pelvis revealed ileitis, 2 cm abscess in the right lower quadrant, and pneumoperitoneum | |
Meckel scan pretreatment (if applicable) | Performed at an outside hospital, unable to determine | |
Endoscopic findings | No EGD or colonoscopy was performed, small bowel VCE‐negative | |
Surgical findings | Laparoscopy revealed perforation and a small abscess cavity | |
Histopathology | Meckel's diverticulum with mucosal ulcer and perforation with abscess, unspecified heterotopic gastric tissue present | |
Challenges faced to diagnosis | Prior surgical findings negative, atypical presentation with perforation of Meckel's diverticulum | |
2 | Age, sex | 10‐year‐old female |
Presenting symptoms | Blood in stool, acute anemia | |
Time to diagnosis | 0 months | |
Pertinent lab results | Hgb ≤ 8, albumin < 4.0, fecal calprotectin 168 μg/g, CRP < 0.9, ESR < 20 | |
Imaging findings | CT abdomen with fluid‐filled structure in central superior pelvis that correlated with positive Meckel's scan; CT angiogram negative | |
Meckel scan pretreatment (if applicable) | NPO 4 h before exam, IV famotidine 1 h before exam. Patient was also receiving IV omeprazole 1 mg/kg twice daily for gastrointestinal bleeding | |
Endoscopic findings | One month before presentation, EGD revealed distal esophagus erythema; colonoscopy revealed pinworm infestation in colon. No VCE performed | |
Surgical findings | Laparoscopy revealed deposit of glandular tissue in proximal jejunum | |
Histopathology | Meckel's diverticulum with oxyntic‐type gastric mucosa and chronic inflammation | |
Challenges faced to diagnosis | Competing differential diagnoses due to recent pinworm infection and abnormal CT abdomen at outside hospital | |
3 | Age, sex | 17‐year‐old male |
Presenting symptoms | Blood in stool, acute anemia | |
Time to diagnosis | 0 months | |
Pertinent lab results | Hgb ≤ 8, albumin < 4.0, fecal calprotectin 327 μg/g, CRP > 0.9, ESR > 20 | |
Imaging findings | CT angiogram negative, Meckel's scan positive | |
Meckel scan pretreatment (if applicable) | NPO 4 h before exam, IV famotidine 1 h before exam. Patient was also receiving IV omeprazole twice daily for 6 days and octreotide 50 μg/h for one day for gastrointestinal bleeding | |
Endoscopic findings | EGD with cobble stoning in stomach; colonoscopy normal. VCE negative | |
Surgical findings | Laparoscopy converted to laparotomy revealed Meckel's diverticulum comprising >50% ileal lumen | |
Histopathology | Meckel's diverticulum and ulcer, unspecified heterotopic gastric mucosa | |
Challenges faced to diagnosis | Competing differential diagnoses given a history of gastrointestinal bleed due to NSAIDs and Helicobacter pylori infection, concern for infectious colitis | |
4 | Age, sex | 15‐year‐old male |
Presenting symptoms | Chronic anemia | |
Time to diagnosis | 15 months | |
Pertinent lab results | Hgb ≤ 8, albumin < 4.0, fecal calprotectin 147 μg/g, CRP < 0.9, ESR > 20 | |
Imaging findings | Negative Meckel's scan, magnetic resonance enterography abdomen and pelvis negative | |
Meckel scan pretreatment (if applicable) | NPO 4 h before exam, oral famotidine 20 mg twice daily for 48 h before exam | |
Endoscopic findings | EGD and colonoscopy normal. Single balloon enteroscopy revealed two lesions suspicious for ulcers. VCE revealed ulcers in jejunum suggestive of Crohn's and signs of bleeding in jejunum and ileum | |
Surgical findings | Laparoscopy revealed healed chronic ulcer on mesenteric wall of small bowel opposite to the Meckel's diverticulum | |
Histopathology | Meckel's diverticulum with focal chronic ulceration and antral‐type gastric mucosa | |
Challenges faced to diagnosis | Negative Meckel's scan, competing differential diagnoses due to concern for bone marrow failure as well as small bowel VCE findings suggesting inflammatory bowel disease | |
5 | Age, sex | 1‐year‐old female |
Presenting symptoms | Blood in stool, abdominal pain, nonbloody, and nonbilious emesis | |
Time to diagnosis | 33 months | |
Pertinent lab results | Hgb ≤ 8, albumin < 4.0, fecal calprotectin NA, CRP < 0.9, ESR < 20 | |
Imaging findings | Two negative Meckel's scans 1 week apart | |
Meckel scan pretreatment (if applicable) | NPO 4 h before the first exam. No pretreatment was given for the first Meckel scan, though the patient was receiving IV omeprazole 1 mg/kg twice daily for gastrointestinal bleeding. NPO status is unclear for the second exam. Pretreatment for the second exam included oral ranitidine twice daily and oral esomeprazole daily for 7 days before exam | |
Endoscopic findings | EGD revealed ulcer in the fundus, treated with APC and 2 clips; normal colonoscopy. VCE revealed Meckel's diverticulum with ulceration | |
Surgical findings | Laparoscopy revealed wide‐based Meckel's with ulceration | |
Histopathology | Meckel's diverticulum with oxyntic‐type gastric mucosa | |
Challenges faced to diagnosis | Two negative Meckel's scans, atypical presentation of emesis and abdominal pain, competing differential diagnoses due to history of gastric ulcer | |
6 | Age, sex | 14‐year‐old male |
Presenting symptoms | Chronic anemia | |
Time to diagnosis | 21 months | |
Pertinent lab results | Hgb ≤ 8, albumin > 4.0, fecal calprotectin 198 μg/g, CRP < 0.9, ESR NA | |
Imaging findings | Negative Meckel's scan, CT abdomen and pelvis negative, MRE negative | |
Meckel scan pretreatment (if applicable) | Performed at an outside hospital, unable to determine | |
Endoscopic findings | EGD and colonoscopy normal. VCE negative | |
Surgical findings | Laparoscopy converted to laparotomy revealed Meckel's diverticulum suspended to midline abdominal wall | |
Histopathology | Meckel's diverticulum with mucosal ulceration and acute inflammation, no heterotopic tissue identified | |
Challenges faced to diagnosis | Atypical presentation of mild chronic anemia with intermittent bleeding per rectum, guaiac stool negative, and negative Meckel's scan | |
7 | Age, sex | 12‐year‐old male |
Presenting symptoms | Blood in stool, acute anemia | |
Time to diagnosis | 2 months | |
Pertinent lab results | Hgb ≤ 8, albumin < 4.0, fecal calprotectin NA, CRP NA, ESR NA | |
Imaging findings | Negative Meckel's scan, NM‐RBC scan revealed active bleeding in the right upper quadrant of the abdomen, likely in the small bowel | |
Meckel scan pretreatment (if applicable) | NPO 4 h before exam, IV famotidine 1 h before exam. Patient was also receiving oral lansoprazole twice daily for 3 days before exam for gastrointestinal bleeding | |
Endoscopic findings | EGD with nodularity and furrowing of esophagus, erythema in antrum; colonoscopy revealed descending colon with edema and mild erythema. VCE negative. | |
Surgical findings | Laparoscopy revealed Meckel's diverticulum adherent to the adjacent ileum | |
Histopathology | Meckel's diverticulum with oxyntic‐type gastric mucosa | |
Challenges faced to diagnosis | Negative Meckel's scan, negative VCE | |
8 | Age, sex | 5‐year‐old male |
Presenting symptoms | Blood in stool, acute anemia, abdominal pain | |
Time to diagnosis | 1 month | |
Pertinent lab results | Hgb ≤ 8, albumin < 4.0, Fecal calprotectin NA, CRP < 0.9, ESR > 20 | |
Imaging findings | Meckel's scan negative | |
Meckel scan pretreatment (if applicable) | No pretreatment medication received, NPO status unclear before the exam | |
Endoscopic findings | EGD revealed erythema and white exudates in the duodenum; colonoscopy revealed old red blood. VCE revealed fresh blood originating from area suspicious for Meckel's diverticulum | |
Surgical findings | Laparoscopy revealed Meckel's diverticulum | |
Histopathology | Meckel's diverticulum with oxyntic‐type gastric mucosa | |
Challenges faced to diagnosis | Negative Meckel's scan, atypical abdominal pain, competing differential diagnoses due to inflammation seen on EGD | |
9 | Age, sex | 12‐year‐old male |
Presenting symptoms | Blood in stool, acute anemia, abdominal pain | |
Time to diagnosis | 0 months | |
Pertinent lab results | Hgb 8–12, Albumin NA, Fecal calprotectin NA, CRP NA, ESR NA | |
Imaging findings | Negative Meckel's scan, negative CT abdomen and pelvis | |
Meckel scan pretreatment (if applicable) | Performed at an outside hospital, unable to determine | |
Endoscopic findings | EGD and colonoscopy normal. VCE normal | |
Surgical findings | Laparoscopy converted to laparotomy revealed inflamed Meckel's diverticulum in the mid‐jejunum | |
Histopathology | Meckel's diverticulum with oxyntic‐type gastric mucosa | |
Challenges faced to diagnosis | Atypical presentation of abdominal pain, negative Meckel's scan at outside facility, negative VCE | |
10 | Age, sex | 11‐year‐old male |
Presenting symptoms | Bilious emesis, abdominal pain | |
Time to diagnosis | 0 months | |
Pertinent lab results | Hgb ≥ 12, albumin < 4.0, fecal calprotectin NA, CRP < 0.9, ESR < 20 | |
Imaging findings | CT abdomen with IV and oral contrast revealed extensive fecalization and bowel wall thickening concerning for chronic partial small bowel obstruction | |
Meckel scan pretreatment (if applicable) | NA | |
Endoscopic findings | NA | |
Surgical findings | Exploratory celiotomy revealed necrotic diverticulitis creating an internal hernia with small bowel stricture; Meckel's resection and small bowel stricturoplasty | |
Histopathology | Meckel's diverticulum with transmural necrosis, hemorrhage, and prominent neutrophilic infiltrate | |
Challenges faced to diagnosis | Atypical presentation of small bowel obstruction | |
11 | Age, sex | 12‐year‐old female |
Presenting symptoms | Constipation, abdominal pain | |
Time to diagnosis | 9 months | |
Pertinent lab results | Hgb 8–12, albumin NA, fecal calprotectin NA, CRP NA, ESR NA | |
Imaging findings | Abdominal x‐ray negative, MRE negative | |
Meckel scan pretreatment (if applicable) | NA | |
Endoscopic findings | EGD revealed findings suggestive of eosinophilic esophagitis; colonoscopy revealed fresh blood in terminal ileum and colon suggestive of recent mid‐intestinal bleeding. VCE revealed polypoid lesions suspicious of Peutz‐Jegher syndrome versus malignancy | |
Surgical findings | Laparoscopy with laparoscopic‐assisted push enterostomy revealed thickened area of mesentery deemed abnormal | |
Histopathology | Meckel's diverticulum with oxyntic‐type gastric mucosa with adjacent deep ulcer | |
Challenges faced to diagnosis | Atypical presentation of abdominal pain and constipation, competing differential diagnoses due to VCE findings suggesting polyps |
Abbreviations: APC, argon plasma coagulation; CRP, C‐reactive protein; CT, computed tomography; EGD, esophagogastroduodenoscopy; ESR, erythrocyte sedimentation rate; Hgb, hemoglobin; IV, intravenous; MRE, magnetic resonance enterography; NA, not obtained; NM‐RBC, nuclear medicine‐tagged red blood cell; NPO, nothing by mouth; NSAIDs, nonsteroidal anti‐inflammatory drugs; VCE, video capsule endoscopy.