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. 2024 Oct 20;5(4):423–432. doi: 10.1002/jpr3.12140

Table 1.

Summary of presentation, diagnostic evaluation, and challenges faced to diagnosis.

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.