Diagnostics of Meckel's diverticulum in children: current opportunities. A review

Meckel's diverticulum is a common pathology in urgent pediatric surgery. Despite a high frequency, its diagnostics is still not easy. It applies to its visualization both as an intact anatomical formation without clinical manifestations and with complications. The mentioned above indicates the necessity to improve diagnostic tools for such patients and is of interest to practicing surgeons. In this literature review, the authors analyzed publications on Meckel's diverticulum diagnostics in source engines like PubMed, GoogleScholar, Cochrane and Scientific Electronic Library eLIBRARY.ru, using keywords "Meckel's diverticulum", "diagnostics", "complications", "diverticulitis", "bleeding", "ultrasound", "scintigraphy", "computed tomography". 195 publications related to the review topic were identified. 44 works corresponding to the review purpose were selected for citation. Large series of observations and rare cases of Meckel's diverticulum in young children are included too. The authors have analyzed potentials of various diagnostic methods, such as radiography, ultrasound, computed tomography, scintigraphy, and less commo ― endoscopic examination, angiography. They also have analyzed their effectiveness depending on the form of pathological changes and patient’s age. Direct and indirect symptoms detected with the discussed methods are described as well. Ultrasound has low sensitivity, no more than 50%; however, the diagnostic efficiency increases after the detection of not only an inflamed infiltrate with expanded intestinal loop, but also with the detection of an unchanged vermiform appendix under inflammatory changes in the abdominal cavity. Due to this, physicians, using the method of exclusion and rejecting appendicitis as the most probable source, look for other causes of the acute process in the abdominal cavity. Computed tomography, despite its high resolution, does not significantly add to the efficiency of diagnostics. Technetium scintigraphy increases diagnostic capabilities and is the gold standard in diagnosing Meckel's diverticulum, but has a high selectivity depending on the clinical course and the presence of ectopic tissue in the diverticulum wall, which limits its diagnostic effectiveness. In addition, this method is not available everywhere in Russia; the lack of technical capabilities in some regions lowers its diagnostic potentials. Other diagnostic options are either at the experimental stage or have been poorly tested in pediatric population what does not allow to speak convincingly about their effectiveness and recommendations for application. All the above leaves the problem open and requires searching for new solutions or improving the effectiveness of existing diagnostic tools.