Clinical features analysis of complications of Meckel diverticulum in children

doi:10.3877/cma.j.issn.1673-5250.2018.04.007

Objective

To investigate the clinical features of complications of Meckel diverticulum (MD) in children.

Methods

A total of 92 cases of children with MD who were admitted to the Children′s Hospital of Soochow University from February 2012 to February 2017 were selected as study subjects. Their age ranged from 2 months to 13 years and 7 months. According to different complications of children with MD, they were divided into intestinal obstruction group (n=33), painless hematochezia group (n=44) and diverticulitis group (n=15). The general clinical data such as age and gender of three groups were collected by retrospective analysis method, as well as complications, diverticulum height-to-diameter ratio (HDR), the distance from MD to ileocecal valve, and the ectopic rate of gastric mucosa. The diverticulum HDR and the distance from MD to ileocecal valve were statistically analyzed by one-way ANOVA, and SNK-q method was used to further compare among different groups. The age among 3 groups was statistically compared by Kruskal-Wallis H rank sum test. Constituent ratio of gender and ectopic rate of gastric mucosa among 3 groups were statistically analyzed by chi-square test. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

Results

①Among 92 MD children, 44 cases (47.8%) of them had painless hematochezia, 33 cases (35.9%) of them had intestinal obstruction, 15 cases (16.3%) of them had diverticulitis. ②There were no significant differences among 3 groups in the general clinical data, such as age and constituent ratio of gender (P>0.05). ③The diverticulum HDR of intestinal obstruction group, hematochezia group and diverticulitis group were (1.8±0.9), (2.7±1.3), and (1.9±1.4), respectively, and there was statistical difference among 3 groups in the diverticulum HDR (F=5.391, P=0.006). Further comparisons showed that diverticulum HDR in hematochezia group was higher than that in intestinal obstruction group and diverticulitis group, respectively, and both the differences were statistically significant (P<0.05), but there was no significant difference between intestinal obstruction group and diverticulitis group in diverticulum HDR (P>0.05). The distances from MD to ileocecal valve of intestinal obstruction group, hematochezia group and diverticulitis group were (44.2±15.1) cm, (52.6±13.8) cm, and (39.7±16.9) cm, respectively, and the overall comparison of distances from MD to ileocecal valve among 3 groups was statistically significant (F=5.464, P=0.006). The results of further comparisons showed that the distance from MD to ileocecal valve in hematochezia group was much greater than that in intestinal obstruction group and diverticulitis group, respectively, and there were statistically significant differences (P<0.05), but there was no significant difference between intestinal obstruction group and diverticulitis group (P>0.05). ④The ectopic rate of gastric mucosa in intestinal obstruction group, hematochezia group and diverticulitis group were 12.1% (4/33), 86.4% (38/44), and 20.0% (3/15), respectively, and there was statistically significant difference among 3 groups in the ectopic rate of gastric mucosa of MD children (χ²=47.590, P<0.001). ⑤Among the 92 children with MD, only 1 child (1.1%) died.

Conclusions

Painless hematochezia and intestinal obstruction are the main complications of children with MD, and diverticulum HDR and clinical location of diverticulum are associated with complications of MD. The diverticulum HDR is higher and the distance from MD to ileocolic valve is longer in children with MD who complicated with painless hematochezia.

Key words: Meckel diverticulum, Jejunum, Ileum, Intestinal obstruction, Gastrointestinal hemorrhage, Complication, Child

表1 3组美克尔憩室患儿一般临床资料比较

组别	例数	年龄[岁，M(P₂₅～P₇₅)]	性别[例数(%)]
组别	例数	年龄[岁，M(P₂₅～P₇₅)]	男	女
肠梗阻组	33	3.7(0.7～6.4)	25(75.8)	8(24.2)
便血组	44	3.4(0.9～5.4)	36(81.8)	8(18.2)
憩室炎组	15	4.1(1.8～6.5)	13(86.7)	2(13.3)
χ²值	?	1.808	—
P值	?	0.405	0.69

表1 3组美克尔憩室患儿一般临床资料比较

组别	例数	年龄[岁，M(P₂₅～P₇₅)]	性别[例数(%)]
组别	例数	年龄[岁，M(P₂₅～P₇₅)]	男	女
肠梗阻组	33	3.7(0.7～6.4)	25(75.8)	8(24.2)
便血组	44	3.4(0.9～5.4)	36(81.8)	8(18.2)
憩室炎组	15	4.1(1.8～6.5)	13(86.7)	2(13.3)
χ²值	?	1.808	—
P值	?	0.405	0.69

表2 3组美克尔憩室患儿憩室HDR及MD与回盲瓣距离比较(±s)

组别	例数	憩室HDR	MD与回盲瓣距离(cm)
肠梗阻组	33	1.8±0.9	44.2±15.1
便血组	44	2.7±1.3	52.6±13.8
憩室炎组	15	1.9±1.4	39.7±16.9
F值	?	5.391	5.464
P值	?	0.006	0.006

表2 3组美克尔憩室患儿憩室HDR及MD与回盲瓣距离比较(±s)

组别	例数	憩室HDR	MD与回盲瓣距离(cm)
肠梗阻组	33	1.8±0.9	44.2±15.1
便血组	44	2.7±1.3	52.6±13.8
憩室炎组	15	1.9±1.4	39.7±16.9
F值	?	5.391	5.464
P值	?	0.006	0.006

表3 3组美克尔憩室患儿胃黏膜异位率比较[例数(%)]

组别	例数	胃黏膜异位
肠梗阻组	33	4(12.1)
便血组	44	38(86.4)
憩室炎组	15	3(20.0)
χ²值	?	47.590
P值	?	<0.001

表3 3组美克尔憩室患儿胃黏膜异位率比较[例数(%)]

组别	例数	胃黏膜异位
肠梗阻组	33	4(12.1)
便血组	44	38(86.4)
憩室炎组	15	3(20.0)
χ²值	?	47.590
P值	?	<0.001

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