Diagnostics of Meckel's diverticulum in children - current capabilities (literature review).

Abstract.

Introduction.

Meckel's diverticulum (MD) is a common pathology in urgent pediatric surgery. Despite its high frequency of occurrence, its diagnosis remains difficult, this applies to its visualization as an intact anatomical formation outside of clinical manifestations, as well as in the development of complications [1]. Most often, the true diagnosis is established either by exclusion or is an intraoperative finding [2,3,4]. Traditionally used research methods - scintigraphy, radiocontrast studies, ultrasound and computed tomography, have insufficient capabilities for diagnosing DM and its complications [5]. The above leaves the issue of clarifying the capabilities of diagnostic methods not fully exhausted and of interest to a practicing surgeon.

Materials and methods.

The literature review was carried out on the basis of publications covering the issues of DM diagnostics, published in the PubMed, Google Scholar, Cochrane and the Scientific Electronic Library Elibrary.ru databases using the keywords: "Meckel's diverticulum", "diagnostics", "complications", "diverticulitis", "bleeding", "ultrasound", "scintigraphy", "computed tomography". 195 publications related to the topic of the review were identified. Forty-four papers of the greatest scientific and practical interest were selected for citation in the review.

Results and discussion.

The possibilities of using various diagnostic methods - radiography, ultrasound, computed tomography, scintigraphy; more rarely used - endoscopic examination, angiography and their effectiveness depending on the form of pathological changes in the DM, the age of patients are analyzed. Direct and indirect symptoms detected using the discussed methods are demonstrated.

Conclusion.

Ultrasound diagnostics has an efficiency of no more than 25%, the efficiency is increased not only by identifying an inflammatory infiltrate with an expanded intestinal loop, but also by identifying an unchanged vermiform appendix in the presence of inflammatory changes in the abdominal cavity, which allows, acting by the exclusion method and rejecting appendicitis as the most probable diagnosis, to look for other causes of the acute process in the abdominal cavity. Computed tomography, despite its high resolution, does not significantly increase the efficiency of diagnostics. Technetium scintigraphy increases diagnostic capabilities and is accepted as the "gold standard" for Meckel's diverticulum diagnostics, however, it has significant selectivity depending on the clinical course and the presence of ectopic tissue in the diverticulum wall, which limits its capabilities. In addition, the method is not used everywhere; the lack of technical capabilities in a number of regions of the Russian Federation reduces the potential for its use. Other methods are experimental in nature or have been poorly tested in childhood to speak convincingly about their effectiveness and methodology of application. All of the above leaves the problem relevant and requires searching for new solutions or improving the effectiveness of existing diagnostic methods.