Bandi A, Tan Y W, Tsang T
Department of Paediatric Surgery, Level 3, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK,
Pediatr Surg Int. 2014 Mar;30(3):313-6. doi: 10.1007/s00383-013-3441-2. Epub 2013 Dec 15.
Meckel's diverticular bleeding is the commonest cause of major gastrointestinal (GI) haemorrhage in children. We hypothesise that gastric heterotopia (GH) is associated with increased risk of bleeding and, therefore, may affect initial management.
Paediatric patients with histological diagnosis of Meckel's diverticulum (MD) following diverticulectomy from 1995 to 2011 were reviewed retrospectively, focusing on histological correlation to bleeding. GH identified on histology was regarded as GH+, and where GH was not found was regarded as GH-. Two-tailed Chi-square test and Fisher's exact test were used, p < 0.05 was statistically significant.
Thirty-nine patients underwent Meckel's diverticulectomy. The number of patients with GH+, GH-, and bowel necrosis were 21, 15, and 3. Eighteen children with MD had GI bleeding. GI bleeding was more commonly associated with GH+ (14/21) than GH- (4/15) (67 vs 27 %, p = 0.02). Further analysis revealed all four GH- bleeding originated from other sources than the MD. GH+ had no significant association with other presentations. GH+ was present in 8/8 (100 %) positive Meckel's scans and 2/5 (40 %) negative scans. Meckel's scan had a sensitivity of 8/10 (80 %), and specificity of 3/3 (100 %).
This study confirmed that GH positive MD is a unique entity presenting typically with GI bleeding.
梅克尔憩室出血是儿童严重胃肠道（GI）出血最常见的原因。我们假设胃异位组织（GH）与出血风险增加相关，因此可能会影响初始治疗。
回顾性分析1995年至2011年接受憩室切除术后经组织学诊断为梅克尔憩室（MD）的儿科患者，重点关注组织学与出血的相关性。组织学检查发现的GH被视为GH+，未发现GH的则视为GH-。采用双侧卡方检验和Fisher精确检验，p<0.05具有统计学意义。
39例患者接受了梅克尔憩室切除术。GH+、GH-和肠坏死患者的数量分别为21例、15例和3例。18例MD患儿发生GI出血。GI出血与GH+（14/21）的相关性高于GH-（4/15）（67%对27%，p=0.02）。进一步分析显示，所有4例GH-出血均源于MD以外的其他部位。GH+与其他表现无显著相关性。梅克尔扫描阳性的患者中8/8（100%）存在GH+，扫描阴性的患者中2/5（40%）存在GH+。梅克尔扫描的敏感性为8/10（80%），特异性为3/3（100%）。
本研究证实GH阳性的MD是一种典型表现为GI出血的独特实体。
