Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen city, Guangdong Province, China.
Medicine (Baltimore). 2021 Mar 12;100(10):e24823. doi: 10.1097/MD.0000000000024823.
The diagnostic and treatment values and safety of preoperative double-balloon enteroscopy (DBE) for Meckel's diverticula (MD) bleeding in children by retrospective review and analyses.The clinical data were collected and analyzed from 10 cases of children with MD receiving preoperative DBE examination and postoperative pathological confirmation. The diagnostic and treatment values and safety were assessed through the comparison of the DBE results and intra-operative observations and subsequently postoperative pathological results.Total cases are 10, 7 males and 3 females. The male to female ratio is 2.3 to 1. The youngest patient is 3.3 years old and oldest 12.1, the average age is 7.4 ± 3.0. The lowest body weight is 12.6 kg and the average is 32.5 ± 18.9 kg. The hematochezia was the main clinical manifestation in all patients with anemia and moderate to severe anemia were common (9/10, 90%). All patients had and tolerated the DBE procedures via anal route with 100% success rate. There were no observable complications during the examinations and post operations. All patients were diagnosed with MD by DBE. Exploratory laparoscopy and surgical operations were subsequently performed. All surgical samples were confirmed by pathology as bleeding MD. The postoperative follow-ups up to April 2019 (from 3 to 12 months) do not show any bleeding sign. Pathological examinations found ectopic gastric mucosa in 9 patients (90%) and one case had both ectopic gastric mucosa pancreatic tissue (10%). The distance of MD to ileocecal valve was from 60 to 100 cm (average 81.0 ± 16.0 cm) by DBE examinations. Surgery showed similar findings from 30 to 100 cm (average 71.0 ± 18.5) consistently to DBE. There is no statistical significance between 2 methods (Ζ = 1.715, Ρ = .086).DBE examination proves to be a safe method for diagnosing children's MD disease and can reliably determine the bleeding lesions in children's MD, providing valuable guidance for surgical treatment of children's MD bleeding.
经回顾性分析，探讨术前双气囊小肠镜（DBE）对儿童 Meckel 憩室（MD）出血的诊断和治疗价值及安全性。收集并分析了 10 例行术前 DBE 检查和术后病理证实的 MD 出血患儿的临床资料。通过比较 DBE 结果与术中观察及术后病理结果，评估其诊断和治疗价值及安全性。
10 例患儿中，男 7 例，女 3 例，男女比例为 2.3:1；年龄最小 3.3 岁，最大 12.1 岁，平均年龄 7.4±3.0 岁；体重最小 12.6kg，平均 32.5±18.9kg；所有患儿均以血便为主要临床表现，伴中重度贫血者 9 例（90%）。所有患儿均经肛门顺利完成 DBE 检查，成功率 100%，均能耐受。检查及术后无明显并发症。所有患儿均经 DBE 诊断为 MD，并进一步行腹腔镜探查术和手术治疗。术后病理均证实为 MD 出血。截至 2019 年 4 月（术后 312 个月）的随访期内，患儿均无再次出血征象。病理检查发现 9 例（90%）患儿存在异位胃黏膜，1 例存在异位胃黏膜胰腺组织（10%）。DBE 检查发现 MD 距回盲瓣距离为 60100cm（平均 81.0±16.0cm），与手术所见 30~100cm（平均 71.0±18.5cm）基本一致，差异无统计学意义（Ζ=1.715，Ρ=0.086）。
DBE 检查是一种安全的诊断儿童 MD 疾病的方法，能可靠地确定儿童 MD 的出血病变，为儿童 MD 出血的外科治疗提供有价值的指导。
