Diagnostic value of hemoglobin concentration in identifying Meckel’s diverticulum in pediatric lower gastrointestinal bleeding

Autores de IIS La Fe

• Miguel Couselo Jerez

  Autor

• Vicente Ibáñez Pradas

  Autor

• Rosa Fonseca Martín

  Autor

• Juan José Vila Carbó

  Autor

Participantes ajenos a IIS La Fe

• Pemartín B.

Grupos

• Hepatología experimental y Trasplante hepático

Abstract

Purpose: To assess the diagnostic performance of hemoglobin concentration for Meckel’s diverticulum (MD) and evaluate if hemoglobin levels could be useful in the surgical decision-making process of children with lower gastrointestinal bleeding (LGIB). Methods: Retrospective cohort study of children with LGIB attending the emergency department between 2011 and 2021. Episodes of LGIB were divided into two groups: MeckD (MD diagnosed by surgery) and non-MeckD. Demographic and clinical variables were recorded. Comparisons between groups were made using the ?2 and the Mann–Whitney U tests. The diagnostic performance of hemoglobin for MD was studied using ROC curves. Results: Eight hundred and nineteen episodes of LGIB were considered. Blood samples were obtained in 233 cases (31 with MD). There were differences between MeckD and non-MeckD in hemoglobin concentration (8.7 vs. 12.6; U = 592; p < 0.01), hematochezia (83.9% vs. 50.5%; ?2 = 12.1; p < 0.01), absence of other symptoms (61.3% vs. 39.6%; ?2 = 5.2; p < 0.02) and blood transfusions (41.9% vs. 9.9%; ?2 = 74.8; p < 0.01). Hemoglobin levels = 8.3 g/dL obtained a specificity = 99.01% and a positive likelihood ratio = 35.8 for MD. The area under the curve was 0.91 (95% CI 0.86–0.94). Conclusion: Hemoglobin showed a good diagnostic performance for MD. Low hemoglobin levels could guide surgical indications in the management of children with LGIB. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.

Keywords

• Adolescent; Child; Child, Preschool; Female; Gastrointestinal Hemorrhage; Hemoglobins; Humans; Infant; Male; Meckel Diverticulum; Retrospective Studies; ROC Curve; hemoglobin; hemoglobin; abdominal pain; activated partial thromboplastin time; anaphylactoid purpura; anus fissure; area under the curve; Article; child; clinical feature; cohort analysis; colon polyp; colonic telangiectasias; colonoscopy; comparative study; decision making; demographics; diagnostic value; diastolic blood pressure; emergency ward; erythrocyte transfusion; female; fever; gastritis; heart rate; hematochezia; hematocrit; hemoglobin blood level; hemoglobin determination; hemorrhoid; human; infant; intussusception; irritability; lower gastrointestinal bleeding; major clinical study; male; mean corpuscular hemoglobin concentration; mean corpuscular volume; Meckel diverticulum; pathogenesis; pediatric patient; predictive value; proctalgia; prothrombin time; receiver operating characteristic; rectoscopy; rectum hemo