Meckel’s Diverticulum: Clinical Feature Differences Between Children and Adults

Meckel’s Diverticulum: Clinical Feature Differences Between Children and Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Meckel’s Diverticulum: Clinical Feature Differences Between Children and Adults Nimmita Srisan, Peerawit Songsiri, Sirima Liukitithara, Anan Sriniworn, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6936165/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Sep, 2025 Read the published version in Pediatric Surgery International → Version 1 posted 9 You are reading this latest preprint version Abstract Meckel’s diverticulum (MD) is a common anomaly of GI tract. Patients with MD may present with various manifestations, including lower GI bleeding, gut obstruction, diverticulitis, or umbilical problems. Also, MD can be incidentally found during operations. PURPOSE: The objectives were to describe and to compare clinical features of patients with MD in terms of demographic data, clinical presentation, investigations, treatment, histopathology, and post-operative complications between pediatric and adult patients. METHODS: Patients with MD were retrospectively reviewed from 2 tertiary hospitals (2002-2021). These included patients with symptomatic MD and patients whose MD was incidentally found during operations. Demographic data, clinical presentation, investigation, treatment, histopathology, and postoperative complications were reviewed. RESULTS: Total of 123 cases with MD (67 children vs 56 adults) were studied. Of 67 children with MD, symptomatic MD was reported in 46 cases (69%). Lower GI bleeding was the most common presentation (54%), followed by obstruction (28%), umbilical problems (11%) and diverticulitis (7%). For children with bleeding MD (25 cases), Meckel scan was an important investigation to confirm the diagnosis with positive predictive value of 91%. Of 56 adults with MD, symptomatic MD was recorded in 32 cases (57%). Diverticulitis was the most common presentation (47%) followed by obstruction (31%), GI bleeding (19%) and umbilical problems (3%). For incidentally found MD during operations, 80% were resected. Interestingly, ectopic gastric tissue was found in 27.4% of the resected MD specimens. Moreover, there was no significant difference in postoperative complications between patients with symptomatic MD and patients with incidentally found MD. CONCLUSION: The most common symptom of MD was lower GI bleeding in children, and diverticulitis in adults. Meckel scan is an important tool to investigate bleeding MD. Since ectopic gastric tissue was found in 19% of asymptomatic MD, therefore, our findings seem to support the concept of resection of MD incidentally found during the operations. Meckel’s diverticulum lower gastrointestinal bleeding ectopic mucosa pediatric and adult surgery diagnostic imaging Figures Figure 1 Figure 2 Figure 3 Introduction Meckel diverticulum (MD) is the most common gastrointestinal anomaly, which occurs in approximately 2% of the general population [ 1 ]. However, the incidence might not be precise since there are asymptomatic patients who do not require therapeutic intervention. Not only can MD be asymptomatic, but also its presentation can vary from bleeding, obstruction, and inflammation [ 2 – 5 ]. The common age of symptomatic patients is younger than 10 years of age [ 6 ]. Therefore, it is quite reluctant for adult surgeons to think of MD as a primary pathology. According to symptomatic diversity, preoperative diagnosis is sometimes difficult to establish, and choices of diagnostic tools can be different due to the presenting symptoms [ 7 ]. This study aims to describe and explore the differences in MD between children and adults regarding demographic data, clinical presentations, investigations, treatments, histopathology, and complications after treatment. Materials and Method Study design We retrospectively reviewed computer-based patient charts for individuals diagnosed with MD considering categories including principal diagnosis, comorbidities, and complications from two tertiary care hospitals: King Chulalongkorn Memorial Hospital (2002–2021) and Hat Yai Hospital (2015–2021). Ethical approvals were obtained before the commencement of the study (IRB No.324/64 and COA No.596/2021). We divided the patients into two main groups which are children and adults (older than 15 years) based on hospital categorization. Demographic data, clinical presentation, investigation, treatment, histopathology, and complications were collected and compared. Statistical analysis Categorical data are presented as the number of patients and corresponding percentages. Continuous data are shown as the mean and standard deviation. Descriptive statistics, Fisher’s Exact Tests, Chi-Square Tests, and Independent T-Tests were used to analyze our study data. All analyses were conducted using IBM SPSS Statistics version 29. A p-value of less than 0.05 was considered statistically significant. Results During the study period, 123 patients with Meckel’s diverticulum (MD) were identified, comprising 67 children and 56 adults. The mean (SD) age of the pediatric group was 2.8 (3.6) years, while the adult group had a mean age of 41.5 (19.1) years. Males were predominant in both groups, accounting for 77.6% of pediatric patients and 73.2% of adult patients. The presentations of MD were categorized as either symptomatic or incidental findings discovered during other indicated operations, as shown in Table 1. Symptoms included lower gastrointestinal bleeding (LGIB), inflammation, intestinal obstruction, and umbilical problems. Among symptomatic patients, the mean (SD) age was 3.4 (3.8) years in children and 39.1 (17.9) years in adults. Complications were observed in 78.3% (36/46) of symptomatic pediatric patients and 78.1% (25/32) of symptomatic adult patients with MD. LGIB was the most common presenting symptom in pediatric patients, occurring significantly more often than in adults (37.3% vs. 10.7%, p<0.001). Conversely, diverticulitis was the leading symptom in adults, occurring significantly more frequently than in pediatric patients (26.8% vs. 4.5%, p<0.001). Regarding gender, 65.6% of male patients and 56.7% of female patients presented with symptoms, but this difference was not statistically significant. In pediatric patients, symptomatic presentations were observed in 69.2% of males and 66.7% of females (p=0.850). Among adults, symptoms were reported in 61.0% of males and 46.7% of females (p=0.338). Table 1. Presenting symptoms of patients with Meckel’s diverticulum categorized by age group Children (N=67) Adult (N=56) P-value Symptomatic 46 (68.7%) 32 (57.1%) LGIB 25 (37.3%) 6 (10.7%) <0.001 Diverticulitis 3 (4.5%) 15 (26.8%) <0.001 Obstruction 13 (19.4%) 10 (17.9%) 0.827 Umbilical problems 5 (7.5%) 1 (1.8%) 0.219 Incidental findings 21 (31.3%) 24 (42.9%) 0.187 For the investigations, we focused on symptomatic patients. The methods used in children included Meckel scan, computerized tomography (CT), angiogram, ultrasound, laparoscopic diagnosis, double balloon endoscopy, red blood cell (RBC) scan, esophagogastroduodenoscopy (EGD), and colonoscopy. Some patients underwent more than one investigation. The frequency of symptomatic patients who underwent each test is demonstrated in Table 2. Due to different presentations, the frequency of Meckel’s scan was conducted significantly higher in children (43.5% vs 6.3%, p<0.001). Table 2. Investigation in symptomatic patients Investigations Children (N=46) Adult (N=32) P-value Meckel’s scan 20 (43.5%) 2 (6.3%) <0.001 CT scan 8 (17.4%) 11 (34.4%) 0.086 Angiogram 2 (4.3%) 2 (4.3%) 1.000 Ultrasound 3 (6.5%) 2 (6.3%) 1.000 Double balloon enteroscopy 1 (2.2%) 2 (6.3%) 0.565 Laparoscopic diagnosis 1 (2.2%) 2 (6.3%) 0.565 RBC scan 0 (0.0%) 1 (1.3%) 0.410 EGD with Colonoscopy 1 (2.2%) 4 (12.5%) 0.153 Colonoscopy alone 1 (2.2%) 0 (0.0%) 1.000 Barium enema 1 (2.2%) 0 (0.0%) 1.000 In the investigations summarized in Table 2, we presented positive test results, defined as suspected MD on any imaging or endoscopic study, as well as contrast extravasation into the bowel lumen on visceral angiography (Figure 1). The accuracy of the Technetium-99m pertechnetate scan or Meckel’s scan was 95% (19/20) in children and 50% (1/2) in adults, while the accuracy of the CT scan was 37.5% (3/8) in children and 45.5% (5/11) in adults. The proportion of investigation findings is demonstrated in Fig. 1. As for the treatment, 98.7% (77/78) of symptomatic patients and 80.0% (36/45) of incidental findings underwent Meckel resection. All incidental findings were discovered during laparotomy. However, three surgical approaches were used for the symptomatic group: laparotomy, laparoscopic assistance, and total laparoscopic procedure. The proportion of each approach is shown in Fig. 2. Among the unresected patients, there was one adult with an obstructive symptom. Incidental findings included two children and seven adults. In our series of 113 MD resections, 36.3% contained ectopic mucosa, 21.2% had no ectopic mucosa, and 41.6% did not have ectopic mucosa mentioned in the report. One patient (0.9%) in the incidental finding group had a spindle cell tumor in the Meckel’s specimen. This patient was operated because of an infrarenal abdominal aortic aneurysm. Among specimens containing ectopic tissue, three types were identified: gastric mucosa (80.5%), pancreatic mucosa (7.3%), and mixed ectopic tissue (12.2%). Pediatric patients with ectopic mucosa accounted for 40.0% (26/65), compared to 31.3% (15/48) in adults. This difference was not statistically significant (p=0.344). In terms of pathology and symptoms, ectopic mucosa was identified in 42.9% (33/77) of specimens from symptomatic patients, compared to 22.2% (8/27) in asymptomatic patients, a statistically significant difference (p=0.044). When comparing symptomatic children and adults, 50% (23/46) of pediatric patients and 32.3% (10/31) of adult patients had ectopic mucosa. Although a higher percentage was observed in children, this difference was not statistically significant (p=0.123). In pediatric patients presenting with lower gastrointestinal bleeding (LGIB), 76% (19/25) had ectopic tissue, including 17 with gastric mucosa, 1 with pancreatic mucosa, and 1 with both types. In this group, 4% (1/25) had no ectopic tissue, and 20% had no mention of ectopic tissue in the report. Among adults with LGIB, 66.7% (4/6) had gastric mucosa, while one patient had no ectopic mucosa, and one had no specific mention of it. For patients presenting with inflammatory symptoms, 27.8% (5/18) of resected specimens contained ectopic mucosa, including one child and three adults with gastric mucosa and one adult with pancreatic mucosa. In this group, 22.2% (4/18) had no ectopic mucosa, while the remaining specimens (50%) had no mention of ectopic tissue. Figure 3 illustrates the histopathology proportions for the overall, pediatric, and adult groups. Postoperative complications occurred in 9.0% (6/67) of children and 7.1% (4/56) of adults, including intestinal obstruction, wound infection, and anastomotic stricture. No statistically significant difference was observed between the two groups. Additionally, there was one death in the pediatric group, which was not related to MD. Comparing patients with and without symptoms, 7.7% of symptomatic and 11.1% of asymptomatic patients experienced postoperative complications (p=0.522). Discussion Meckel’s diverticulum (MD) is a true diverticulum containing all layers of the intestinal wall and is the most common congenital malformation of the gastrointestinal tract [ 7 ], with a prevalence ranging from 0.3–2.9% [ 8 – 10 ]. Although its complications decrease with age, MD is often overlooked in adults presenting with acute abdominal symptoms, which can lead to delayed diagnosis and severe complications such as hemorrhagic shock and peritonitis [ 11 – 13 ]. Understanding the presentation and optimal management of MD in both pediatric and adult populations is essential for improving patient outcomes. Our study reported a proportion of symptomatic patients at 68.7% in children, 57.1% in adults, and 63.4% overall. This total percentage aligns with previous literature [ 13 – 15 ] but is notably higher than that reported by Ueberruck et al [ 16 ]. This discrepancy may stem from our institution’s clinical approach; in pediatric cases with suspected appendicitis where the appendix appears inflamed, further investigation for MD is not typically pursued. Consequently, our report may reflect a higher incidence of symptomatic cases. In symptomatic presentations of MD, our findings show that children most commonly presented with lower gastrointestinal bleeding, followed by intestinal obstruction. In contrast, adults more frequently presented with inflammatory symptoms, followed by intestinal obstruction. While the symptomatic patterns in children aligned with previous reports [ 3 , 17 ], our study revealed a distinct trend in adults: unlike prior studies [ 4 , 18 ] that identified bleeding and intestinal obstruction as the predominant symptoms, inflammation emerged as the leading presentation in our adult cohort. Our study found no significant difference in symptom prevalence between male and female patients. While previous studies [ 2 , 6 , 12 – 13 , 15 – 16 , 19 ] have reported male predominance among symptomatic MD cases, our findings suggest that gender may not be a reliable predictor of symptomatic MD. Further studies with larger sample sizes may be necessary to clarify this relationship. For diagnostic investigations, given the wide range of symptoms associated with MD, the choice of diagnostic tool is typically guided by clinical presentation. In our study, the frequency of each investigation aligned closely with the symptoms presented by patients. Abdominal radiographs were excluded, as they are not effective in identifying MD [ 7 ]. Meckel’s scintigraphy, the only method with a statistically significant difference in usage, was more commonly performed in pediatric cases due to the higher prevalence of Meckel’s pathology, which in adults is more often evaluated with endoscopy. For cases presenting with obstruction or inflammation, abdominal CT scans were the preferred diagnostic tool. Although CT may not always definitively identify MD [ 20 – 23 ], our study observed that it frequently revealed abnormal findings in the distal ileum, particularly in young adults with a previously unoperated (virgin) abdomen. These findings suggest that clinicians should maintain a high index of suspicion for MD in patients with unexplained distal ileal abnormalities. Our study revealed that laparoscopic diagnosis had the highest accuracy among all investigations in both pediatric and adult groups. However, this finding may be affected by selection bias, as our retrospective study included only patients with confirmed MD, with laparoscopy often serving as the final diagnostic option after multiple inconclusive studies. Regarding other diagnostic methods, the accuracy of the Technetium-99m pertechnetate scan in our study was consistent with previous literature, showing higher accuracy in pediatric patients than in adults [ 24 ]. Recently, double-balloon enteroscopy (DBE) has emerged as a promising diagnostic tool for Meckel’s diverticulum. In our study, only three patients underwent DBE, achieving an accuracy of 66.7% (2/3). A recent retrospective study by He et al. reported a 100% positive detection rate using DBE; however, they did not specify its application in pediatric patients [ 25 ]. In another study focused on pediatric patients with lower gastrointestinal bleeding (LGIB), DBE was utilized as the primary diagnostic tool, identifying Meckel’s diverticulum in 14 of 21 patients [ 26 ]. Patients with positive findings subsequently underwent resection through a small umbilical incision with scope-guided assistance. Several studies have also highlighted the benefits of DBE in diagnosing Meckel’s diverticulum, particularly in cases where Meckel’s scintigraphy yielded negative results. Given its high detection rate in recent studies, DBE may play a crucial role in diagnosing MD in patients with unexplained lower GI bleeding [ 25 – 27 ]. However, due to limited data, further research is needed to establish standardized indications for DBE in the evaluation of MD. The decision to remove asymptomatic MD remains controversial, particularly in adult patients. In our study, among asymptomatic cases, pediatric patients had a higher proportion of resections; however, 70% of asymptomatic adults in our study also underwent diverticulum removal. The surgeon’s discretion primarily influenced treatment decisions for this group. The criteria for resecting asymptomatic MD remain widely debated. Robijn et al.[ 28 ] proposed four risk factors that support resection: male gender, age younger than 45 years, a pathology length > 2 cm, and the presence of a fibrous band. Additionally, macroscopic features, such as the presence of ectopic mucosa and a narrow-necked diverticulum, have been suggested as indicators for removal [ 29 ]. However, studies have varied on the age threshold for risk, ranging from under 45 to 50 years [ 30 ]. Regarding macroscopic appearance, Gezer et al. concluded that this factor does not reliably predict whether MD will become symptomatic [ 31 ]. Similarly, the perception of thickness as an indicator of ectopic mucosa was found to be unreliable. Another consideration is the association between Meckel’s diverticulum and malignancy. Thirunavukarasu et al. reported that MD carries a higher risk of malignancy than other ileal sites, supporting resection [ 32 ]. Conversely, other studies argue against resection of asymptomatic MD, citing a low lifetime risk of complications and the potential for increased postoperative morbidity [ 33 – 34 ]. A risk-based approach may help guide clinical decisions, and standardized guidelines incorporating risk stratification models may help optimize management strategies in the future. Our study found no statistically significant difference in the prevalence of ectopic mucosa between children and adults. However, consistent with prior research, ectopic mucosa was a major contributing factor to symptomatic presentations, particularly bleeding and inflammation [ 2 , 6 , 35 ]. These findings reinforce the need to consider ectopic mucosa when evaluating MD patients for resection. Our study has several limitations. First, its retrospective nature may introduce selection bias, particularly in the decision-making process for resection. Second, the sample size for certain diagnostic modalities, such as DBE, was small, limiting generalizability. Finally, histopathology reports did not always specify the presence of ectopic mucosa, which may have influenced our findings. Future research should focus on refining diagnostic criteria for MD, particularly in adult patients, and establishing clear guidelines for the resection of asymptomatic cases. Prospective studies comparing long-term outcomes in resected versus non-resected asymptomatic MD cases may provide valuable insights into optimal management strategies. Conclusion The most common symptom of MD was lower gastrointestinal bleeding in children and diverticulitis in adults. Meckel’s scan remains an important diagnostic tool for detecting bleeding MD, particularly in pediatric cases. Our findings suggest that incidental MD identified during surgery may warrant resection, given that ectopic gastric tissue was found in 19% of asymptomatic MD cases. However, given the ongoing debate regarding the management of asymptomatic MD, further prospective studies are necessary to establish standardized guidelines and optimize patient outcomes. Declarations Author contributions Peerawit Songsiri and Paisarn Vejchapipat developed the study concept, including the generation of ideas and hypotheses. Nimmita Srisan and Peerawit Songsiri collected data, performed the analysis, interpreted the outcomes, critically reviewed the findings, evaluated them against existing knowledge, and contributed to the study’s conclusions. Nimmita Srisan drafted the manuscript. Nimmita Srisan, Sirima Liukitithara, Anan Sriniworn, Katawaetee Decharun, Prapapan Rajatapiti, Somboon Reukvibunsi, Bunthoon Nonthasoot, Supparerk Prichayudh, Chadin Tharavej, Sopark Manasnayakorn, and Paisarn Vejchapipat supported the data, concept development, and study design. All authors read and approved the final manuscript. Ethics approval and consent to participate This study was reviewed and approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (IRB No.324/64). The research protocol also received certification of approval (COA No. 596/2021) from Hatyai Hospital.The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflict of interest. We would like to declare that the abstract entitled above has been previously presented as an oral presentation at the 47th Annual National Scientific Congress of the Royal College of Surgeons of Thailand, held from 13 to 16 July 2022 at the Ambassador City Jomtien Hotel, Pattaya, Chonburi, Thailand. Only the abstract (not the full manuscript) was published soon in the Thai Journal of Surgery in 2022. However, the full manuscript of the abstract has never been previously considered or published in any other journal. References Stallion A, Shuck JM. Meckel's diverticulum. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6918 Huang, C. C., Lai, M. W., Hwang, F. M., Yeh, Y. C., Chen, S. Y., Kong, M. S., Lai, J. Y., Chen, J. C., & Ming, Y. C. (2014). Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol, 55(5), 369-375. https://doi.org/10.1016/j.pedneo.2013.12.005 Chen, Q., Gao, Z., Zhang, L., Zhang, Y., Pan, T., Cai, D., Xiong, Q., Shu, Q., & Qian, Y. (2018). Multifaceted behavior of Meckel's diverticulum in children. J Pediatr Surg, 53(4), 676-681. https://doi.org/10.1016/j.jpedsurg.2017.11.059 Hernández, J. D., Valencia, G., Girón, F., García Sierra, A. M., Núñez-Rocha, R. E., Rodríguez, L. M., Rey Chaves, C. E., Londoño, E. E., & Nassar, R. (2023). Meckel's diverticulum: analysis of 27 cases in an adult population. Front Surg, 10, 1327545. https://doi.org/10.3389/fsurg.2023.1327545 Rho, J. H., Kim, J. S., Kim, S. Y., Kim, S. K., Choi, Y. M., Kim, S. M., Tchah, H., Jeon, I. S., Son, D. W., Ryoo, E., Cho, K. H., Choi, D. Y., & Kim, Y. M. (2013). Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis. Pediatr Gastroenterol Hepatol Nutr, 16(1), 41-48. https://doi.org/10.5223/pghn.2013.16.1.41 Park, J. J., Wolff, B. G., Tollefson, M. K., Walsh, E. E., & Larson, D. R. (2005). Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002). Ann Surg, 241(3), 529-533. https://doi.org/10.1097/01.sla.0000154270.14308.5f Kuru, S., & Kismet, K. (2018). Meckel's diverticulum: clinical features, diagnosis and management. Rev Esp Enferm Dig , 110 (11), 726-732. https://doi.org/10.17235/reed.2018.5628/2018 Hansen, C. C., & Søreide, K. (2018). Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century. Medicine (Baltimore), 97(35), e12154. https://doi.org/10.1097/md.0000000000012154 Yang, X., & Guo, K. (2013). Massive lower gastrointestinal bleeding from Meckel's diverticulum with heterotopic pancreas: case report and a brief review of the literature. Jop, 14(3), 269-272. https://doi.org/10.6092/1590-8577/1407 Jayawickrama, A., Mohamed Ozaal, O., Ranaweera, G., Fernandopulle, N., & Subasinghe, D. (2024). Severe obscure gastrointestinal bleeding from Meckel's diverticulum with predominant ectopic pancreatic tissue. SAGE Open Med Case Rep, 12, 2050313x241266480. https://doi.org/10.1177/2050313x241266480 Jain, H., Joshi, R., Sudan, A., & Banga, A. (2023). Spontaneous Perforation of Meckel's Diverticulum: An Unusual Cause of Peritonitis in an Adult. J Brown Hosp Med, 2(4), 88127. https://doi.org/10.56305/001c.88127 Fraser, A. A., Opie, D. D., Gnecco, J., Nashed, B., & Johnson, D. C. (2018). Spontaneous perforation of Meckel’s diverticulum in an adult female with literature review. Surgical Case Reports, 4(1), 129. https://doi.org/10.1186/s40792-018-0536-y Groebli, Y., Bertin, D., & Morel, P. (2001). Meckel's diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg, 167(7), 518-524. https://doi.org/10.1080/110241501316914894 Ruscher, K. A., Fisher, J. N., Hughes, C. D., Neff, S., Lerer, T. J., Hight, D. W., Bourque, M. D., & Campbell, B. T. (2011). National trends in the surgical management of Meckel's diverticulum. J Pediatr Surg, 46(5), 893-896. https://doi.org/10.1016/j.jpedsurg.2011.02.024 Chen, J. J., Lee, H. C., Yeung, C. Y., Chan, W. T., Jiang, C. B., Sheu, J. C., & Wang, N. L. (2014). Meckel's Diverticulum: Factors Associated with Clinical Manifestations. ISRN Gastroenterol, 2014, 390869. https://doi.org/10.1155/2014/390869 Ueberrueck, T., Meyer, L., Koch, A., Hinkel, M., Kube, R., & Gastinger, I. (2005). The significance of Meckel's diverticulum in appendicitis--a retrospective analysis of 233 cases. World J Surg, 29(4), 455-458. https://doi.org/10.1007/s00268-004-7615-x Lin, X.-k., Huang, X.-z., Bao, X.-z., Zheng, N., Xia, Q.-z., & Chen, C.-d. (2017). Clinical characteristics of Meckel diverticulum in children: A retrospective review of a 15-year single-center experience. Medicine, 96(32), e7760. https://doi.org/10.1097/md.0000000000007760 Blouhos, K., Boulas, K. A., Tsalis, K., Barettas, N., Paraskeva, A., Kariotis, I., Keskinis, C., & Hatzigeorgiadis, A. (2018). Meckel's Diverticulum in Adults: Surgical Concerns. Front Surg, 5, 55. https://doi.org/10.3389/fsurg.2018.00055 Karaman, A., Karaman, İ., Çavuşoağlu, Y. H., Erdoağan, D., & Aslan, M. K. (2010). Management of asymptomatic or incidental Meckels diverticulum. Indian Pediatr, 47(12), 1055-1057. https://doi.org/10.1007/s13312-010-0176-1 Mohiuddin, S. S., Gonzalez, A., & Corpron, C. (2011). Meckel's diverticulum with small bowel obstruction presenting as appendicitis in a pediatric patient. Jsls, 15(4), 558-561. https://doi.org/10.4293/108680811x13176785204553 Won, Y., Lee, H. W., Ku, Y. M., Lee, S. L., Seo, K. J., Lee, J. I., & Chung, J. H. (2016). Multidetector-row computed tomography (MDCT) features of small bowel obstruction (SBO) caused by Meckel's diverticulum. Diagnostic and Interventional Imaging, 97(2), 227-232. https://doi.org/https://doi.org/10.1016/j.diii.2015.09.006 Kotecha, M., Bellah, R., Pena, A. H., Jaimes, C., & Mattei, P. (2012). Multimodality imaging manifestations of the Meckel diverticulum in children. Pediatr Radiol, 42(1), 95-103. https://doi.org/10.1007/s00247-011-2252-7 Lee, J. M., Jeen, C. D., Kim, S. H., Lee, J. S., Nam, S. J., Choi, H. S., Kim, E. S., & Keum, B. (2014). Meckel's diverticulum detected by computed tomographic enterography: report of 3 cases and review of the literature. Turk J Gastroenterol, 25(2), 212-215. https://doi.org/10.5152/tjg.2014.6044 Lindeman, R.-J., & Søreide, K. (2020). The Many Faces of Meckel’s Diverticulum: Update on Management in Incidental and Symptomatic Patients. Current Gastroenterology Reports, 22(1), 3. https://doi.org/10.1007/s11894-019-0742-1 He, T., Yang, C., Wang, J., Zhong, J. S., Li, A. H., Yin, Y. J., Luo, L. L., Rao, C. M., Mao, N. F., Guo, Q., Zuo, Z., Zhang, W., & Wan, P. (2024). Single-center retrospective study of the diagnostic value of double-balloon enteroscopy in Meckel's diverticulum with bleeding. World J Gastrointest Surg, 16(4), 1043-1054. https://doi.org/10.4240/wjgs.v16.i4.1043 Qi, S., Huang, H., Wei, D., Lv, C., & Yang, Y. (2015). Diagnosis and minimally invasive surgical treatment of bleeding Meckel's diverticulum in children using double-balloon enteroscopy. J Pediatr Surg, 50(9), 1610-1612. https://doi.org/10.1016/j.jpedsurg.2015.05.002 He, Q., Zhang, Y. L., Xiao, B., Jiang, B., Bai, Y., & Zhi, F. C. (2013). Double-balloon enteroscopy for diagnosis of Meckel's diverticulum: comparison with operative findings and capsule endoscopy. Surgery, 153(4), 549-554. https://doi.org/10.1016/j.surg.2012.09.012 Robijn, J., E., S., & and Miserez, M. (2006). Management of Incidentally Found Meckel’s Diverticulum A New Approach: Resection Based on a Risk Score. Acta Chirurgica Belgica, 106(4), 467-470. https://doi.org/10.1080/00015458.2006.11679933 Żyluk, A. (2019). Management of incidentally discovered unaffected Meckel's diverticulum - a review. Pol Przegl Chir, 91(6), 41-46. https://doi.org/10.5604/01.3001.0013.3400 Yagnik, V. D., Garg, P., & Dawka, S. (2024). Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review. Clin Exp Gastroenterol, 17, 147-155. https://doi.org/10.2147/ceg.S460053 Gezer, H., Temiz, A., İnce, E., Ezer, S. S., Hasbay, B., & Hiçsönmez, A. (2016). Meckel diverticulum in children: Evaluation of macroscopic appearance for guidance in subsequent surgery. J Pediatr Surg, 51(7), 1177-1180. https://doi.org/10.1016/j.jpedsurg.2015.08.066 Thirunavukarasu, P., Sathaiah, M., Sukumar, S., Bartels, C. J., Zeh, H., 3rd, Lee, K. K., & Bartlett, D. L. (2011). Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management. Ann Surg, 253(2), 223-230. https://doi.org/10.1097/SLA.0b013e3181ef488d Stone, P. A., Hofeldt, M. J., Campbell, J. E., Vedula, G., DeLuca, J. A., & Flaherty, S. K. (2004). Meckel diverticulum: ten-year experience in adults. South Med J, 97(11), 1038-1041. https://doi.org/10.1097/01.Smj.0000125222.90696.03 Zani, A., Eaton, S., Rees, C. M., & Pierro, A. (2008). Incidentally detected Meckel diverticulum: to resect or not to resect? Ann Surg, 247(2), 276-281. https://doi.org/10.1097/SLA.0b013e31815aaaf8 Bandi, A., Tan, Y. W., & Tsang, T. (2014). Correlation of gastric heterotopia and Meckel's diverticular bleeding in children: a unique association. Pediatr Surg Int, 30(3), 313-316. https://doi.org/10.1007/s00383-013-3441-2 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Sep, 2025 Read the published version in Pediatric Surgery International → Version 1 posted Editorial decision: Revision requested 10 Aug, 2025 Reviews received at journal 27 Jul, 2025 Reviews received at journal 12 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers invited by journal 07 Jul, 2025 Editor assigned by journal 24 Jun, 2025 Submission checks completed at journal 24 Jun, 2025 First submitted to journal 20 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6936165","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482133531,"identity":"c96de7ec-b188-4201-be01-f2f8526c79f3","order_by":0,"name":"Nimmita Srisan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYDACZiBOADHYG9gYGAoQggS0gPTwHABqMQCLMTYTtgqkRSKBSC3m7NypGx7+sGOQn/n42WMeAzsG/vYD7I8L8GixbObddiMhIZnB4HaauTGPQTKDxJkExuYZeLQYHAZrYWYwkM5hk+YxAHrtBtBhPIS11AMddgakBcggUsthoOE8IC2HGQyI05J2nMfgTJqZ5ByD4zyGZxIbZ+PVcv7stps/bKrl5NsPP5N4U1EtJ3f88IHP+LTAAA8Sg7GBCA2jYBSMglEwCvABAH3LRFCqff5QAAAAAElFTkSuQmCC","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":true,"prefix":"","firstName":"Nimmita","middleName":"","lastName":"Srisan","suffix":""},{"id":482133532,"identity":"daf6935d-9397-40bd-9705-c1908d068bae","order_by":1,"name":"Peerawit Songsiri","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Peerawit","middleName":"","lastName":"Songsiri","suffix":""},{"id":482133533,"identity":"07fc1f07-8399-489e-b9e8-ce43da2bca24","order_by":2,"name":"Sirima Liukitithara","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sirima","middleName":"","lastName":"Liukitithara","suffix":""},{"id":482133534,"identity":"9c9d0a54-ebea-4ee8-97e7-41bd0fe1124c","order_by":3,"name":"Anan Sriniworn","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anan","middleName":"","lastName":"Sriniworn","suffix":""},{"id":482133535,"identity":"5f43af2f-973b-4404-87aa-0a9027b8c3ff","order_by":4,"name":"Katawaetee Decharun","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Katawaetee","middleName":"","lastName":"Decharun","suffix":""},{"id":482133536,"identity":"4af08f7c-688a-4171-9e61-eb1ac2da11bb","order_by":5,"name":"Prapapan Rajatapiti","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Prapapan","middleName":"","lastName":"Rajatapiti","suffix":""},{"id":482133537,"identity":"73f0e254-f6b9-44e5-a2f9-93b7b92268aa","order_by":6,"name":"Somboon Reukvibunsi","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Somboon","middleName":"","lastName":"Reukvibunsi","suffix":""},{"id":482133540,"identity":"464f7ebe-ac11-440c-8974-d6d9ae8fb6e8","order_by":7,"name":"Bunthoon Nonthasoot","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Bunthoon","middleName":"","lastName":"Nonthasoot","suffix":""},{"id":482133541,"identity":"ccf2e4fa-d799-46c9-86b9-7f420a31e2cd","order_by":8,"name":"Supparerk Prichayudh","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Supparerk","middleName":"","lastName":"Prichayudh","suffix":""},{"id":482133542,"identity":"355f27f7-c9f8-435d-9d14-8b57cade6439","order_by":9,"name":"Chadin Tharavej","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Chadin","middleName":"","lastName":"Tharavej","suffix":""},{"id":482133545,"identity":"bf4225a1-9c2c-4463-91de-c25eda5018f0","order_by":10,"name":"Sopark Manasnayakorn","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Sopark","middleName":"","lastName":"Manasnayakorn","suffix":""},{"id":482133548,"identity":"344d85fa-552e-4161-ae94-f6636da5a8c9","order_by":11,"name":"Paisarn Vejchapipat","email":"","orcid":"","institution":"Chulalongkorn University","correspondingAuthor":false,"prefix":"","firstName":"Paisarn","middleName":"","lastName":"Vejchapipat","suffix":""}],"badges":[],"createdAt":"2025-06-20 07:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6936165/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6936165/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00383-025-06183-8","type":"published","date":"2025-09-04T15:57:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86386690,"identity":"e63f5ea9-1b24-44ac-b5ea-6e0b88861dfb","added_by":"auto","created_at":"2025-07-10 06:01:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24535,"visible":true,"origin":"","legend":"\u003cp\u003eInvestigation results in A. Children, B. Adults\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6936165/v1/18000cfc7e692a2e97942e1c.png"},{"id":86386685,"identity":"01e45fa2-418b-4cd2-a178-8a9bb56ad9a0","added_by":"auto","created_at":"2025-07-10 06:01:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17805,"visible":true,"origin":"","legend":"\u003cp\u003eManagement of Meckel’s diverticulum categorized based on symptom presentation\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6936165/v1/41ce239a60c8c5227549614e.png"},{"id":86386689,"identity":"91deed88-dd68-4aa8-bf39-19d66d8ba3cc","added_by":"auto","created_at":"2025-07-10 06:01:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":142829,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of histopathological findings in resected Meckel’s diverticulum: (a) overall, (b) pediatric patients, and (c) adult patients\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6936165/v1/85683d903ec30eeb34e0b4d2.png"},{"id":90827947,"identity":"8f953c57-3a62-49b5-ac69-54a8cc91bbe1","added_by":"auto","created_at":"2025-09-08 16:03:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":683954,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6936165/v1/7df719a5-e0f8-4744-9f7f-c486113a7f86.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMeckel’s Diverticulum: Clinical Feature Differences Between Children and Adults\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMeckel diverticulum (MD) is the most common gastrointestinal anomaly, which occurs in approximately 2% of the general population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, the incidence might not be precise since there are asymptomatic patients who do not require therapeutic intervention. Not only can MD be asymptomatic, but also its presentation can vary from bleeding, obstruction, and inflammation [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The common age of symptomatic patients is younger than 10 years of age [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, it is quite reluctant for adult surgeons to think of MD as a primary pathology. According to symptomatic diversity, preoperative diagnosis is sometimes difficult to establish, and choices of diagnostic tools can be different due to the presenting symptoms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This study aims to describe and explore the differences in MD between children and adults regarding demographic data, clinical presentations, investigations, treatments, histopathology, and complications after treatment.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cp\u003eStudy design\u003c/p\u003e\u003cp\u003eWe retrospectively reviewed computer-based patient charts for individuals diagnosed with MD considering categories including principal diagnosis, comorbidities, and complications from two tertiary care hospitals: King Chulalongkorn Memorial Hospital (2002\u0026ndash;2021) and Hat Yai Hospital (2015\u0026ndash;2021). Ethical approvals were obtained before the commencement of the study (IRB No.324/64 and COA No.596/2021).\u003c/p\u003e\u003cp\u003eWe divided the patients into two main groups which are children and adults (older than 15 years) based on hospital categorization. Demographic data, clinical presentation, investigation, treatment, histopathology, and complications were collected and compared.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eCategorical data are presented as the number of patients and corresponding percentages. Continuous data are shown as the mean and standard deviation. Descriptive statistics, Fisher\u0026rsquo;s Exact Tests, Chi-Square Tests, and Independent T-Tests were used to analyze our study data. All analyses were conducted using IBM SPSS Statistics version 29. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 123 patients with Meckel\u0026rsquo;s diverticulum (MD) were identified, comprising 67 children and 56 adults. The mean (SD) age of the pediatric group was 2.8 (3.6) years, while the adult group had a mean age of 41.5 (19.1) years. Males were predominant in both groups, accounting for 77.6% of pediatric patients and 73.2% of adult patients.\u003c/p\u003e\n\u003cp\u003eThe presentations of MD were categorized as either symptomatic or incidental findings discovered during other indicated operations, as shown in Table 1. Symptoms included lower gastrointestinal bleeding (LGIB), inflammation, intestinal obstruction, and umbilical problems. Among symptomatic patients, the mean (SD) age was 3.4 (3.8) years in children and 39.1 (17.9) years in adults. Complications were observed in 78.3% (36/46) of symptomatic pediatric patients and 78.1% (25/32) of symptomatic adult patients with MD.\u003c/p\u003e\n\u003cp\u003eLGIB was the most common presenting symptom in pediatric patients, occurring significantly more often than in adults (37.3% vs. 10.7%, p\u0026lt;0.001). Conversely, diverticulitis was the leading symptom in adults, occurring significantly more frequently than in pediatric patients (26.8% vs. 4.5%, p\u0026lt;0.001). Regarding gender, 65.6% of male patients and 56.7% of female patients presented with symptoms, but this difference was not statistically significant. In pediatric patients, symptomatic presentations were observed in 69.2% of males and 66.7% of females (p=0.850). Among adults, symptoms were reported in 61.0% of males and 46.7% of females (p=0.338).\u003c/p\u003e\n\u003cp\u003eTable 1. Presenting symptoms of patients with Meckel\u0026rsquo;s diverticulum categorized by age group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5748%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.5814%;\"\u003e\n \u003cp\u003eChildren (N=67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9169%;\"\u003e\n \u003cp\u003eAdult (N=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9269%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5748%;\"\u003e\n \u003cp\u003eSymptomatic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.5814%;\"\u003e\n \u003cp\u003e46 (68.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9169%;\"\u003e\n \u003cp\u003e32 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9269%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5748%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eLGIB\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.5814%;\"\u003e\n \u003cp\u003e25 (37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9169%;\"\u003e\n \u003cp\u003e6 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9269%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5748%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDiverticulitis\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.5814%;\"\u003e\n \u003cp\u003e3 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9169%;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9269%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5748%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eObstruction\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.5814%;\"\u003e\n \u003cp\u003e13 (19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9169%;\"\u003e\n \u003cp\u003e10 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9269%;\"\u003e\n \u003cp\u003e0.827\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5748%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eUmbilical problems\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.5814%;\"\u003e\n \u003cp\u003e5 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9169%;\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9269%;\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5748%;\"\u003e\n \u003cp\u003eIncidental findings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.5814%;\"\u003e\n \u003cp\u003e21 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9169%;\"\u003e\n \u003cp\u003e24 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9269%;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFor the investigations, we focused on symptomatic patients. The methods used in children included Meckel scan, computerized tomography (CT), angiogram, ultrasound, laparoscopic diagnosis, double balloon endoscopy, red blood cell (RBC) scan, esophagogastroduodenoscopy (EGD), and colonoscopy. Some patients underwent more than one investigation. The frequency of symptomatic patients who underwent each test is demonstrated in Table 2. Due to different presentations, the frequency of Meckel\u0026rsquo;s scan was conducted significantly higher in children (43.5% vs 6.3%, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eTable 2. Investigation in symptomatic patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eInvestigations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003eChildren (N=46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003eAdult (N=32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eMeckel\u0026rsquo;s scan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e20 (43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e2 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eCT scan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e8 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e11 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eAngiogram\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eUltrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e3 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e2 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eDouble balloon enteroscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e2 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eLaparoscopic diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e2 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eRBC scan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e1 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eEGD with Colonoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e4 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eColonoscopy alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1065%;\"\u003e\n \u003cp\u003eBarium enema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.1248%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6273%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1414%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn the investigations summarized in Table 2, we presented positive test results, defined as suspected MD on any imaging or endoscopic study, as well as contrast extravasation into the bowel lumen on visceral angiography (Figure 1). The accuracy of the Technetium-99m pertechnetate scan or Meckel\u0026rsquo;s scan was 95% (19/20) in children and 50% (1/2) in adults, while the accuracy of the CT scan was 37.5% (3/8) in children and 45.5% (5/11) in adults. The proportion of investigation findings is demonstrated in Fig. 1.\u003c/p\u003e\n\u003cp\u003eAs for the treatment, 98.7% (77/78) of symptomatic patients and 80.0% (36/45) of incidental findings underwent Meckel resection. All incidental findings were discovered during laparotomy. However, three surgical approaches were used for the symptomatic group: laparotomy, laparoscopic assistance, and total laparoscopic procedure. The proportion of each approach is shown in Fig. 2. Among the unresected patients, there was one adult with an obstructive symptom. Incidental findings included two children and seven adults. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our series of 113 MD resections, 36.3% contained ectopic mucosa, 21.2% had no ectopic mucosa, and 41.6% did not have ectopic mucosa mentioned in the report. One patient (0.9%) in the incidental finding group had a spindle cell tumor in the Meckel\u0026rsquo;s specimen. This patient was operated because of an infrarenal abdominal aortic aneurysm. Among specimens containing ectopic tissue, three types were identified: gastric mucosa (80.5%), pancreatic mucosa (7.3%), and mixed ectopic tissue (12.2%). Pediatric patients with ectopic mucosa accounted for 40.0% (26/65), compared to 31.3% (15/48) in adults. This difference was not statistically significant (p=0.344).\u003c/p\u003e\n\u003cp\u003eIn terms of pathology and symptoms, ectopic mucosa was identified in 42.9% (33/77) of specimens from symptomatic patients, compared to 22.2% (8/27) in asymptomatic patients, a statistically significant difference (p=0.044). When comparing symptomatic children and adults, 50% (23/46) of pediatric patients and 32.3% (10/31) of adult patients had ectopic mucosa. Although a higher percentage was observed in children, this difference was not statistically significant (p=0.123).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn pediatric patients presenting with lower gastrointestinal bleeding (LGIB), 76% (19/25) had ectopic tissue, including 17 with gastric mucosa, 1 with pancreatic mucosa, and 1 with both types. In this group, 4% (1/25) had no ectopic tissue, and 20% had no mention of ectopic tissue in the report. Among adults with LGIB, 66.7% (4/6) had gastric mucosa, while one patient had no ectopic mucosa, and one had no specific mention of it.\u003c/p\u003e\n\u003cp\u003eFor patients presenting with inflammatory symptoms, 27.8% (5/18) of resected specimens contained ectopic mucosa, including one child and three adults with gastric mucosa and one adult with pancreatic mucosa. In this group, 22.2% (4/18) had no ectopic mucosa, while the remaining specimens (50%) had no mention of ectopic tissue. Figure 3 illustrates the histopathology proportions for the overall, pediatric, and adult groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostoperative complications occurred in 9.0% (6/67) of children and 7.1% (4/56) of adults, including intestinal obstruction, wound infection, and anastomotic stricture. No statistically significant difference was observed between the two groups. Additionally, there was one death in the pediatric group, which was not related to MD. Comparing patients with and without symptoms, 7.7% of symptomatic and 11.1% of asymptomatic patients experienced postoperative complications (p=0.522).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMeckel\u0026rsquo;s diverticulum (MD) is a true diverticulum containing all layers of the intestinal wall and is the most common congenital malformation of the gastrointestinal tract [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], with a prevalence ranging from 0.3\u0026ndash;2.9% [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although its complications decrease with age, MD is often overlooked in adults presenting with acute abdominal symptoms, which can lead to delayed diagnosis and severe complications such as hemorrhagic shock and peritonitis [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Understanding the presentation and optimal management of MD in both pediatric and adult populations is essential for improving patient outcomes.\u003c/p\u003e\u003cp\u003eOur study reported a proportion of symptomatic patients at 68.7% in children, 57.1% in adults, and 63.4% overall. This total percentage aligns with previous literature [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] but is notably higher than that reported by Ueberruck et al [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This discrepancy may stem from our institution\u0026rsquo;s clinical approach; in pediatric cases with suspected appendicitis where the appendix appears inflamed, further investigation for MD is not typically pursued. Consequently, our report may reflect a higher incidence of symptomatic cases.\u003c/p\u003e\u003cp\u003eIn symptomatic presentations of MD, our findings show that children most commonly presented with lower gastrointestinal bleeding, followed by intestinal obstruction. In contrast, adults more frequently presented with inflammatory symptoms, followed by intestinal obstruction. While the symptomatic patterns in children aligned with previous reports [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], our study revealed a distinct trend in adults: unlike prior studies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] that identified bleeding and intestinal obstruction as the predominant symptoms, inflammation emerged as the leading presentation in our adult cohort. Our study found no significant difference in symptom prevalence between male and female patients. While previous studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] have reported male predominance among symptomatic MD cases, our findings suggest that gender may not be a reliable predictor of symptomatic MD. Further studies with larger sample sizes may be necessary to clarify this relationship.\u003c/p\u003e\u003cp\u003eFor diagnostic investigations, given the wide range of symptoms associated with MD, the choice of diagnostic tool is typically guided by clinical presentation. In our study, the frequency of each investigation aligned closely with the symptoms presented by patients. Abdominal radiographs were excluded, as they are not effective in identifying MD [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Meckel\u0026rsquo;s scintigraphy, the only method with a statistically significant difference in usage, was more commonly performed in pediatric cases due to the higher prevalence of Meckel\u0026rsquo;s pathology, which in adults is more often evaluated with endoscopy.\u003c/p\u003e\u003cp\u003eFor cases presenting with obstruction or inflammation, abdominal CT scans were the preferred diagnostic tool. Although CT may not always definitively identify MD [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], our study observed that it frequently revealed abnormal findings in the distal ileum, particularly in young adults with a previously unoperated (virgin) abdomen. These findings suggest that clinicians should maintain a high index of suspicion for MD in patients with unexplained distal ileal abnormalities.\u003c/p\u003e\u003cp\u003eOur study revealed that laparoscopic diagnosis had the highest accuracy among all investigations in both pediatric and adult groups. However, this finding may be affected by selection bias, as our retrospective study included only patients with confirmed MD, with laparoscopy often serving as the final diagnostic option after multiple inconclusive studies.\u003c/p\u003e\u003cp\u003eRegarding other diagnostic methods, the accuracy of the Technetium-99m pertechnetate scan in our study was consistent with previous literature, showing higher accuracy in pediatric patients than in adults [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Recently, double-balloon enteroscopy (DBE) has emerged as a promising diagnostic tool for Meckel\u0026rsquo;s diverticulum. In our study, only three patients underwent DBE, achieving an accuracy of 66.7% (2/3). A recent retrospective study by He et al. reported a 100% positive detection rate using DBE; however, they did not specify its application in pediatric patients [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In another study focused on pediatric patients with lower gastrointestinal bleeding (LGIB), DBE was utilized as the primary diagnostic tool, identifying Meckel\u0026rsquo;s diverticulum in 14 of 21 patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Patients with positive findings subsequently underwent resection through a small umbilical incision with scope-guided assistance. Several studies have also highlighted the benefits of DBE in diagnosing Meckel\u0026rsquo;s diverticulum, particularly in cases where Meckel\u0026rsquo;s scintigraphy yielded negative results. Given its high detection rate in recent studies, DBE may play a crucial role in diagnosing MD in patients with unexplained lower GI bleeding [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, due to limited data, further research is needed to establish standardized indications for DBE in the evaluation of MD.\u003c/p\u003e\u003cp\u003eThe decision to remove asymptomatic MD remains controversial, particularly in adult patients. In our study, among asymptomatic cases, pediatric patients had a higher proportion of resections; however, 70% of asymptomatic adults in our study also underwent diverticulum removal. The surgeon\u0026rsquo;s discretion primarily influenced treatment decisions for this group.\u003c/p\u003e\u003cp\u003eThe criteria for resecting asymptomatic MD remain widely debated. Robijn et al.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] proposed four risk factors that support resection: male gender, age younger than 45 years, a pathology length\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, and the presence of a fibrous band. Additionally, macroscopic features, such as the presence of ectopic mucosa and a narrow-necked diverticulum, have been suggested as indicators for removal [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, studies have varied on the age threshold for risk, ranging from under 45 to 50 years [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Regarding macroscopic appearance, Gezer et al. concluded that this factor does not reliably predict whether MD will become symptomatic [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Similarly, the perception of thickness as an indicator of ectopic mucosa was found to be unreliable. Another consideration is the association between Meckel\u0026rsquo;s diverticulum and malignancy. Thirunavukarasu et al. reported that MD carries a higher risk of malignancy than other ileal sites, supporting resection [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Conversely, other studies argue against resection of asymptomatic MD, citing a low lifetime risk of complications and the potential for increased postoperative morbidity [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. A risk-based approach may help guide clinical decisions, and standardized guidelines incorporating risk stratification models may help optimize management strategies in the future.\u003c/p\u003e\u003cp\u003eOur study found no statistically significant difference in the prevalence of ectopic mucosa between children and adults. However, consistent with prior research, ectopic mucosa was a major contributing factor to symptomatic presentations, particularly bleeding and inflammation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These findings reinforce the need to consider ectopic mucosa when evaluating MD patients for resection.\u003c/p\u003e\u003cp\u003eOur study has several limitations. First, its retrospective nature may introduce selection bias, particularly in the decision-making process for resection. Second, the sample size for certain diagnostic modalities, such as DBE, was small, limiting generalizability. Finally, histopathology reports did not always specify the presence of ectopic mucosa, which may have influenced our findings.\u003c/p\u003e\u003cp\u003e Future research should focus on refining diagnostic criteria for MD, particularly in adult patients, and establishing clear guidelines for the resection of asymptomatic cases. Prospective studies comparing long-term outcomes in resected versus non-resected asymptomatic MD cases may provide valuable insights into optimal management strategies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe most common symptom of MD was lower gastrointestinal bleeding in children and diverticulitis in adults. Meckel\u0026rsquo;s scan remains an important diagnostic tool for detecting bleeding MD, particularly in pediatric cases. Our findings suggest that incidental MD identified during surgery may warrant resection, given that ectopic gastric tissue was found in 19% of asymptomatic MD cases. However, given the ongoing debate regarding the management of asymptomatic MD, further prospective studies are necessary to establish standardized guidelines and optimize patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePeerawit Songsiri and Paisarn Vejchapipat developed the study concept, including the generation of ideas and hypotheses. Nimmita Srisan and Peerawit Songsiri collected data, performed the analysis, interpreted the outcomes, critically reviewed the findings, evaluated them against existing knowledge, and contributed to the study\u0026rsquo;s conclusions. Nimmita Srisan drafted the manuscript. Nimmita Srisan, Sirima Liukitithara, Anan Sriniworn, Katawaetee Decharun, Prapapan Rajatapiti, Somboon Reukvibunsi, Bunthoon Nonthasoot, Supparerk Prichayudh, Chadin Tharavej, Sopark Manasnayakorn, and Paisarn Vejchapipat supported the data, concept development, and study design. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (IRB No.324/64).\u0026nbsp;The research protocol also received certification of approval (COA No. 596/2021) from Hatyai Hospital.The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest.\u0026nbsp;\u003c/strong\u003eWe would like to declare that the abstract entitled above has been previously presented as an oral presentation at the 47th Annual National Scientific Congress of the Royal College of Surgeons of Thailand, held from 13 to 16 July 2022 at the Ambassador City Jomtien Hotel, Pattaya, Chonburi, Thailand. Only the abstract (not the full manuscript) was published soon in the Thai Journal of Surgery in 2022. However, the full manuscript of the abstract has never been previously considered or published in any other journal.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStallion A, Shuck JM. Meckel\u0026apos;s diverticulum. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6918\u003c/li\u003e\n\u003cli\u003eHuang, C. C., Lai, M. W., Hwang, F. M., Yeh, Y. C., Chen, S. Y., Kong, M. S., Lai, J. Y., Chen, J. C., \u0026amp; Ming, Y. C. (2014). Diverse presentations in pediatric Meckel\u0026apos;s diverticulum: a review of 100 cases. Pediatr Neonatol, 55(5), 369-375. https://doi.org/10.1016/j.pedneo.2013.12.005 \u003c/li\u003e\n\u003cli\u003eChen, Q., Gao, Z., Zhang, L., Zhang, Y., Pan, T., Cai, D., Xiong, Q., Shu, Q., \u0026amp; Qian, Y. (2018). Multifaceted behavior of Meckel\u0026apos;s diverticulum in children. J Pediatr Surg, 53(4), 676-681. https://doi.org/10.1016/j.jpedsurg.2017.11.059 \u003c/li\u003e\n\u003cli\u003eHern\u0026aacute;ndez, J. D., Valencia, G., Gir\u0026oacute;n, F., Garc\u0026iacute;a Sierra, A. M., N\u0026uacute;\u0026ntilde;ez-Rocha, R. E., Rodr\u0026iacute;guez, L. M., Rey Chaves, C. E., Londo\u0026ntilde;o, E. E., \u0026amp; Nassar, R. (2023). Meckel\u0026apos;s diverticulum: analysis of 27 cases in an adult population. Front Surg, 10, 1327545. https://doi.org/10.3389/fsurg.2023.1327545 \u003c/li\u003e\n\u003cli\u003eRho, J. H., Kim, J. S., Kim, S. Y., Kim, S. K., Choi, Y. M., Kim, S. M., Tchah, H., Jeon, I. S., Son, D. W., Ryoo, E., Cho, K. H., Choi, D. Y., \u0026amp; Kim, Y. M. (2013). Clinical Features of Symptomatic Meckel\u0026apos;s Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis. Pediatr Gastroenterol Hepatol Nutr, 16(1), 41-48. https://doi.org/10.5223/pghn.2013.16.1.41\u003c/li\u003e\n\u003cli\u003ePark, J. J., Wolff, B. G., Tollefson, M. K., Walsh, E. E., \u0026amp; Larson, D. R. (2005). Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002). Ann Surg, 241(3), 529-533. https://doi.org/10.1097/01.sla.0000154270.14308.5f \u003c/li\u003e\n\u003cli\u003eKuru, S., \u0026amp; Kismet, K. (2018). Meckel\u0026apos;s diverticulum: clinical features, diagnosis and management. \u003cem\u003eRev Esp Enferm Dig\u003c/em\u003e,\u003cem\u003e 110\u003c/em\u003e(11), 726-732. https://doi.org/10.17235/reed.2018.5628/2018 \u003c/li\u003e\n\u003cli\u003eHansen, C. C., \u0026amp; S\u0026oslash;reide, K. (2018). Systematic review of epidemiology, presentation, and management of Meckel\u0026apos;s diverticulum in the 21st century. Medicine (Baltimore), 97(35), e12154. https://doi.org/10.1097/md.0000000000012154\u003c/li\u003e\n\u003cli\u003eYang, X., \u0026amp; Guo, K. (2013). Massive lower gastrointestinal bleeding from Meckel\u0026apos;s diverticulum with heterotopic pancreas: case report and a brief review of the literature. Jop, 14(3), 269-272. https://doi.org/10.6092/1590-8577/1407 \u003c/li\u003e\n\u003cli\u003eJayawickrama, A., Mohamed Ozaal, O., Ranaweera, G., Fernandopulle, N., \u0026amp; Subasinghe, D. (2024). Severe obscure gastrointestinal bleeding from Meckel\u0026apos;s diverticulum with predominant ectopic pancreatic tissue. SAGE Open Med Case Rep, 12, 2050313x241266480. https://doi.org/10.1177/2050313x241266480 \u003c/li\u003e\n\u003cli\u003eJain, H., Joshi, R., Sudan, A., \u0026amp; Banga, A. (2023). Spontaneous Perforation of Meckel\u0026apos;s Diverticulum: An Unusual Cause of Peritonitis in an Adult. J Brown Hosp Med, 2(4), 88127. https://doi.org/10.56305/001c.88127 \u003c/li\u003e\n\u003cli\u003eFraser, A. A., Opie, D. D., Gnecco, J., Nashed, B., \u0026amp; Johnson, D. C. (2018). Spontaneous perforation of Meckel\u0026rsquo;s diverticulum in an adult female with literature review. Surgical Case Reports, 4(1), 129. https://doi.org/10.1186/s40792-018-0536-y\u003c/li\u003e\n\u003cli\u003eGroebli, Y., Bertin, D., \u0026amp; Morel, P. (2001). Meckel\u0026apos;s diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg, 167(7), 518-524. https://doi.org/10.1080/110241501316914894 \u003c/li\u003e\n\u003cli\u003eRuscher, K. A., Fisher, J. N., Hughes, C. D., Neff, S., Lerer, T. J., Hight, D. W., Bourque, M. D., \u0026amp; Campbell, B. T. (2011). National trends in the surgical management of Meckel\u0026apos;s diverticulum. J Pediatr Surg, 46(5), 893-896. https://doi.org/10.1016/j.jpedsurg.2011.02.024\u003c/li\u003e\n\u003cli\u003eChen, J. J., Lee, H. C., Yeung, C. Y., Chan, W. T., Jiang, C. B., Sheu, J. C., \u0026amp; Wang, N. L. (2014). Meckel\u0026apos;s Diverticulum: Factors Associated with Clinical Manifestations. ISRN Gastroenterol, 2014, 390869. https://doi.org/10.1155/2014/390869 \u003c/li\u003e\n\u003cli\u003eUeberrueck, T., Meyer, L., Koch, A., Hinkel, M., Kube, R., \u0026amp; Gastinger, I. (2005). The significance of Meckel\u0026apos;s diverticulum in appendicitis--a retrospective analysis of 233 cases. World J Surg, 29(4), 455-458. https://doi.org/10.1007/s00268-004-7615-x \u003c/li\u003e\n\u003cli\u003eLin, X.-k., Huang, X.-z., Bao, X.-z., Zheng, N., Xia, Q.-z., \u0026amp; Chen, C.-d. (2017). Clinical characteristics of Meckel diverticulum in children: A retrospective review of a 15-year single-center experience. Medicine, 96(32), e7760. https://doi.org/10.1097/md.0000000000007760 \u003c/li\u003e\n\u003cli\u003eBlouhos, K., Boulas, K. A., Tsalis, K., Barettas, N., Paraskeva, A., Kariotis, I., Keskinis, C., \u0026amp; Hatzigeorgiadis, A. (2018). Meckel\u0026apos;s Diverticulum in Adults: Surgical Concerns. Front Surg, 5, 55. https://doi.org/10.3389/fsurg.2018.00055 \u003c/li\u003e\n\u003cli\u003eKaraman, A., Karaman, İ., \u0026Ccedil;avuşoağlu, Y. H., Erdoağan, D., \u0026amp; Aslan, M. K. (2010). Management of asymptomatic or incidental Meckels diverticulum. Indian Pediatr, 47(12), 1055-1057. https://doi.org/10.1007/s13312-010-0176-1\u003c/li\u003e\n\u003cli\u003eMohiuddin, S. S., Gonzalez, A., \u0026amp; Corpron, C. (2011). Meckel\u0026apos;s diverticulum with small bowel obstruction presenting as appendicitis in a pediatric patient. Jsls, 15(4), 558-561. https://doi.org/10.4293/108680811x13176785204553 \u003c/li\u003e\n\u003cli\u003eWon, Y., Lee, H. W., Ku, Y. M., Lee, S. L., Seo, K. J., Lee, J. I., \u0026amp; Chung, J. H. (2016). Multidetector-row computed tomography (MDCT) features of small bowel obstruction (SBO) caused by Meckel\u0026apos;s diverticulum. Diagnostic and Interventional Imaging, 97(2), 227-232. https://doi.org/https://doi.org/10.1016/j.diii.2015.09.006 \u003c/li\u003e\n\u003cli\u003eKotecha, M., Bellah, R., Pena, A. H., Jaimes, C., \u0026amp; Mattei, P. (2012). Multimodality imaging manifestations of the Meckel diverticulum in children. Pediatr Radiol, 42(1), 95-103. https://doi.org/10.1007/s00247-011-2252-7\u003c/li\u003e\n\u003cli\u003eLee, J. M., Jeen, C. D., Kim, S. H., Lee, J. S., Nam, S. J., Choi, H. S., Kim, E. S., \u0026amp; Keum, B. (2014). Meckel\u0026apos;s diverticulum detected by computed tomographic enterography: report of 3 cases and review of the literature. Turk J Gastroenterol, 25(2), 212-215. https://doi.org/10.5152/tjg.2014.6044 \u003c/li\u003e\n\u003cli\u003eLindeman, R.-J., \u0026amp; S\u0026oslash;reide, K. (2020). The Many Faces of Meckel\u0026rsquo;s Diverticulum: Update on Management in Incidental and Symptomatic Patients. Current Gastroenterology Reports, 22(1), 3. https://doi.org/10.1007/s11894-019-0742-1 \u003c/li\u003e\n\u003cli\u003eHe, T., Yang, C., Wang, J., Zhong, J. S., Li, A. H., Yin, Y. J., Luo, L. L., Rao, C. M., Mao, N. F., Guo, Q., Zuo, Z., Zhang, W., \u0026amp; Wan, P. (2024). Single-center retrospective study of the diagnostic value of double-balloon enteroscopy in Meckel\u0026apos;s diverticulum with bleeding. World J Gastrointest Surg, 16(4), 1043-1054. https://doi.org/10.4240/wjgs.v16.i4.1043 \u003c/li\u003e\n\u003cli\u003eQi, S., Huang, H., Wei, D., Lv, C., \u0026amp; Yang, Y. (2015). Diagnosis and minimally invasive surgical treatment of bleeding Meckel\u0026apos;s diverticulum in children using double-balloon enteroscopy. J Pediatr Surg, 50(9), 1610-1612. https://doi.org/10.1016/j.jpedsurg.2015.05.002 \u003c/li\u003e\n\u003cli\u003eHe, Q., Zhang, Y. L., Xiao, B., Jiang, B., Bai, Y., \u0026amp; Zhi, F. C. (2013). Double-balloon enteroscopy for diagnosis of Meckel\u0026apos;s diverticulum: comparison with operative findings and capsule endoscopy. Surgery, 153(4), 549-554. https://doi.org/10.1016/j.surg.2012.09.012\u003c/li\u003e\n\u003cli\u003eRobijn, J., E., S., \u0026amp; and Miserez, M. (2006). Management of Incidentally Found Meckel\u0026rsquo;s Diverticulum A New Approach: Resection Based on a Risk Score. Acta Chirurgica Belgica, 106(4), 467-470. https://doi.org/10.1080/00015458.2006.11679933 \u003c/li\u003e\n\u003cli\u003eŻyluk, A. (2019). Management of incidentally discovered unaffected Meckel\u0026apos;s diverticulum - a review. Pol Przegl Chir, 91(6), 41-46. https://doi.org/10.5604/01.3001.0013.3400 \u003c/li\u003e\n\u003cli\u003eYagnik, V. D., Garg, P., \u0026amp; Dawka, S. (2024). Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review. Clin Exp Gastroenterol, 17, 147-155. https://doi.org/10.2147/ceg.S460053 \u003c/li\u003e\n\u003cli\u003eGezer, H., Temiz, A., İnce, E., Ezer, S. S., Hasbay, B., \u0026amp; Hi\u0026ccedil;s\u0026ouml;nmez, A. (2016). Meckel diverticulum in children: Evaluation of macroscopic appearance for guidance in subsequent surgery. J Pediatr Surg, 51(7), 1177-1180. https://doi.org/10.1016/j.jpedsurg.2015.08.066 \u003c/li\u003e\n\u003cli\u003eThirunavukarasu, P., Sathaiah, M., Sukumar, S., Bartels, C. J., Zeh, H., 3rd, Lee, K. K., \u0026amp; Bartlett, D. L. (2011). Meckel\u0026apos;s diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management. Ann Surg, 253(2), 223-230. https://doi.org/10.1097/SLA.0b013e3181ef488d\u003c/li\u003e\n\u003cli\u003eStone, P. A., Hofeldt, M. J., Campbell, J. E., Vedula, G., DeLuca, J. A., \u0026amp; Flaherty, S. K. (2004). Meckel diverticulum: ten-year experience in adults. South Med J, 97(11), 1038-1041. https://doi.org/10.1097/01.Smj.0000125222.90696.03 \u003c/li\u003e\n\u003cli\u003eZani, A., Eaton, S., Rees, C. M., \u0026amp; Pierro, A. (2008). Incidentally detected Meckel diverticulum: to resect or not to resect? Ann Surg, 247(2), 276-281. https://doi.org/10.1097/SLA.0b013e31815aaaf8 \u003c/li\u003e\n\u003cli\u003eBandi, A., Tan, Y. W., \u0026amp; Tsang, T. (2014). Correlation of gastric heterotopia and Meckel\u0026apos;s diverticular bleeding in children: a unique association. Pediatr Surg Int, 30(3), 313-316. https://doi.org/10.1007/s00383-013-3441-2 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Meckel’s diverticulum, lower gastrointestinal bleeding, ectopic mucosa, pediatric and adult surgery, diagnostic imaging","lastPublishedDoi":"10.21203/rs.3.rs-6936165/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6936165/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMeckel’s diverticulum (MD) is a common anomaly of GI tract. Patients with MD may present with various manifestations, including lower GI bleeding, gut obstruction, diverticulitis, or umbilical problems. Also, MD can be incidentally found during operations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePURPOSE:\u003c/strong\u003e The objectives were to describe and to compare clinical features of patients with MD in terms of demographic data, clinical presentation, investigations, treatment, histopathology, and post-operative complications between pediatric and adult patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS: \u003c/strong\u003ePatients with MD were retrospectively reviewed from 2 tertiary hospitals (2002-2021). These included patients with symptomatic MD and patients whose MD was incidentally found during operations. Demographic data, clinical presentation, investigation, treatment, histopathology, and postoperative complications were reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e Total of 123 cases with MD (67 children vs 56 adults) were studied.\u003c/p\u003e\n\u003cp\u003eOf 67 children with MD, symptomatic MD was reported in 46 cases (69%). Lower GI bleeding was the most common presentation (54%), followed by obstruction (28%), umbilical problems (11%) and diverticulitis (7%). For children with bleeding MD (25 cases), Meckel scan was an important investigation to confirm the diagnosis with positive predictive value of 91%.\u003c/p\u003e\n\u003cp\u003eOf 56 adults with MD, symptomatic MD was recorded in 32 cases (57%). Diverticulitis was the most common presentation (47%) followed by obstruction (31%), GI bleeding (19%) and umbilical problems (3%).\u003c/p\u003e\n\u003cp\u003eFor incidentally found MD during operations, 80% were resected. Interestingly, ectopic gastric tissue was found in 27.4% of the resected MD specimens. Moreover, there was no significant difference in postoperative complications between patients with symptomatic MD and patients with incidentally found MD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION:\u003c/strong\u003e The most common symptom of MD was lower GI bleeding in children, and diverticulitis in adults. Meckel scan is an important tool to investigate bleeding MD. Since ectopic gastric tissue was found in 19% of asymptomatic MD, therefore, our findings seem to support the concept of resection of MD incidentally found during the operations.\u003c/p\u003e","manuscriptTitle":"Meckel’s Diverticulum: Clinical Feature Differences Between Children and Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-10 06:01:22","doi":"10.21203/rs.3.rs-6936165/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-10T18:42:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-27T16:40:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-12T04:04:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109154138064889377479526626641151186705","date":"2025-07-11T18:14:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284370162272059628065654615255363471825","date":"2025-07-08T05:11:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-07T13:49:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-24T20:20:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-24T09:29:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2025-06-20T07:02:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5567df19-50c8-41fa-9a29-7a9baf8db2ae","owner":[],"postedDate":"July 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T16:00:05+00:00","versionOfRecord":{"articleIdentity":"rs-6936165","link":"https://doi.org/10.1007/s00383-025-06183-8","journal":{"identity":"pediatric-surgery-international","isVorOnly":false,"title":"Pediatric Surgery International"},"publishedOn":"2025-09-04 15:57:01","publishedOnDateReadable":"September 4th, 2025"},"versionCreatedAt":"2025-07-10 06:01:22","video":"","vorDoi":"10.1007/s00383-025-06183-8","vorDoiUrl":"https://doi.org/10.1007/s00383-025-06183-8","workflowStages":[]},"version":"v1","identity":"rs-6936165","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6936165","identity":"rs-6936165","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}