Diverse clinical features of symptomatic Meckel's diverticulum: A multicenter study of 151 consecutive pediatric patients from the Western Balkans

Purpose Symptomatic Meckel’s diverticulum (MD) has various clinical presentations and can be easily misdiagnosed. This study explores its clinical characteristics, management, and outcomes at five academic pediatric surgery centers in Bosnia & Herzegovina and Serbia. Methods All pediatric patients with symptomatic MD from 2011 to 2020 were included. Demographics, clinical and radiological features, surgical treatment approaches, histopathology, and clinical outcomes were collected and analyzed. Results The study included 151 patients. The most common complications of MD were intestinal obstruction and GI bleeding (76.2%), followed by MD inflammation (23.8%). Nonspecific abdominal pain with/without nausea or vomiting and lower GI bleeding were the most common symptoms (58.9% and 52.3%, respectively). Technetium-99m pertechnetate imaging was performed in emergent patients with lower GI bleeding and was positive in 80.7% of patients. Diverticulectomy was performed in 19.2%, while partial resection of the small intestine and anastomosis were required in 80.8% of patients ( p  < 0.0001). The positive rate of ectopic mucosa distribution in the whole cohort was 55.6% (84/151) ( p =  0.05). Conclusions Clinical complications of MD are markedly diverse. Symptomatic MD requires a high index of suspicion, especially in children with unexplained GI bleeding or abdominal pain. Early diagnosis and treatment are essential to prevent complications.