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

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 χ2 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%; χ2 = 12.1; p < 0.01), absence of other symptoms (61.3% vs. 39.6%; χ2 = 5.2; p < 0.02) and blood transfusions (41.9% vs. 9.9%; χ2 = 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.

Keywords: Child; Diagnosis; Gastrointestinal hemorrhage; Hemoglobin; Meckel diverticulum.