Sonographic features of axial torsion of Meckel's diverticulum in 12 pediatric patients: a retrospective analysis and literature review.

Abstract

Background: As described in isolated case reports, axial torsion is an extremely rare complication of Meckel's diverticulum (MD). Diagnosis based on preoperative imaging alone is challenging for clinicians.

Objective: The aim of this study was to investigate the clinical and sonographic characteristics of axial torsion of MD in Chinese pediatric patients treated at a single center and to review the published literature on this condition.

Materials and methods: We conducted a retrospective analysis of pediatric patients (< 18 years) who underwent surgical treatment for MD torsion between November 2008 and January 2023 at our institution, focusing on clinical presentation and ultrasound findings. In addition, a systematic review of English-language articles in PubMed (1989-2023) was performed to summarize reported cases of MD torsion in pediatric populations.

Results: Twelve patients (10 males, 2 females; male-to-female ratio 5:1; median age 4 years, range 2-15) were included. The predominant symptoms were abdominal pain (91.7%) and vomiting (75.0%). Preoperative ultrasound revealed key findings: a cystic mass with digestive wall structure (83.3%), the 'whirlpool' sign (58.3%), and small bowel obstruction (75.0%). There were nine cases of MD gangrene, but no cases of intestinal necrosis. The diagnostic accuracy of preoperative ultrasound was 75.0% for MD and 41.7% for axial torsion of MD. A review of 18 pediatric cases from the English literature showed that our ultrasound detection rates exceeded those of previous reports-83.3% vs. 27.3% for cystic masses and 58.3% vs. 18.2% for the 'whirlpool' sign.

Conclusion: The characteristic sonographic features of MD torsion include a cystic mass with digestive tract wall structure, the 'whirlpool' sign, and bowel obstruction. Early recognition of these features may expedite preoperative diagnosis, enable timely surgical intervention and improve clinical outcomes. While experienced sonographers utilizing multi-frequency probes can enhance detection accuracy, preoperative ultrasound diagnosis of this condition remains challenging.