Inverted U-shaped relationship between diverticular width and gastrointestinal bleeding in symptomatic Meckel's diverticulum children: a retrospective single-center study.

OBJECTIVE: Meckel's diverticulum (MD) is the most common congenital gastrointestinal malformation in children, with gastrointestinal bleeding being the most frequent associated complication. While existing studies have primarily focused on ectopic mucosa and diverticulum length as predictors of complications, no research has specifically evaluated the association between diverticulum width and MD symptoms, particularly gastrointestinal bleeding. This study aimed to determine whether diverticulum width is an independent predictor of gastrointestinal bleeding risk in symptomatic patients, and to evaluate its potential utility for individualized surgical decision-making.

METHODS: This retrospective cohort study investigated the association between diverticulum width and the risk of gastrointestinal bleeding in children with symptomatic Meckel's diverticulum. To do this, we conducted an in-depth analysis of the relationship between diverticulum width and gastrointestinal bleeding risk using multivariate logistic regression models, generalised additive models and two-stage linear regression models.

RESULTS: A total of 310 paediatric patients with symptomatic Meckel's diverticulum were ultimately enrolled based on inclusion and exclusion criteria. After adjusting for potential confounding factors, diverticular width was found to be an independent predictor of gastrointestinal bleeding risk. A inverted U-shaped relationship was observed between diverticular width and gastrointestinal bleeding risk, with the highest risk occurring at approximately 1.25 cm. Furthermore, a significant interaction was identified between ectopic mucosa and diverticular width in modulating gastrointestinal bleeding risk.

CONCLUSION: In paediatric patients with symptomatic Meckel's diverticulum, the width of diverticula shows an inverse U-shaped relationship with the risk of gastrointestinal bleeding, with the highest risk occurring at around 1.25 cm. The presence of ectopic mucosa modulates this relationship through an interactive effect. These findings could help to improve risk stratification and inform surgical decision-making in cases of Meckel's diverticulum.