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Alemayehu H, Hall M, Desai AA, St Peter SD, Snyder CL. Demographic disparities of children presenting with symptomatic Meckel's diverticulum in children's hospitals. Pediatr Surg Int 2014; 30:649-53. [PMID: 24811048 DOI: 10.1007/s00383-014-3513-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Most of the literature about Meckel's diverticulum (MD) consists of single institutional longitudinal case series. We queried the pediatric hospital information system (PHIS) database to obtain information about the epidemiology of MD from a large number of children at geographically diverse locations. METHODS After IRB approval, the PHIS database was queried over a 9-year period for de-identified patients with both ICD-9 diagnoses of MD and a procedure code for Meckel's diverticulectomy. Data from five hospitals were excluded due to incomplete information. RESULTS 4,338,396 were children admitted during the study interval; 945 had a symptomatic MD. The incidence decreased with age: 56.4% were under 5 years old, 26.8% were between the ages of 6-12 years, and 16.8% were older than 12 years. 74% were male, which was significantly higher than the PHIS population (53.8% male, P < 0.0001). Caucasians are over-represented in the symptomatic MD group (63.4%) compared to the rest of the PHIS population (48.1%, P < 0.0001). CONCLUSIONS According to the PHIS data, there appears to be significant gender and race influence on symptomatic MD. Males present more commonly, as do non-Hispanic White patients, while it is less common among non-Hispanic Black patients.
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Affiliation(s)
- Hanna Alemayehu
- Section of General Surgery, Department of Surgery, The Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
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Meckel's Diverticulum: Factors Associated with Clinical Manifestations. ISRN GASTROENTEROLOGY 2014; 2014:390869. [PMID: 25006469 PMCID: PMC4004103 DOI: 10.1155/2014/390869] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/24/2014] [Indexed: 12/27/2022]
Abstract
Objectives. The purpose of this study was to investigate the clinical features of Meckel's diverticula at different ages, genders, and pathology in order to serve as a reminder to clinicians when evaluating potential cases and to help obtain an early diagnosis. Methods. We collected information of patients with Meckel's diverticulum diagnosed at Mackay Memorial Hospital in Taiwan from 1984 to 2009. After performing a thorough review of their charts, the clinical features of the Meckel's diverticula were analyzed according to age groups, gender, and pathology. Result. A total of 126 patients, with 90 males and 36 females, were enrolled in this study. Seventy-five patients were symptomatic and 51 Meckel's diverticula were found incidentally during surgery for other diseases. Among symptomatic patients, 39% of pediatric patients and 5% of adult patients had intestinal hemorrhage. Twenty-eight percent of pediatric patients and 67% of adult patients had inflammation of Meckel's diverticulum. Forty-six percent of males and 16% of females had inflammation. Conversely, 27% of males and 58% percent of females had intestinal obstruction. When Meckel's diverticulum had ectopic gastric mucosa, it tended to cause intestinal hemorrhage when the patient is young. Conclusions. Age, gender, and pathology affect the clinical presentations of Meckel's diverticula.
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Bandi A, Tan YW, Tsang T. Correlation of gastric heterotopia and Meckel's diverticular bleeding in children: a unique association. Pediatr Surg Int 2014; 30:313-6. [PMID: 24337683 DOI: 10.1007/s00383-013-3441-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Meckel's diverticular bleeding is the commonest cause of major gastrointestinal (GI) haemorrhage in children. We hypothesise that gastric heterotopia (GH) is associated with increased risk of bleeding and, therefore, may affect initial management. METHODS Paediatric patients with histological diagnosis of Meckel's diverticulum (MD) following diverticulectomy from 1995 to 2011 were reviewed retrospectively, focusing on histological correlation to bleeding. GH identified on histology was regarded as GH+, and where GH was not found was regarded as GH-. Two-tailed Chi-square test and Fisher's exact test were used, p < 0.05 was statistically significant. RESULTS Thirty-nine patients underwent Meckel's diverticulectomy. The number of patients with GH+, GH-, and bowel necrosis were 21, 15, and 3. Eighteen children with MD had GI bleeding. GI bleeding was more commonly associated with GH+ (14/21) than GH- (4/15) (67 vs 27 %, p = 0.02). Further analysis revealed all four GH- bleeding originated from other sources than the MD. GH+ had no significant association with other presentations. GH+ was present in 8/8 (100 %) positive Meckel's scans and 2/5 (40 %) negative scans. Meckel's scan had a sensitivity of 8/10 (80 %), and specificity of 3/3 (100 %). CONCLUSION This study confirmed that GH positive MD is a unique entity presenting typically with GI bleeding.
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Affiliation(s)
- A Bandi
- Department of Paediatric Surgery, Level 3, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK,
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Double-balloon enteroscopy for the diagnosis of Meckel's diverticulum in pediatric patients with obscure GI bleeding. Gastrointest Endosc 2014; 79:354-8. [PMID: 24016356 DOI: 10.1016/j.gie.2013.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/18/2013] [Indexed: 12/22/2022]
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Marshall ASJ, Jayapal SSK, Whitburn JAS, Akinbiyi BA, Willetts IE. Recognising serious umbilical cord anomalies. BMJ Case Rep 2013; 2013:bcr-2013-201663. [PMID: 24285812 DOI: 10.1136/bcr-2013-201663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Umbilical vessel catheterisation is a common intervention in neonatal care. Many complications are recognised, some of which are life-threatening. We report the case of a term neonate who was compromised at birth following antepartum haemorrhage with evidence of multiorgan ischaemic injury. Following resuscitation and umbilical vessel catheterisation, she developed pneumoperitoneum. At laparotomy, a patent vitellointestinal duct was identified and resected. Intestinal perforation was found in the duct wall, most plausibly explained by the unintentional catheterisation of the duct via the umbilicus. Learning to recognise umbilical cord anomalies, such as patent vitellointestinal duct, can be simple and could prevent potentially serious complications.
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Affiliation(s)
- Andrew S J Marshall
- Department of Paediatrics, Oxford University Hospitals, Children's Hospital, Oxford, UK
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56
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Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years. Pediatr Surg Int 2013; 29:511-7. [PMID: 23417523 DOI: 10.1007/s00383-013-3270-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 12/24/2022]
Abstract
AIM To review our practice of Meckel's Tc-99m pertechnetate scans over 18 years with regard to indications for the test, sensitivity and specificity in our particular referral patients' population. MATERIALS AND METHODS This is a retrospective review of Meckel's scans performed in two paediatric tertiary care teaching hospitals from April 1993 to March 2011 and followed up till October 2011. The scan was performed according to published international guidelines. 183 patients were included in this study. We classified the patients into two groups: group 1, which included 77 patients (42 %) presenting with painless per rectum bleeding, and group 2, which included 106 patients (58 %) presenting with other non-specific symptoms (e.g. abdominal pain, possibly associated with nausea and/or vomiting, failure to thrive). Data were analysed using Chi square test, considering P value less than 0.05 as significant. The age of the patients ranged from 4 days to 16.5 years (median 3 years). RESULTS 161 of the total 183 children on the study (88 %) had a negative Meckel's scan, and 22 children (12 %) had a positive scan. In the group with a positive Meckel's scan (22 children), all patients underwent surgical exploration and ectopic gastric mucosa was found in 17 cases (77 %, true positives). In the remaining 5 cases (23 %), there was no evidence of ectopic gastric mucosa (false positives). Within the group with a negative scan, 8 children (5 %) underwent surgery; only 1 child had a ectopic gastric mucosa detected following surgery (false negative). In other 52 children (32 %) of the group with a negative Meckel's scan, an endoscopy was done, which showed a normal result in 21 children and was abnormal in 31 children. Of the remaining 101 (63 %) children with a negative Meckel's scan, 74 children (46 %) improved without any further intervention. In 13 cases (8 %), other pathologies were identified. The sensitivity and specificity of the Meckel's scan for ectopic gastric mucosa were 94 and 97 %, respectively. The Meckel's scan was positive in 26 % of the patients of group 1 and in only 2 % patients of group 2. The difference between the two groups was highly significant [P < 0.0001 (Yates-corrected Chi square); odds ratio 18 (Woolf-logit method 95 % CI)]. CONCLUSION The Meckel's scan retains a high diagnostic accuracy in children for detecting a Meckel's diverticulum with ectopic gastric mucosa within it, when performed according to the recommended guidelines. The test yields its highest positive result in children presenting with significant per rectum bleeding.
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Kwait DC, Nazarenko A, Derman A, Lui P. Perforated Meckel's diverticulum presenting as a hematocele on scrotal sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:242-244. [PMID: 22886435 DOI: 10.1002/jcu.21976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 06/29/2012] [Indexed: 06/01/2023]
Abstract
Hemorrhage from ectopic gastric mucosa is the most common presenting symptom of Meckel's diverticulum. Diverticular perforation, although rare, is a potentially life-threatening complication. Various imaging modalities can aid in the preoperative detection of Meckel's diverticulum. We report the sonographic findings of a hematocele as the heralding sequela of a perforated Meckel's diverticulum in an 11-month-old boy.
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Affiliation(s)
- Dylan C Kwait
- Maimonides Medical Center, Department of Radiology, Brooklyn, NY 11219, USA
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58
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Rho JH, Kim JS, Kim SY, Kim SK, Choi YM, Kim SM, Tchah H, Jeon IS, Son DW, Ryoo E, Cho KH, Choi DY, Kim YM, Kim YM, Kim YM. Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis. Pediatr Gastroenterol Hepatol Nutr 2013; 16:41-8. [PMID: 24010105 PMCID: PMC3746044 DOI: 10.5223/pghn.2013.16.1.41] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Meckel's diverticulum (MD) has various clinical manifestations, and diagnosis or selectection of proper diagnostic tools is not easy. This study was conducted in order to assess the clinical differences of MD diagnosed by scintigraphic and non-scintigraphic methods and to find the proper diagnostic tools. METHODS We conducted a retrospective review ofthe clinical, surgical, radiologic, and pathologic findings of 34 children with symptomatic MD, who were admitted to Gachon University Gil Medical Center, Inha University Hospital, and The Catholic University of Korea, Incheon St. Mary's Hospital between January 2000 and December 2012. The patients were evaluated according to scintigraphic (12 cases; group 1) and non-scintigraphic (22 cases; group 2) diagnosis. RESULTS The male to female ratio was 7.5: 1. The most frequent chief complaint was lower gastrointestinal (GI) bleeding in group 1 and nonspecific abdominal pain in group 2, respectively. The most frequent pre-operative diagnosis was MD in both groups. Red blood cell (RBC) index was significantly lower in group 1. MD was located at 7 cm to 85cm from the ileocecal valve. Four patients in group 1 had ectopic gastric tissues causing lower GI bleeding. The most frequent treatment modality was diverticulectomy in group 1 and ileal resection in group 2, respectively. CONCLUSION To diagnose MD might be delayed unless proper diagnostic tools are considered. It is important to understand indications of scintigraphic and non-scintigraphic methods according to clinical and hematologic features of MD. Scintigraphy would be weighed in patients with anemia as well as GI symptoms.
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Affiliation(s)
- Jung Hee Rho
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea
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Xinias I, Mavroudi A, Fotoulaki M, Tsikopoulos G, Kalampakas A, Imvrios G. Wireless Capsule Endoscopy Detects Meckel's Diverticulum in a Child with Unexplained Intestinal Blood Loss. Case Rep Gastroenterol 2012; 6:650-9. [PMID: 23139657 PMCID: PMC3493004 DOI: 10.1159/000343593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, affecting about 2% of the population. Most cases of Meckel's diverticula are asymptomatic. The diagnosis of symptomatic MD is often difficult to make. We report the case of an 8-year-old boy who presented with GI bleeding due to MD. The diagnostic difficulties after an initial negative endoscopic evaluation and the diagnostic value of the various endoscopic procedures are discussed. The patient had suffered from bright red stools for 20 h before hospital admission. GI scintigraphy with 99mTc-Na-pertechnetate was negative for heterotopic gastric tissue in the small bowel area. Colonoscopy performed in order to exclude Crohn's disease was also negative. He was placed on ranitidine at a dose of 6 mg/kg body weight twice daily. The patient remained asymptomatic over a period of 6 months before he was readmitted due to macroscopic rectal bleeding. Upper endoscopy and colonoscopy used to investigate the source of bleeding showed normal macroscopic findings. Radiolabeling of blood constituents with 99mTc on delayed imaging showed radionucleotide concentration in the ascending and transverse colon suggestive of a lesion in the ileocecal area. Further investigation with the use of wireless capsule endoscopy revealed a MD. Wireless capsule endoscopy may thus be indicated for patients with GI blood loss when other diagnostic methods, such as upper and lower endoscopy and colonoscopy, have failed to identify the source of bleeding.
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Affiliation(s)
- I Xinias
- Third Pediatric Department and Pediatric Surgery Clinic, Hippocration Hospital, Thessaloniki, Greece
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60
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Yang PF, Chen CY, Yu FJ, Yang SF, Chen YT, Kao LC, Wang JY. A rare complication of Meckel's diverticulum: a fistula between Meckel's diverticulum and the appendix. Asian J Surg 2012; 35:163-5. [PMID: 23063090 DOI: 10.1016/j.asjsur.2012.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/03/2011] [Accepted: 01/19/2012] [Indexed: 11/16/2022] Open
Abstract
Meckel diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2%-4% of the population. Meckel diverticulum results from incomplete closure of the omphalomesenteric duct. The presentation of symptomatic Meckel diverticulum includes gastrointestinal hemorrhage, intestinal obstruction, volvulus, intussusception, diverticulitis, and neoplasms. The development of fistula is an extremely rare complication. Previous literature has even shown an enterocolonic fistula, a vesicodiverticular fistula, ileorectal fistula, and fistula-in-ano. To the best of our knowledge, we present the first case of the fistula complicated between Meckel diverticulum and the appendix in a review of the English literature.
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Affiliation(s)
- Ping-Fu Yang
- Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Kotecha M, Bellah R, Pena AH, Jaimes C, Mattei P. Multimodality imaging manifestations of the Meckel diverticulum in children. Pediatr Radiol 2012; 42:95-103. [PMID: 21984316 DOI: 10.1007/s00247-011-2252-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 07/03/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
Abstract
Meckel diverticulum is the most common congenital abnormality of the gastrointestinal (GI) tract, occurring in approximately 2% of the general population. The lifetime complication rate from a Meckel diverticulum is 0.5%-2%. The most common complications include bleeding, obstruction, inflammation and perforation. However, the clinical manifestations of a Meckel diverticulum are frequently nonspecific. As a result, complications secondary to Meckel diverticulitis can mimic a variety of more common intra-abdominal processes, such as appendicitis, inflammatory bowel disease and any other cause of small bowel inflammation or obstruction. The radiologist should be aware of potential manifestations of the disease on different imaging modalities. In this pictorial essay, we illustrate several complications related to the Meckel diverticulum, in multiple modalities.
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Affiliation(s)
- Manish Kotecha
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 3NW 39, Philadelphia, PA 19104, USA
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62
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Martínez-Criado Y, Espín B, Millán A, Rodríguez A, Agustín JCD. [Endoscopic diagnosis of intussusception due to Meckel's diverticulum]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:663-5. [PMID: 21855176 DOI: 10.1016/j.gastrohep.2011.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 03/30/2011] [Accepted: 04/09/2011] [Indexed: 11/30/2022]
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Bevernage C, Maleux G, De Hertogh G, Miserez M. Life-threatening lower gastrointestinal bleeding in a 2-year-old boy treated by transcatheter embolization: uncommon features of a complicated Meckel diverticulum. Pediatr Radiol 2010; 40:1702-5. [PMID: 20623119 DOI: 10.1007/s00247-010-1641-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 02/04/2010] [Accepted: 02/04/2010] [Indexed: 11/28/2022]
Abstract
A 2.5-year-old boy presented with life-threatening lower gastrointestinal (GI) bleeding. Radiological investigation, including US, CT and 99 m-Technetium (Tc) pertechnate scintigraphy, was negative. Emergency visceral angiography was performed, showing a left-side, non-branching artery, originating from a side branch of the superior mesenteric artery (SMA) with extravasation of contrast material. At the same time, embolization of the bleeding point was performed, resulting in haemostasis. In the days following the procedure the boy developed an intestinal obstruction. At laparoscopy, a complicated Meckel diverticulum was resected.
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Affiliation(s)
- Charlotte Bevernage
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Abstract
Perforation of a Meckel diverticulum (MD) is a rare complication that can often mimic appendicitis. This case report identifies a child who presented to our Emergency Department (ED) with right lower quadrant abdominal pain, free fluid and air in the abdomen and pelvis, and inflammatory changes visualized on Ultrasonography (US) and computer tomography (CT) scan. In our patient, ruptured appendicitis was suspected, and the diagnosis of ruptured MD was ultimately made by laparoscopy. This case demonstrates that a healthy degree of suspicion for complicated MD should be present when dealing with a questionable diagnosis of appendicitis, particularly in the pediatric population.
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Durakbasa CU, Okur H, Mutus HM, Bas A, Ozen MA, Sehiralti V, Tosyali AN, Zemheri IE. Symptomatic omphalomesenteric duct remnants in children. Pediatr Int 2010; 52:480-4. [PMID: 19863751 DOI: 10.1111/j.1442-200x.2009.02980.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The present study gathers a single institutional experience of symptomatic omphalomesenteric duct (OMD) remnants in children with an emphasis on the age and modes of presentation, the surgical intervention and the histopathological findings. METHODS The data on children who underwent surgical treatment for symptomatic OMD remnants during a 17-year period were reviewed retrospectively, excluding incidental diverticulectomies. RESULTS A total of 59 children with a median age of 36 months underwent operations for symptomatic OMD remnants. There were 48 boys and 11 girls. The presenting signs were gastrointestinal tract (GIT) obstruction in 21 (36%) patients, acute abdomen in 18 (31%), umbilical abnormalities in 17 (29%), and rectal bleeding in three (5%). Patients presenting with umbilical anomalies were significantly younger than others. At surgery, a wedge resection of the remnant was carried out in 32 cases and an ileal resection was carried out in 27. Children presenting with GIT obstruction underwent segmentary ileal resection more often than other groups. Histopathology revealed inflammation in 26 (44%) specimens, ectopic tissue in 18 (31%) and necrosis in four (7%). Ectopic gastric mucosa was detected in 15 specimens, pancreatic tissue in two and both gastric and pancreatic tissue in one. CONCLUSIONS Symptomatic OMD remnants in children most commonly presented with GIT obstruction, acute abdomen and umbilical anomalies. Rectal bleeding was not a predominant finding in the present series. Surgery is curative and can safely be done either by way of wedge resection or ileal segmentary resection. Ectopic tissue is detected in approximately one third of symptomatic remnants.
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Affiliation(s)
- Cigdem Ulukaya Durakbasa
- Istanbul Goztepe Education and Research Hospital, Department of Pediatric Surgery, Istabul, Turkey.
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66
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Lai HC. Intestinal obstruction due to Meckel's enterolith. Pediatr Neonatol 2010; 51:139-40. [PMID: 20417467 DOI: 10.1016/s1875-9572(10)60025-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 04/30/2009] [Accepted: 05/19/2009] [Indexed: 12/14/2022] Open
Abstract
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. The most common clinical presentation is intermittent and painless rectal bleeding, followed by intestinal obstruction. Intestinal obstruction due to Meckel's enterolith is rarely reported in children. We report a patient who presented with ileus secondary to fecalith impaction of Meckel's diverticulum, causing intestinal obstruction and diverticulitis.
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Affiliation(s)
- Hui-Chien Lai
- Department of Pediatrics, Show Chwan Memorial Hospital, Chang-Hwa, Taiwan.
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67
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Tseng YY, Yang YJ. Clinical and diagnostic relevance of Meckel's diverticulum in children. Eur J Pediatr 2009; 168:1519-23. [PMID: 19575216 DOI: 10.1007/s00431-009-1023-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 06/17/2009] [Indexed: 11/30/2022]
Abstract
Meckel's diverticulum (MD) has varied clinical manifestations and is a diagnostic challenge for pediatricians. This study investigates the clinical and diagnostic characteristics of MD in children with different presentations. We retrospectively reviewed the medical records of pediatric patients diagnosed with MD from 1988 to 2008. The data including the age, sex, clinical features, laboratory data, sensitivity of diagnostic methods, and pathological finding were recorded. These patients were classified into three groups: diverticulitis, intestinal obstruction, and intestinal bleeding. A total of 47 children (35 boys and 12 girls) with a median age of 5.6 years were enrolled and categorized as follows: diverticulitis (n = 12), obstruction (n = 12), bleeding (n = 21), and two diagnosed incidentally. Patients with intestinal obstruction were significantly younger than those with bleeding (3.7, 95% CI, 1.6-5.7 vs. 6.6, 95% CI, 4.5-8.7, P = 0.04). In the obstruction group, intussusception was found in eight of 12 patients, of whom 62.5% were aged older than 3 years. Heterotopic tissues were found in 46.3% of surgical specimens and more frequently existed in patients with bleeding than those with diverticulitis (P = 0.02) and obstruction (P = 0.047). Tc-99m scans yielded a diagnostic sensitivity of about 65% in bleeding patients. Repeated Tc-99m scans and red blood cell (RBC) scans can be good supplementary tools in Tc-99m scan-negative bleeding patients. In conclusion, manifestations of childhood MD are variable and may depend on the presence of heterotopic tissues and the patients' age. Tc-99m scans supplemented with RBC scans are appropriate to diagnose childhood MD with bleeding.
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Affiliation(s)
- Yi-Yuan Tseng
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
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Radiological features of Meckel's diverticulum and its complications. Clin Radiol 2008; 64:109-18. [PMID: 19103339 DOI: 10.1016/j.crad.2008.07.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 07/16/2008] [Accepted: 07/22/2008] [Indexed: 12/16/2022]
Abstract
Meckel's diverticulum is the most common congenital abnormality of the small bowel. The majority of patients with this anomaly will remain asymptomatic; however, several complications may occur, including obstruction, intussusception, perforation, diverticulitis, and gastrointestinal haemorrhage. These complications may produce a variety of different clinical features and radiological appearances. The purpose of this article is to review the potential imaging manifestations of Meckel's diverticulum and its complications and discuss the advantages and disadvantages of the imaging techniques available.
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