Complications and diagnosis of Meckel's diverticulum in 776 patients

Enterolithiasis

Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis in the presence of the intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, and stenosing or stricturing Crohn’s disease and intestinal tuberculosis. Enterolithiasis is classified into primary and secondary types. Its prevalence ranges from 0.3% to 10% in selected populations. Proximal primary enteroliths are composed of choleic acid salts and distal enteroliths are calcified. Clinical presentation includes abdominal pains, distention, nausea, and vomiting of occasionally sudden but often fluctuating subacute nature which occurs as a result of the enterolith tumbling through the bowel lumen. Thorough history and physical exam coupled with radiologic imaging helps establish a diagnosis in a patient at risk. Complications include bowel obstruction, direct pressure injury to the intestinal mucosa, intestinal gangrene, intussusceptions, afferent loop syndrome, diverticulitis, iron deficiency anemia, gastrointestinal hemorrhage, and perforation. Mortality of primary enterolithiasis may reach 3% and secondary enterolithiasis 8%. Risk factors include poorly conditioned patients with significant obstruction and delay in diagnosis. Treatment relies on timely recognition of the disease and endoscopic or surgical intervention. With advents in new technology, improved outcome is expected for patients with enterolithiasis.

Ileosigmoid knotting in patients under 25 years of age: A report of two cases

INTRODUCTION

Ileosigmoid knotting is a rare cause of acute abdomen with high morbidity and mortality. Its diagnosis is infrequently made before surgery because of its varying ways of presentation and rarity.

PRESENTATION OF CASE

The first was a 21-year-old male who presented with a history of sudden generalized abdominal pain and progressive abdominal distension. He was pale and severely dehydrated. His extremities were cold and clammy. His pulse rate was 110 per minute and blood pressure was 90/50 mmHg.

The second case was 20-year-old male who presented with similar symptoms as above. He was not pale but mildly dehydrated. His pulse rate was 92 per minute and blood pressure 110/70 mmHg.

Both patients were resuscitated and had exploratory laparotomy a few hours after presentation. The first patient was found to have ileosigmoid knotting with gangrenous sigmoid colon and terminal ileum. He had Hartmann's procedure and right hemicolectomy with ileo-transverse anastomosis.

The second patient was found to have ileosigmoid knotting with viable loops of bowel. He had careful detorsion, sigmoidectomy with primary anastomosis. Both patients’ have good outcome.

DISCUSSION

This is to report two cases of ileosigmoid knotting in two male patients aged 21 and 20 years, respectively, with the hope of increasing awareness.

CONCLUSION

Ileosigmoid knotting though more common in fourth or fifth decade of life, can also occur in the 2nd decade. Early diagnosis, careful resuscitation and skilful surgical intervention will improve outcome.

Gastroenteropancreatic neuroendocrine tumour arising in Meckel's diverticulum coexisting with colon adenocarcinoma

Although colon cancer is the third most common cause of cancer-related death worldwide, the prevalence of gastroenteropancreatic neuroendocrine tumours (GEP-NETs) remains rare. To date, very few cases of GEP-NETs within Meckel’s diverticulum and synchronous colorectal cancer have been reported. Although the coexistence of these two tumour types is uncommon, it is important to be aware of their disease patterns. We present a rare case of a patient with an intestinal GEP-NET arising in Meckel’s diverticulum coexisting with metastatic colon adenocarcinoma, and we discuss the clinical manifestations and the diagnostic procedures and treatment modalities used. This case report underlines the importance of being aware of this particular coexistence, as well as the unlikely metastatic spread of GEP-NETs and the importance of a multidisciplinary approach to cancer treatment. Finally, individualizing the treatment according to the stages of the primaries will result in durable cancer control, particularly in synchronous double malignancy.

Imaging of Meckel's diverticulum in adults: pictorial essay

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is usually asymptomatic but may present with complications of acute diverticular inflammation, ulceration, hemorrhage, small bowel obstruction, perforation, retained foreign bodies, enterolith formation, and neoplasm development. Thus, the preoperative radiological diagnosis is crucial for proper management of the patients. This article reviews the anatomic and clinical features of Meckel's and describes the role of imaging in the detection of Meckel's and evaluation of its associated pathological processes.

Radiologist's perspective for the Meckel's diverticulum and its complications

The Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract, often presenting with complications such as gastrointestinal bleeding, intussusception, bowel obstruction and diverticulitis, which are often misdiagnosed. Imaging plays an important role in the early diagnosis and characterization of these conditions and is very helpful in decision making. The Meckel's diverticulum and its complications have myriad presentations and appearances on various imaging modalities. Thus, sound knowledge of the anatomy, embryology, clinical presentation, imaging characteristics and complications is crucial to the practice of abdominal imaging. We present a review of the literature and current radiological practices in the diagnosis and management of the Meckel's diverticulum and its various complications with special emphasis on the imaging of various complications, mimickers and pathological correlation.

Perforated Meckel's Diverticulum Lithiasis: An Unusual Cause of Peritonitis

Meckel's diverticulum is the commonest congenital malformation of gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, it can present as bleeding, perforation, intestinal obstruction, intussusception, and tumours. These complications, especially bleeding, tend to be more common in the paediatric group and intestinal obstruction in adults. Stone formation (lithiasis) in Meckel's diverticulum is rare. We report a case of Meckel's diverticulum lithiasis which presented as an acute abdomen in an otherwise healthy individual. The patient underwent an exploratory laparotomy which revealed a perforated Meckel's diverticulum with lithiasis; a segmental resection with end-to-end anastomosis of small bowel was performed. Patient recovery was delayed due to pneumonia, discharged on day 20 with no further complications at 6 months following surgery.

Adenocarcinoma arising from Meckel's diverticulum in the ileum with malrotation of the midgut

Meckel's diverticulum (MD) is a true congenital diverticulum that is remnant by incomplete obliteration of the omphalomesenteric duct. It is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of 2% (0.3% to 3% in autopsy studies). About 90% of MD occurs within 100 cm of the ileocecal valve. A primary malignant tumor arising within an MD is extremely uncommon. Malignancies are reported to account for only 0.5% to 3.2% of the complications. Carcinoids are the most common malignant tumors occurring in MD. Adenocarcinomas are extremely uncommon and very poor prognosis has been reported. We report a case of radiographically diagnosed chronic inflammatory mass caused by adenocarcinoma arising from MD in the ileum with malrotation of the midgut incidentally discovered at exploration.

Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis

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.

Wireless Capsule Endoscopy Detects Meckel's Diverticulum in a Child with Unexplained Intestinal Blood Loss

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.

Perforation of Meckel's diverticulum with enteroliths

Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with enteroliths, which could be accurately diagnosed by the preoperative computed tomography (CT). A 46-year-old man with acute onset of severe abdominal pain, and a localized muscle guarding in the right hypochondrium, had a solitary stone detected in the right abdomen by the radiography. The abdominal CT revealed a saclike outpouching of the small intestine, containing air/fluid levels and an enterolith, with surrounding free air and mesenteric inflammatory change in the right paraumbilical area. He was diagnosed as the perforation of Meckel's diverticulum with enterolith, and the emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 90 cm proximal to the ileocecal valve. The diverticulum was transected at the base, and removed. The patient's postoperative course was uneventful. This case strongly suggested the ability of CT enterography to accurately diagnose pathologies involving the small intestine, such as the perforation of Meckel's diverticulum, which open premises for its use in the diagnosis of acute abdomen preoperatively.

Large enterolith in a meckels diverticulum causing perforation and bowel obstruction: an interesting case with review of literature

Enteroliths are a rare complication of Meckel's diverticula, with perforation of the diverticulum being an even rarer occurrence. Bowel obstruction secondary to a Meckel's enterolith, albeit uncommon, occurs due to inflammation, intussusception, or impaction after extrusion from the diverticulum. We report an unusual case of Meckel's enterolithiasis causing perforation and bowel obstruction.

An unusual presentation of Meckel's diverticulum

Meckel's diverticulum can present with unusual symptoms and signs and therefore delay diagnosis. We present the case of a 63 year old lady who presented to the gynaecologists with a huge right sided ovarian cyst. She had required 13 units blood transfusion previously (5 years ago) for massive gastrointestinal bleed with no cause found despite extensive investigations. At operation she was found to have a Meckel's diverticulum in the left lumbar region containing a large calculus. She had an unremarkable post-operative course.

Synchronous Association of Two Neuroendocrine Gastroenteropancreatic Tumors, An Adenocarcinoma of the Cecum, and a Meckel's Diverticulum: A Case Report

Neuroendocrine gastroenteropancreatic tumors constitute a heterogeneous group of neoplasms, with the primary tumors being located in the gastric mucosa, pancreas, and small and large intestine. The development of a second primary malignancy in patients with these tumors is a well-described phenomenon, and the reported incidence ranges from 12% to 46%. The most common site of associated noncarcinoid malignancies is the gastrointestinal tract, which involves from 30% to 60% of the tumors. We report a case of concurrent colon carcinoma and two neuroendocrine tumors of the duodenum.

Multimodality imaging manifestations of the Meckel diverticulum in children

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.

An uncommon location of Meckel's diverticulum or small intestine duplication? Case report and literature review

Meckel's diverticulum is the most common congenital abnormality of alimentary tract. The antimesenteric location is one of the cardinal attribiutes of this pathology. We report case which tries to verify this dogma. The literature regarding uncommon location of Meckel's diverticulum was also reviewed.

Ileosigmoid knot: A case report

The ileosigmoid knot is an uncommon but life-threatening cause of closed loop intestinal obstruction. Its treatment is different from a simple volvulus in that it has to be operated upon immediately. Preoperative CT scan diagnosis and prompt treatment can lead to a good outcome. Findings of simultaneous ileal and sigmoid ischemia with non-ischemic colon interposed in between should, in an appropriate clinical setting, indicate this condition. The presence of the whirl sign, medially deviated distal descending colon and cecum, and mesenteric vascular structures from the superior mesenteric vessels that converge toward the sigmoid colon on CT scan help clinch the diagnosis.

Risk factors for intestinal gangrene in children with small-bowel volvulus

OBJECTIVES

Pediatric small-bowel volvulus (SBV) is a surgical emergency, and early diagnosis is difficult. We analyzed the clinical manifestations, imaging findings, and laboratory parameters in children with SBV and attempted to determine the risk factors for bowel gangrene.

PATIENTS AND METHODS

Forty-nine children (35 boys and 14 girls) with SBV who were admitted to the hospital for a period of 13 years were enrolled. Clinical and laboratory parameters and evaluation measures included fever, abdominal pain, vomiting, bloody stool, peritoneal signs, severe dehydration, disease duration, white blood cell counts, sugar, C-reactive protein (CRP), sodium, potassium, metabolic acidosis, blood urea nitrogen, and creatinine. These parameters were statistically compared between patients with and without bowel gangrene.

RESULTS

Thirty-six patients (73.5%) were 5 years old or younger, and nearly half were younger than 1 year old. Abdominal pain and vomiting were 2 major symptoms. Malrotation was the most common cause of SBV. In univariate analysis, nonbilious vomiting, peritoneal signs, severe dehydration, leukocytosis (WBC count >18,000 cells/mm3), elevated CRP (>50 mg/dL), and hyponatremia (<130 mmol/L) were significantly associated with bowel gangrene (P < 0.05). In multivariate analysis, nonbilious vomiting, leukocytosis, and elevated CRP were significantly (P < 0.05) associated with bowel gangrene. The resection rate for bowel gangrene was 44.9%, and no mortality was found. Seven (14.3%) patients had postoperative complications, including short-bowel syndrome (n = 2), adhesion ileus (n = 3), and intraabdominal abscess (n = 3). Seven experienced failure to thrive in later follow-up.

CONCLUSIONS

Specific clinical manifestations and laboratory parameters are helpful in the identification of bowel gangrene in children with SBV.

Abdominal pain in children

Abdominal pain is one of the most common reasons pediatric patients seek emergency care. The emergency physician must be able to distinguish diagnoses requiring immediate attention from self-limiting processes. Pediatric patients can be challenging, particularly those who are preverbal, and therefore, the clinician must rely on a detailed history from a parent or caregiver as well as a careful physical examination in order to narrow the differential diagnosis. This article highlights several pediatric diagnoses presenting as abdominal pain, including surgical emergencies, nonsurgical diagnoses, and extraabdominal processes, and reviews the clinical presentation, diagnostic evaluation, and management of each.

Perforated Meckel diverticulum

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.

Meckel's diverticulum with benign stricture: A very rare cause of intestinal obstruction

We report a very rare case of Meckel's diverticulum with benign stricture presenting as recurrent small bowel obstruction in a malnourished young adult female. Extensive preoperative investigations were unable to diagnose the cause of recurrent obstruction. Segmental small bowel resection with attached diverticulum was performed.

Intermittent small bowel obstruction caused by Meckel's enterolith

A 56-year-old man presented with small bowel obstruction after a 6-week history of intermittent resolving subacute small bowel obstruction. After investigations, he underwent laparotomy. A mobile, narrow-necked Meckel's diverticulum packed with enteroliths pressing against proximal small bowel was discovered. A small bowel resection was performed.

Pathological feature of a giant ileal Meckel's diverticulum with ectopic gastric mucosa

The ileum generally works well, whereas Meckel's diverticulum (MD) has complications including bleeding, obstruction, intussusception, diverticulitis, and perforation. Our knowledge of the pathological features of the MD muscular layer and mucosa is limited. We report a rare case of giant MD that was diagnosed by double-balloon enteroscopy (DBE). The pathological features of the mucosa were evaluated by investigation for Helicobacter pylori; and the nuclear proliferation antigen Ki-67, the gastrointestinal cancer-associated biomarker TRAK1, synaptophysin, and neurofilament were used to precisely define the mucosa and neuronal and ganglion cell components. The pathophysiology of MD is discussed and a literature review is presented. We believe that this is the first report of a systematic histochemical analysis of the mucosa and myenteric plexus of MD and the normal ileum. The present investigation may provide novel evidence of pathological abnormalities resulting in the complex complications of MD.

Intestinal obstruction due to Meckel's enterolith

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.

Utility of SPECT/CT with Meckel's scintigraphy

Meckel's diverticulum is a relatively common source of gastrointestinal tract morbidity in children. Individuals may present with symptoms of lower gastrointestinal tract bleeding, bowel obstruction or diverticulitis. Technetium-99 m pertechnetate scintigraphy is used to demonstrate those Meckel's diverticula that contain heterotopic gastric mucosa. We present a case of an adolescent male patient with rectal bleeding and suspected Meckel's diverticulum where the use of SPECT/CT fusion imaging provided valuable diagnostic information and prevented a false-negative study.

Technetium-99m scan in the laparoscopic management of a misdiagnosed Meckel's diverticulum: a case report

Introduction

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract and modern imaging techniques are available, its diagnosis remains problematic.

Case presentation

A technetium-99 scan was performed in an 18-year-old man with abdominal pain, vomiting and rectal bleeding to confirm the presence of a Meckel's diverticulum which was not diagnosed laparoscopically elsewhere. The technetium-99 scan was positive and a diagnostic laparoscopy was re-performed which revealed a Meckel's diverticulum that was subsequently resected.

Conclusion

We suggest that a technetium-99m scan should be performed before laparoscopy in children and adolescents with suspected Meckel's diverticulum. A positive technetium-99m scan may significantly contribute to the laparoscopic definitive diagnosis and treatment of a bleeding Meckel's diverticulum. However, diagnostic laparoscopy should only be performed by experienced surgeons.

Bleeding Meckel's diverticulum in a 4-month-old infant: Treatment with laparoscopic diverticulectomy. A case report and review of the literature

A bleeding Meckel’s diverticulum is presented in a 4-month-old African American infant. This event is rare at this age, and our patient is only the second 4-month-old infant reported in the English literature. The infant presented with painless frank rectal bleeding, the blood being maroon-colored, and clots were found in the diaper. There was also anemia, with an hemoglobin of less than 8 gm/dl. The color of the blood suggested a bleeding site in the ileo-cecal region, a Meckel’s diverticulum was suspected, which was then confirmed by an isotope scan. A typical Meckel’s diverticulum was found on laparoscopic surgery, was excised, and the infant made an uneventful recovery.

Inflammation of ectopic pancreatic tissue in a Meckel's diverticulum causing acute abdominal symptoms: a case report and review of the literature

An unusual case of acute abdomen was caused by the inflammation of ectopic pancreatic tissue in a Meckel's diverticulum. A 49-year-old man presented with acute abdominal pain, and the clinical diagnosis of acute appendicitis was established. During laparotomy, a normal appendix of unusual localization near the gallbladder and a Meckel's diverticulum with an inflamed tip were found. Histological examination showed acute inflammation of heterotopic pancreatic tissue along with normal ectopic gastric and duodenal mucosa within the wall of the diverticulum. Fat necrosis was also ascertained. The authors believe that this is the first report of acute inflammation of ectopic pancreatic tissue and the presence of normal ectopic gastric and duodenal tissue in the same Meckel's diverticulum.

Radiological features of Meckel's diverticulum and its complications

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.

[Retrospective diagnosis of stromal tumor with liver and nodal metastasis in a hemorrhagic Meckel's diverticulum appearing 8 years after the first resection]

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract (0.3-4%). The gastrointestinal stromal tumours (GIST) are rare tumours. Only few cases of GIST developed in Meckel's diverticulum have been published in the literature. We reported a case of a woman with a diagnosis of GIST of Meckel's diverticulum retrospectively made 8 years after the resection of an haemorrhagic Meckel's diverticulum, whom she developed a large size intra-abdominal tumour with liver and nodes metastasis.

Les diverticules de Meckel chez l’enfant : à propos de 11 cas

We report 11 cases of Meckel's diverticulum in children admitted to the department of Paediatrics Surgery of Lomé (Togo). None of the cases was identified before surgery. A systematic search during appendectomy identified 3 cases. It was fortuitously discovered four times, and due to complications in four cases. There was one complication related death. Segmental intestinal resection was the only technique used.

Gastrointestinal stromal tumour in Meckel's diverticulum

Background

Meckel's Diverticulum is the most commonly encountered congenital anomaly of the small intestine, occurring in approximately 2% of the population. Occasionally Meckel's diverticulum harbors neoplasms.

Case presentation

A 65 year old gentleman, presented with a pelvic mass. On exploratory laparotomy, it turned out to be gastrointestinal stromal tumour (GIST) arising from Meckel's diverticulum. Short history and review of literature are discussed.

Conclusion

Neoplasms occurring from Meckel's diverticulum, even though rare, should be considered as differential diagnosis of pelvic masses arising from bowel, wherever imaging modalities fail to give a definitive diagnosis.

Bleeding Meckel diverticulum associated with a vitellointestinal artery aneurysm found on preoperative angiography: report of a case

An 18-year-old man was admitted to a local hospital with abdominal pain and bloody stool. Upper and lower gastrointestinal endoscopy failed to show any bleeding sites; however, an angiography of the superior mesenteric artery done on hospital day 4 showed an abnormal artery with an aneurysm, branching from the ileal artery. This artery was thought to be the vitellointestinal artery, a feeding artery of Meckel diverticulum. After embolization, he was transferred to our hospital, where we performed emergency laparotomy with partial resection of the ileum, including a bleeding Meckel diverticulum. Pathological examination revealed ectopic gastric mucosa and peptic ulceration, which we assumed was the origin of the bleeding. The patient had an uneventful postoperative course. Visceral artery aneurysms are rare but important vascular lesions because of their potential for fatal rupture. Although a minimally invasive procedure can be performed for a vitellointestinal artery aneurysm in patients with asymptomatic Meckel diverticulum, we treated our patient surgically because he presented with hemorrhagic shock and had been unresponsive to an H(2)-receptor antagonist.

Meckel's diverticulum: a systematic review

Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours. These complications, especially bleeding, are more common in the paediatric age group than in adults; however it is not uncommon to miss the diagnosis of Meckel's diverticulum in adults. Here, we reviewed the literature regarding the complications of this forgotten clinical entity in adults with potential diagnostic difficulties and management strategies.

Meckel's diverticulum: a systematic review

Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours. These complications, especially bleeding, are more common in the paediatric age group than in adults; however it is not uncommon to miss the diagnosis of Meckel's diverticulum in adults. Here, we reviewed the literature regarding the complications of this forgotten clinical entity in adults with potential diagnostic difficulties and management strategies.

Abdominal pain in children

Abdominal pain and gastrointestinal symptoms such as vomiting or diarrhea are common chief complaints in young children who present in emergency departments. It is the emergency physician's role to differentiate between a self-limited process such as viral gastroenteritis or constipation and more life-threatening surgical emergencies. Considering the difficulties inherent in the pediatric examination, it is not surprising that appendicitis, intussusception, and malrotation with volvulus continue to be among the most elusive diagnoses. This article reviews both the self-limited and more life-threatening gastrointestinal conditions that may present in the emergency department.

CT diagnosis of Meckel diverticulum in a paracolic internal hernia

The autopsy incidence of internal hernia has been reported to be between 0.2% and 0.9%, and these hernias are usually diagnosed on imaging due to their complications or at surgery. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 1% to 3% of the population according to autopsy studies. The condition also is usually diagnosed at surgery, by barium studies or scintigraphy, or on cross-sectional imaging due to complications. We present an unusual case of a large Meckel diverticulum in a right paracolic hernia diagnosed on multidetector computed tomography. This diagnosis was made after attacks of subacute intestinal obstruction with the aid of multiplanar reconstructions. This case emphasizes the role of multidetector computed tomography and postprocessing techniques such as multiplanar reconstruction in the diagnosis of bowel pathology.

Meckel's diverticulum: comparison of incidental and symptomatic cases

Although Meckel's diverticulum is the commonest congenital gastrointestinal anomaly, there is still debate concerning the proper management of asymptomatic diverticula. Records of all patients whose Meckel's diverticulum was resected at our hospitals between 1990 and 2002 were reviewed. Clinical characteristics, mode of presentations, and management for all patients were analyzed. Meckel's diverticula were resected in 68 patients. Patients were divided into two groups: the incidental group included 40 patients (24 males) in whom the diagnosis of diverticula was incidental. The symptomatic group included 28 patients (20 males) who presented with diverticulum-related complications. Preoperative diagnosis was possible in only four cases. In four patients from the symptomatic group, Meckel's diverticula were found and left untouched during a previous laparotomy. There was no significant difference between the two groups with respect to gender (p = 0.48). Patients in the symptomatic group were significantly younger than patients in the incidental group (p = 0.002). The diverticula in the symptomatic group tended to be longer (p = 0.001) with a narrower base (p = 0.001) than the diverticula in the incidental group. A diameter of < or = 2 cm was significantly associated with more complications (p = 0.01). Heterotopic tissue was present more significantly in the symptomatic group than the incidental group (p = 0.01). There was no significant difference in the morbidity rate between the two groups (p = 0.71), and there was no mortality in either group. Preoperative diagnosis of Meckel's diverticulum is difficult and should be kept in mind in cases of acute abdomen. Resection of incidentally found diverticula is not associated with increased operative morbidity or mortality.

From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2%-3% of the population. It results from improper closure and absorption of the omphalomesenteric duct. Meckel diverticulum is the most common end result of the spectrum of omphalomesenteric duct anomalies, which also include umbilicoileal fistula, umbilical sinus, umbilical cyst, and a fibrous cord connecting the ileum to the umbilicus. The formation of Meckel diverticulum occurs with equal frequency in both sexes, but symptoms from complications are more common in male patients. Sixty percent of patients come to medical attention before 10 years of age, with the remainder of cases manifesting in adolescence and adulthood. Heterotopic gastric and pancreatic mucosa are frequently found histologically within the diverticula of symptomatic patients. The most common complications are hemorrhage from peptic ulceration, small intestinal obstruction, and diverticulitis. Although the clinical, pathologic, and radiologic features of the complications of Meckel diverticulum are well known, the diagnosis of Meckel diverticulum is difficult to establish preoperatively.

Ileosigmoid knotting

Intestinal obstruction is a common cause of emergency surgical admission. The most frequent causes are well known and may often be safely treated conservatively in the first instance. The rarer causes of intestinal obstruction require prompt diagnosis and surgery if they are not to progress rapidly to strangulation and gangrene. One such cause is the ileosigmoid knotting, which is associated with a high morbidity and mortality. With increasing travel activity and population migration this condition is now being seen outside its original geographical sites of origin. This article focuses on the aetiology, pathophysiology, clinical features, investigations and the various surgical options for the management of the ileosigmoid knotting. Studies and case reports in English literature were identified by PubMed, ISIS, Embase and CAS searches between the years 1966-2004 using the following free text keywords: ileo- sigmoid knotting, ileosigmoid knot(ting), intestinal knot(ting), compound volvulus and double volvulus. All the reference lists were reviewed to retrieve additional articles. Aggressive resuscitation, prompt surgical relief of obstruction, appropriate antibiotics, accurate intra-operative assessment of the viability of the involved loops of intestine and the use of modern postoperative intensive care will help reduce the mortality and morbidity associated with this life threatening condition.