101
|
Kotha VK, Khandelwal A, Saboo SS, Shanbhogue AKP, Virmani V, Marginean EC, Menias CO. Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol 2014; 87:20130743. [PMID: 24611767 PMCID: PMC4075535 DOI: 10.1259/bjr.20130743] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- V K Kotha
- Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
102
|
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.
Collapse
|
103
|
Akbulut S, Yagmur Y. Giant Meckel’s diverticulum: An exceptional cause of intestinal obstruction. World J Gastrointest Surg 2014; 6:47-50. [PMID: 24672650 PMCID: PMC3964415 DOI: 10.4240/wjgs.v6.i3.47] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/05/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Meckel’s diverticulum (MD) results from incomplete involution of the proximal portion of the vitelline (also known as the omphalomesenteric) duct during weeks 5-7 of foetal development. Although MD is the most commonly diagnosed congenital gastrointestinal anomaly, it is estimated to affect only 2% of the population worldwide. Most cases are asymptomatic, and diagnosis is often made following investigation of unexplained gastrointestinal bleeding, perforation, inflammation or obstruction that prompt clinic presentation. While MD range in size from 1-10 cm, cases of giant MD (≥ 5 cm) are relatively rare and associated with more severe forms of the complications, especially for obstruction. Herein, we report a case of giant MD with secondary small bowel obstruction in an adult male that was successfully managed by surgical resection and anastomosis created with endoscopic stapler device (80 mm, endo-GIA stapler). Patient was discharged on post-operative day 6 without any complications. Histopathologic examination indicated Meckel’s diverticulitis without gastric or pancreatic metaplasia.
Collapse
|
104
|
Kim SW, Kim HC, Yang DM, Kim GY, Choi SI. MDCT findings of a Meckel's diverticulum with ectopic pancreatic tissue. Clin Imaging 2014; 38:70-2. [DOI: 10.1016/j.clinimag.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 08/22/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
|
105
|
Kuru S, Bulus H, Kismet K, Aydin A, Yavuz A, Tantoglu U, Boztas A, Çoskun A. Mesodiverticular Band of Meckel's Diverticulum as a Rare Cause of Small Bowel Obstruction: Case Report and Review of the Literature. Visc Med 2013. [DOI: 10.1159/000357533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
106
|
Erol V, Yoldaş T, Cin S, Çalışkan C, Akgün E, Korkut M. Complicated Meckel's diverticulum and therapeutic management. ULUSAL CERRAHI DERGISI 2013; 29:63-6. [PMID: 25931848 DOI: 10.5152/ucd.2013.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckel's diverticulum at our clinics. MATERIAL AND METHODS This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckel's diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012. RESULTS Fourteen patients with a diagnosis of Meckel's diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckel's diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%). CONCLUSION Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckel's diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.
Collapse
Affiliation(s)
- Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Tayfun Yoldaş
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Samet Cin
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cemil Çalışkan
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Erhan Akgün
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Korkut
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| |
Collapse
|
107
|
Vitello-intestinal duct injury after transabdominal preperitoneal inguinal hernia repair. Surg Laparosc Endosc Percutan Tech 2013; 23:e27-8. [PMID: 23386168 DOI: 10.1097/sle.0b013e31826cec16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 71-year-old patient underwent a transabdominal preperitoneal right inguinal hernia repair and presented to the emergency department 48 hours postoperatively with nonspecific abdominal and chest pain and was diagnosed an abdominal abscess at the umbilicus by computed tomography. Laparotomy showed a vitello-intestinal duct injury caused by the umbilical trocar at his previous laparoscopic surgery. We will discuss this rare complication and how to avoid it in future practice.
Collapse
|
108
|
Singh A, Desser TS, Ferucci J. Imaging of Small Bowel. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
109
|
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.
Collapse
Affiliation(s)
- I Xinias
- Third Pediatric Department and Pediatric Surgery Clinic, Hippocration Hospital, Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
110
|
Nishikawa T, Takei Y, Tsuno NH, Maeda M. Perforation of Meckel's diverticulum with enteroliths. Clin J Gastroenterol 2012; 5:298-301. [PMID: 26182397 DOI: 10.1007/s12328-012-0313-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Takeshi Nishikawa
- Department of Surgery, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan.
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
| | - Yoshiki Takei
- Department of Surgery, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Nelson H Tsuno
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Mamoru Maeda
- Department of Surgery, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| |
Collapse
|
111
|
Sodhi JS, Zargar SA, Rashid W, Shaheen F, Singh M, Javid G, Ali S, Khan BA, Yattoo GN, Shah A, Gulzar GM, Khan MA, Ahmad Z. 64-section multiphase CT enterography as a diagnostic tool in the evaluation of obscure gastrointestinal bleeding. Indian J Gastroenterol 2012; 31:61-8. [PMID: 22585567 DOI: 10.1007/s12664-012-0176-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 03/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Small bowel follow through (SBFT) and enteroclysis have low sensitivity in picking up lesions in obscure gastrointestinal bleed (OGIB). Computed tomographic enterography (CT-EG), performed with 64-slice multiphase CT system by using large volumes of ingested neutral enteric contrast material, has high spatial and temporal resolution in visualization of the small bowel wall and lumen. The role of 64-slice multiphase CT-EG in the evaluation of OGIB is still evolving, and data on this role are scarce. We evaluated the efficacy of 64-slice multiphase CT-EG using polyethylene glycol (PEG) electrolyte solution as neutral contrast in patients of OGIB. METHODS CT-EG was performed with 64-slice multiphase CT system using large volume (2,000 mL) of PEG electrolyte solution as oral contrast in patients of OGIB. RESULTS Thirty-five patients (21 men, age 41.4 [13.5] y, range 19-70 year) with OGIB underwent CT-EG; 20 patients had overt OGIB whereas 15 patients had occult OGIB. Among 15 patients with occult OGIB, 10 patients had iron deficiency anemia (IDA) with fecal occult blood test (FOBT) positive and 5 had IDA with FOBT negative. Thirty-two patients (92 %) completed the procedure successfully. The total time taken for the ingestion of 2,000 mL of PEG electrolyte solution was median 64 (range 60-78) minutes. Adequate luminal distension of small bowel was seen in 29 (90.6 %) patients for successful interpretation of radiological images. Fifteen of 32 (46.9 %) patients had positive findings on CT-EG; 12 of them underwent exploratory laparotomy. The surgical findings were in conformity with CT-EG findings in all patients, which included gastrointestinal stromal tumors (GIST; n = 6), carcinoid (1), Meckel's diverticulum (1), small bowel adenocarcinoma (2) and jejunal vascular malformation (2). CONCLUSION 64-slice multiphase CT-EG is a useful investigation in the evaluation of both occult and overt OGIB.
Collapse
Affiliation(s)
- Jaswinder Singh Sodhi
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190 011, India.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
112
|
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: 23] [Impact Index Per Article: 1.9] [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.
Collapse
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
| | | | | | | | | |
Collapse
|
113
|
El Mouhadi S, Ait-Oufella H, Maury E, Menu Y, Arrivé L. Ileal diverticulitis complicated by portal-mesenteric pylephlebitis and pulmonary septic foci. Diagn Interv Imaging 2012; 93:57-9. [PMID: 22277712 DOI: 10.1016/j.diii.2011.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S El Mouhadi
- Service de radiologie, hôpital Saint-Antoine, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, Assistance publique—Hôpitaux de Paris, 184 rue du Faubourg-Saint-Antoine, Paris, France
| | | | | | | | | |
Collapse
|
114
|
Heller MT, Hattoum A. Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis. Emerg Radiol 2011; 19:61-73. [PMID: 22072087 DOI: 10.1007/s10140-011-0997-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 10/24/2011] [Indexed: 12/11/2022]
Abstract
Evaluation of acute right lower quadrant pain remains a common and challenging clinical scenario for emergency medicine physicians due to frequent nonspecific signs, symptoms, and physical examination findings. Therefore, imaging has evolved to play a pivotal role in the emergency setting. While appendicitis is a common cause for acute pain, there are numerous other important differential considerations with which the radiologist must be aware. The purpose of this review is to list an anatomy-based, encompassing differential diagnosis in addition to acute appendicitis for right lower quadrant pain; demonstrate the key imaging findings of numerous differential considerations; and describe helpful imaging and clinical features useful in narrowing the differential diagnosis.
Collapse
Affiliation(s)
- Matthew T Heller
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
115
|
Pilhatsch A, Riccabona M. Role and potential of modern ultrasound in pediatric abdominal imaging. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
116
|
Cartanese C, Petitti T, Marinelli E, Pignatelli A, Martignetti D, Zuccarino M, Ferrozzi L. Intestinal obstruction caused by torsed gangrenous Meckel’s diverticulum encircling terminal ileum. World J Gastrointest Surg 2011; 3:106-9. [PMID: 21860699 PMCID: PMC3158886 DOI: 10.4240/wjgs.v3.i7.106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 06/16/2011] [Accepted: 06/24/2011] [Indexed: 02/06/2023] Open
Abstract
Meckel’s diverticulum (MD) is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage, obstruction, and inflammation. Obstruction of various types is the most common presenting symptom in the adult population. Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications. The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies. Delay in the diagnosis of a complicated MD can lead to significant morbidity and mortality. Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum. To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.
Collapse
Affiliation(s)
- Carmine Cartanese
- Department of General Surgery, Masselli-Mascia Hospital, 71016 San Severo, Italy
| | | | | | | | | | | | | |
Collapse
|
117
|
Purysko AS, Remer EM, Filho HML, Bittencourt LK, Lima RV, Racy DJ. Beyond appendicitis: common and uncommon gastrointestinal causes of right lower quadrant abdominal pain at multidetector CT. Radiographics 2011; 31:927-947. [PMID: 21768232 DOI: 10.1148/rg.314105065] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Right lower quadrant abdominal pain is one of the most common causes of a patient visit to the emergency department. Although appendicitis is the most common condition requiring surgery in patients with abdominal pain, right lower quadrant pain can be indicative of a vast list of differential diagnoses and is thus a challenge for clinicians. Other causes of right lower quadrant pain beyond appendicitis include inflammatory and infectious conditions involving the ileocecal region; diverticulitis; malignancies; conditions affecting the epiploic appendages, omentum, and mesentery; and miscellaneous conditions. Multidetector computed tomography (CT) has emerged as the modality of choice for evaluation of patients with several acute traumatic and nontraumatic conditions causing right lower quadrant pain. Multidetector CT is an extremely useful noninvasive method for diagnosis and management of not only the most common causes such as appendicitis but also less common conditions.
Collapse
|
118
|
Abdominal Twists and Turns: Part I, Gastrointestinal Tract Torsions With Pathologic Correlation. AJR Am J Roentgenol 2011; 197:86-96. [DOI: 10.2214/ajr.10.7292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
119
|
Shelat VG, Kelvin Li K, Rao A, Sze Guan T. Meckel's diverticulitis causing small bowel obstruction by a novel mechanism. Clin Pract 2011; 1:e51. [PMID: 24765312 PMCID: PMC3981389 DOI: 10.4081/cp.2011.e51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/21/2011] [Indexed: 12/18/2022] Open
Abstract
Meckel’s diverticulum occurs in 2% of the general population and majority of patients remain asymptomatic. Gastrointestinal bleeding is the most common presentation in the paediatric population. While asymptomatic and incidentally found Meckel’s diverticulum may be left alone, surgery is essential for treating a symptomatic patient. Despite advances in imaging and technology, pre-operative diagnosis is often difficult. We present a first report of an unusual mechanism of small bowel obstruction due to Meckel’s diverticulitis in a paediatric patient. The diagnosis was only apparent at laparotomy.
Collapse
Affiliation(s)
| | - Kaiwen Kelvin Li
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anil Rao
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tay Sze Guan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| |
Collapse
|
120
|
|
121
|
Lee NK, Kim S, Jeon TY, Kim HS, Kim DH, Seo HI, Park DY, Jang HJ. Complications of congenital and developmental abnormalities of the gastrointestinal tract in adolescents and adults: evaluation with multimodality imaging. Radiographics 2011; 30:1489-507. [PMID: 21071371 DOI: 10.1148/rg.306105504] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a wide variety of congenital anomalies that may affect the gastrointestinal tract. Most symptomatic congenital anomalies are found in newborns and infants. Such anomalies are relatively rare in adolescents and adults, and they may be difficult to identify because clinical symptoms often are nonspecific and insidious, causing them to be mistaken for other common abdominal conditions. Multimodality imaging is useful in evaluating congenital anomalies of the gastrointestinal tract in adults. The imaging features at radiography, fluoroscopy, ultrasonography, computed tomography, and magnetic resonance imaging may help identify congenital gastrointestinal anomalies such as congenital esophageal stenosis, gastric volvulus, duodenal web, annular pancreas, heterotopic pancreas, cecal volvulus, anomalies of the omphalomesenteric duct, Hirschsprung disease, and gastrointestinal duplication cyst. Familiarity with the imaging features of the various congenital anomalies of the gastrointestinal tract and their complications is important to establish the correct diagnosis and determine appropriate treatment, which is critical to avoid life-threatening complications.
Collapse
Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, Seo-Gu, Busan, Korea
| | | | | | | | | | | | | | | |
Collapse
|
122
|
|
123
|
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.
Collapse
|
124
|
Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report. Case Rep Med 2010; 2010. [PMID: 20814563 PMCID: PMC2931429 DOI: 10.1155/2010/901456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 05/30/2010] [Accepted: 07/16/2010] [Indexed: 12/05/2022] Open
Abstract
Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.
Collapse
|
125
|
Laparoscopy as a diagnostic tool in patients with occult gastrointestinal bleeding – Report of a case. Eur Surg 2010. [DOI: 10.1007/s10353-010-0540-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
126
|
Platon A, Gervaz P, Becker CD, Morel P, Poletti PA. Computed tomography of complicated Meckel's diverticulum in adults: a pictorial review. Insights Imaging 2010; 1:53-61. [PMID: 22347905 PMCID: PMC3259399 DOI: 10.1007/s13244-010-0017-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 03/02/2010] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE: To show various CT aspects of complicated Meckel's diverticulum in adult patients to facilitate the preoperative diagnosis of this rare pathology in emergency settings. METHODS: A computer search of medical records over a 15 year period identified 23 adult patients who underwent surgery for acute abdomen generated by a complicated Meckel's diverticulum. CT images available for review were analyzed, and some specific patterns leading to the diagnosis of complicated Meckel's diverticulum are presented in this review. RESULTS: Complications were related to inflammation (14 patients), bleeding (5 patients), intestinal obstruction (3 patients), and penetrating foreign body (1 patient). The presence of a Meckel's diverticulum was usually suggested at CT scan by an abnormal outpouching, blind-ending digestive structure connected to the terminal ileum by a neck of variable caliber. Depending on the type of complications, the diverticulum was surrounded by mesenteric inflammatory changes, or presented as a localized fluid or air-fluid collection contiguous with the terminal ileum. The diverticulum was also the source of active bleeding or acted as the lead point to intestinal obstruction or intussusception. CONCLUSION: CT findings of complicated Meckel's diverticulum are polymorphic and should be considered in the evaluation of adult patients with acute abdomen.
Collapse
|
127
|
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.
Collapse
Affiliation(s)
- Hui-Chien Lai
- Department of Pediatrics, Show Chwan Memorial Hospital, Chang-Hwa, Taiwan.
| |
Collapse
|
128
|
Adenocarcinoma of Meckel’s diverticulum diagnosed by capsule endoscopy and single-balloon enteroscopy. Clin J Gastroenterol 2009; 2:388-393. [DOI: 10.1007/s12328-009-0111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
|
129
|
Chou JW. Meckel's diverticulum diagnosed by double-balloon enteroscopy in an adult presenting with obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2009; 7:A24. [PMID: 19281868 DOI: 10.1016/j.cgh.2009.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 02/26/2009] [Accepted: 03/01/2009] [Indexed: 02/07/2023]
Affiliation(s)
- Jen-Wei Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
130
|
Rodney JRM, Shou J, Barie PS. Meckel diverticulitis. Surg Infect (Larchmt) 2009; 10:315-6. [PMID: 19566420 DOI: 10.1089/sur.2008.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John R M Rodney
- Department of Surgery, Weill Medical College of Cornell University, New York, New York 10065, USA
| | | | | |
Collapse
|
131
|
Van Weyenberg SJB, Van Waesberghe JHTM, Ell C, Pohl J. Enteroscopy and its relationship to radiological small bowel imaging. Gastrointest Endosc Clin N Am 2009; 19:389-407. [PMID: 19647648 DOI: 10.1016/j.giec.2009.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The field of radiological small bowel imaging is changing rapidly, as is small bowel enteroscopy. New techniques allow the depiction of intraluminal, mural, and extraintestinal features of various small bowel disorders, such as Crohn disease, small bowel polyposis syndromes, small intestinal malignancies, and celiac disease. For patients requiring repeated small bowel imaging, modalities that do not use ionizing radiation, such as ultrasound or magnetic resonance imaging, should be considered.
Collapse
Affiliation(s)
- Stijn J B Van Weyenberg
- Department of Gastroenterology and Hepatology, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
132
|
CT findings in children with Meckel diverticulum. Pediatr Radiol 2009; 39:659-63; quiz 766-7. [PMID: 19189094 DOI: 10.1007/s00247-008-1138-9] [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: 10/20/2008] [Revised: 12/11/2008] [Accepted: 12/23/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately 0.04% of the general population will present with a complication related to Meckel diverticulum. The classic teaching is that symptomatic children with Meckel diverticulum present with painless rectal bleeding and are evaluated with a radionuclide scan. Our subjective experience is that we see children with Meckel diverticulum who present with abdominal pain and are evaluated by CT. OBJECTIVE We reviewed the findings on CT in children with pathologically proven Meckel diverticulum to identify characteristic patterns of presentation. MATERIALS AND METHODS Databases were searched (2004-2008) for all children who had a pathologic diagnosis of Meckel diverticulum and a CT scan performed prior to surgery. Demographics, pathology, and CT features were reviewed. CT features reviewed included: soft-tissue stranding, abnormal calcifications, bowel obstruction, free air, free peritoneal fluid, cystic mass, intussusception, obvious lead point, location, and whether a normal appendix was identified. The frequency of Meckel diverticulum encountered on CT scans was compared to that found during the same period of time on technetium pertechnetate studies. RESULTS The review identified 16 subjects (mean age 9.5 years, M:F 9:7). CT findings included: soft-tissue stranding in nine (56%), small-bowel obstruction (SBO) in nine (56%), intussusception in three (19%), free fluid in ten (63%), cystic mass in four (25%), calcification in none (0%), free air in one (6%), and no abnormalities in two (13%). A normal appendix was identified in only five children (31%). There were three basic patterns of presentation of abnormalities: SBO only in five, intussusception with SBO in three, or cystic mass with inflammatory stranding in four (one with SBO). Also, 2.3 times more Meckel diverticulum was encountered on CT than on technetium pertechnetate studies. CONCLUSION Meckel diverticulum is currently more commonly encountered in children on CT performed for abdominal pain than on technetium pertechnetate studies. There are three categories of appearance on CT: SBO only, intussusception, or a cystic inflammatory mass.
Collapse
|
133
|
Light TD, Light JA. Pancreas transplant and incidental Meckel's diverticulum: not always a straightforward decision. Clin Transplant 2009; 23:765-8. [PMID: 19563483 DOI: 10.1111/j.1399-0012.2009.01029.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Unexpected intraoperative findings are not rare in surgical practice. Meckel's diverticulum with a mass is one such example. There are only two previously reported cases of Meckel's in transplantation, and neither involved pancreas transplant. RESULTS AND DISCUSSION We present a case report of novel surgical technique using a Meckel's diverticulectomy site for the duodeno-enterostomy to managing the exocrine secretions of the transplanted pancreas. We also discuss management of Meckel's diverticulum. The patient tolerated the procedure without complication, and continues to have normal renal and pancreatic function without any gastrointestinal (GI) complaints. The excised Meckel's diverticulum contained both gastric and pancreatic tissue. CONCLUSION Although uncertainty about the best management practices exists in the general surgery patient population, given the potential complications that may arise from Meckel's diverticulum, in transplant patients the Meckel's should be removed when encountered. The point of excision can safely be incorporated into other intestinal anastomoses.
Collapse
Affiliation(s)
- Timothy D Light
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1009, USA.
| | | |
Collapse
|
134
|
Codrich D, Taddio A, Schleef J, Ventura A, Marchetti F. Meckel’s diverticulum masked by a long period of intermittent recurrent subocclusive episodes. World J Gastroenterol 2009; 15:2809-11. [PMID: 19522035 PMCID: PMC2695900 DOI: 10.3748/wjg.15.2809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Meckel’s diverticulum (MD) is the most frequent congenital abnormality of the small bowel and it is often difficult to diagnose. It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. The authors report a case of a 7-year-old boy with a one-year history of recurrent periumbilical colicky pain with associated alimentary vomiting, symptoms erroneously related to a cyclic vomiting syndrome but not to MD. The clinical features and the differential diagnostic methods employed for diagnosis of MD are discussed.
Collapse
|
135
|
Perforated Meckel's diverticulum in a micropremature infant and review of the literature. Pediatr Surg Int 2009; 25:539-41. [PMID: 19437023 DOI: 10.1007/s00383-009-2378-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2009] [Indexed: 10/20/2022]
Abstract
A 28-week estimated gestational age infant presented to our neonatal intensive care unit at 6 days of life with intestinal perforation. Urgent surgical exploration revealed a perforated Meckel's diverticulum (MD) with no other intestinal abnormalities. Pathologic examination of the specimen demonstrated a perforated MD with no heterotopic mucosa present. According to our literature review, this is the first reported case of a perforated MD in a micropremature infant. In the English literature, there have been a total of seven reported cases of perforated MD in the last 25 years. This report summarizes those cases and characterizes the presentation, prognosis and management of this very rare complication in neonates.
Collapse
|
136
|
Abstract
CT enterography is a new imaging modality that has distinct advantages over conventional CT, wireless capsule endoscopy, and barium examination. CT enterography is noninvasive and allows rapid mapping of disease activity before endoscopy and in cases where the endoscope cannot reach the diseased segment. CT enterography is readily available, is operator independent, and allows evaluation of extraenteric complications of small bowel disease. This article describes the latest techniques and applications of CT enterography.
Collapse
|
137
|
Fontenot BB, Deutmeyer CM, Feldman ME, Hebra A. Volvular small bowel obstruction secondary to adherence of a Meckel's diverticulum at a previous umbilical laparoscopic port site. J Laparoendosc Adv Surg Tech A 2009; 19:251-4. [PMID: 19215218 DOI: 10.1089/lap.2008.0237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This is a case of an otherwise asymptomatic Meckel's diverticulum, which became fibrously adherent to a previous umbilical laparoscopic port site, causing volvulus and small bowel obstruction in a pediatric patient. The diverticulum was diagnosed and resected laparoscopically, remaining bowel viability was maintained, and the child recovered without further sequelae. This complication, though rare, should be considered in the differential diagnosis when a child presents with abdominal pain after undergoing previous laparoscopic surgery. More important, this supports the consideration for the resection of asymptomatic Meckel's diverticulm when discovered incidentally, which is currently a controversial topic.
Collapse
Affiliation(s)
- Bennett B Fontenot
- Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, South Carolina, USA
| | | | | | | |
Collapse
|
138
|
Katz DS, Yam B, Hines JJ, Mazzie JP, Lane MJ, Abbas MA. Uncommon and Unusual Gastrointestinal Causes of the Acute Abdomen: Computed Tomographic Diagnosis. Semin Ultrasound CT MR 2008; 29:386-98. [DOI: 10.1053/j.sult.2008.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
139
|
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.
Collapse
|
140
|
MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature. AJR Am J Roentgenol 2008; 191:736-42. [DOI: 10.2214/ajr.07.3741] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
141
|
Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage. Pediatr Radiol 2008; 38:909-11. [PMID: 18491085 DOI: 10.1007/s00247-008-0874-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 03/28/2008] [Accepted: 04/03/2008] [Indexed: 10/22/2022]
Abstract
A Meckel diverticulum is an embryonic remnant of the omphalomesenteric duct that occurs in approximately 2% of the population. Most are asymptomatic; however, they are vulnerable to inflammation with subsequent consequences including diverticulitis and perforation. We report an 11-year-old boy who underwent laparoscopic appendectomy for perforated appendicitis at an outside institution. During his convalescence he underwent percutaneous drainage of a presumed postoperative abscess. A follow-up drain study demonstrated an enteric fistula. The drain was slowly removed from the abdomen over a period of 1 week. Three weeks following drain removal the patient reported recurrent nausea and abdominal pain. A CT scan demonstrated a 3.7-cm rim-enhancing air-fluid level with dependent contrast consistent with persistent enteric fistula and abscess. Exploratory laparoscopy was performed, at which time a Meckel diverticulum was identified and resected. This case highlights the diagnostic challenge and limitations of conventional radiology in complicated Meckel diverticulum.
Collapse
|
142
|
Kühn JP, Puls R, Maier S, Hosten N. [Rare differential diagnosis of the acute abdomen in the adult age]. Radiologe 2008; 48:969-71. [PMID: 18210058 DOI: 10.1007/s00117-007-1608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- J-P Kühn
- Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Greifswald, Friedrich Löffler - Strasse 23b, 17489, Greifswald, Deutschland,
| | | | | | | |
Collapse
|