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Shenoy A, Jadhav D, Gandhi R, Parekh RA. A Rare Case of a Meckel's Diverticulum Complicated by a Mesodiverticular Band. Cureus 2024; 16:e67364. [PMID: 39310622 PMCID: PMC11415136 DOI: 10.7759/cureus.67364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
A Meckel's diverticulum is a true congenital diverticulum arising from the ileum, approximately 2 feet from the ileocaecal junction. Named after Johann Meckel, who first described its embryological origins, the anomaly remains asymptomatic for most. Uncommonly, it is found to be the cause of serious complications such as interstitial obstruction and/or gangrene, bowel perforation, and, in rare cases, internal bowel herniations. A mesodiverticular band is a congenital fibrous band connecting the Meckel's diverticulum to its own mesentery, predisposing it to complications. Both conditions arise from a failure of regression of the vitellointestinal duct and its feeding artery. The presence of a mesodiverticular band significantly raises the possibility of complications, especially those of internal herniation and subsequent bowel obstruction. Detection of a Meckel's diverticulum is challenging in routine investigations such as contrast-enhanced computed tomography, and scintigraphy with Tc99 is required. The availability of such scans is limited, and their use is further difficult in emergent situations such as intestinal obstruction. This condition is, therefore, more frequently detected at laparotomies. Herein, we report a case of intestinal obstruction in a young female who presented to our emergency room with an acute abdomen and was found to have a mesodiverticular band causing internal herniation and subsequent obstruction.
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Affiliation(s)
- Abhishek Shenoy
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Digvijay Jadhav
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Rishabh Gandhi
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Rushabh A Parekh
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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2
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Yagnik VD, Garg P, Dawka S. Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review. Clin Exp Gastroenterol 2024; 17:147-155. [PMID: 38736719 PMCID: PMC11088382 DOI: 10.2147/ceg.s460053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024] Open
Abstract
Background Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, poses a dilemma when incidentally encountered during surgery. Despite historical descriptions and known complications of symptomatic MD, the decision to resect an incidental MD (IMD) lacks clear guidelines. This study aims to assess whether resecting IMDs is justified by synthesizing evidence from studies published between 2000 and 2023. Factors influencing this decision, such as demographic risks, surgical advancements and complications, are systematically examined. Methods and Material Following the PRISMA 2020 guidelines, this review incorporates 42 eligible studies with data on outcomes of asymptomatic MD management. Studies, both favoring and opposing resection, were analyzed. Results Considering complications, malignancy potential, and operative safety, the risk-benefit analysis presents a nuanced picture. Some authors propose conditional resection based on specific criteria, emphasizing patient-specific factors. Of 2934 cases analyzed for short- and long-term complications, the morbidity rate was 5.69%. Of 571 cases where mortality data were available, all 5 fatalities were attributed to the primary disease rather than IMD resection. Conclusion The sporadic, unpredictable presentation of IMD and the variability of both the primary disease and the patient make formulation of definitive guidelines challenging. The non-uniformity of complications reporting underscores the need for standardized categorization. While the balance of evidence leans towards resection of IMDs, this study acknowledges the individualized nature of this decision. Increased safety in surgery and anesthesia, along with better understanding and management of complications favor a judicious preference for resection, while taking into account patient characteristics and the primary disease.
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Affiliation(s)
- Vipul D Yagnik
- Department of Surgery, Banas Medical College and Research Institute, Palanpur, GJ, India
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, GJ, India
| | - Pankaj Garg
- Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, HR, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
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3
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Lee C, Antoun I. Post-appendicectomy small bowel obstruction due to internal hernia involving Meckel's diverticulum. BMJ Case Rep 2024; 17:e257717. [PMID: 38316488 PMCID: PMC10859988 DOI: 10.1136/bcr-2023-257717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Meckel's diverticulum is the most common congenital abnormality of the small bowel, present in about 2% of the population. A man in his 20s underwent a laparoscopic appendicectomy for acute appendicitis and recovered uneventfully. He presented to the emergency department 1 month later with features of acute small bowel obstruction. Emergency diagnostic laparoscopy revealed a band adhesion between the apex of a Meckel's diverticulum to the appendicectomy stump. Internal herniation of ileum under this band adhesion resulted in small bowel obstruction and ischaemic necrosis of the Meckel's diverticulum. The band adhesion was divided, and the Meckel's diverticulum was resected at the base with a linear cutting stapler. This complication has not been reported previously. A Meckel's diverticulum is an important differential diagnosis of acute appendicitis and should routinely be searched for among other pathologies. It can rarely cause a postoperative complication of internal hernia.
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Affiliation(s)
- Chanyang Lee
- East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Iman Antoun
- Kalgoorlie Health Campus, Kalgoorlie, Western Australia, Australia
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4
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Aly MS, Jamal Z. Spontaneous Perforation of Meckel's Diverticulum in a Young Adult Male: A Case Report and Review of the Literature. Cureus 2024; 16:e53598. [PMID: 38449992 PMCID: PMC10915699 DOI: 10.7759/cureus.53598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Meckel's diverticulum, a congenital defect that affects about 2% of the population, is a remnant of the embryologic vitelline duct. Perforated Meckel's diverticulum, a rare consequence of an already rare disease process, frequently presents and is diagnosed as a perforated appendix. We report a case of a 28-year-old male who presented with a two-day history of right-sided lower abdominal pain associated with nausea. The abdominal examination revealed a soft, nondistended abdomen with tenderness in the right iliac fossa. A CT scan of the abdomen showed a normal appendix and inflammation of Meckel's diverticulum without any signs of perforation. Bowel exploration through a small midline incision indicated the presence of a highly inflamed Meckel's diverticulum with localized perforation 75 cm from the ileocecal valve. A resection of 15 cm of the small bowel and an end-to-end primary anastomosis were performed. The patient had an uncomplicated recovery and was discharged after a five-day admission to a surgical ward. This case report illustrates the significance of keeping Meckel's diverticulum as a differential diagnosis in all the patients who present with an acute abdomen.
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Affiliation(s)
- Mahmoud S Aly
- Department of Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
| | - Zohaib Jamal
- Department of Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
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5
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Palma Zapata JA, Llamas Domínguez AE, Fernández Álvarez ZL, Palma Zapata J. Ileo-Ileal Intussusception Caused by a Meckel's Diverticulum With Ectopic Pancreatic Tissue: A Case Report. Cureus 2024; 16:e51888. [PMID: 38333458 PMCID: PMC10851032 DOI: 10.7759/cureus.51888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/10/2024] Open
Abstract
A Meckel's diverticulum (MD) is an embryonic remnant of the omphalomesenteric duct. Although most MDs are usually asymptomatic, pediatric patients tend to present serious complications more frequently (4-25% of cases), mainly in digestive tract bleeding, intestinal obstruction, and perforation, which have a high potential to compromise the patient's life. An ectopic pancreas (EP) is pancreatic tissue found outside the pancreas, usually in the stomach, duodenum, and jejunum. It is typically asymptomatic but can increase the risk of complications in the MD. A clinical case of a female infant with an MD complicated with bleeding and ileo-ileal intussusception is presented, in which the histopathological finding of type 1 ectopic pancreatic tissue was also found based on the Heinrich classification, being an entity uncommon in our environment. An EP arising within an MD is infrequent, requiring clinical attention and timely preoperative diagnosis to prevent and treat associated severe complications. This continues to be a superior challenge for the clinician and requires a multidisciplinary team for comprehensive treatment.
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Affiliation(s)
- Julio A Palma Zapata
- Medical Didactic Unit, Autonomous University of Aguascalientes, Aguascalientes, MEX
| | | | | | - Juliana Palma Zapata
- Department of Medicine, Health Sciences Center, Autonomous University of Aguascalientes, Aguascalientes, MEX
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Zanchetta M, Inversini D, Pappalardo V, Grappolini N, Morabito M, Gianazza S, Carcano G, Ietto G. Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD. Life (Basel) 2023; 13:1996. [PMID: 37895380 PMCID: PMC10608533 DOI: 10.3390/life13101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
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Affiliation(s)
- Matteo Zanchetta
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Davide Inversini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Vincenzo Pappalardo
- Department of Surgery, Cittiglio-Angera Hospital-ASST Settelaghi, 21100 Varese, Italy
| | - Niccolo Grappolini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Marika Morabito
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Simone Gianazza
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Giulio Carcano
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
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7
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Fernandez Trokhimtchouk T, Flores LF, Morillo Cox Á, Otanez ES, Crespo Martinez JK. Perforated Meckel's Diverticulum Caused by a Toothpick: A Case Report and Review of Literature. Cureus 2023; 15:e37390. [PMID: 37182090 PMCID: PMC10171705 DOI: 10.7759/cureus.37390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Although Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is rare in the general adult population. When it does become symptomatic, it is usually due to complications such as perforation. We report the case of a 38-year-old man who presented with acute abdominal pain in the right iliac fossa, fever, and tachycardia. Complementary exams at the emergency department showed leukocytosis and elevated C-reactive protein. Acute appendicitis was suspected, so he was taken to the operating room for a diagnostic laparoscopy. During surgical exploration, a perforated Meckel's diverticulum caused by a toothpick was found. Surgery was converted to laparotomy with resection of the small bowel segment containing the diverticulum, followed by a primary anastomosis. The postoperative period was uneventful, and the patient was discharged on day seven. No abnormalities were reported in the histopathology study. In this report, we review and discuss similar cases found in the literature, all of them male with acute abdomen and suspicion of appendicitis. We aim to remark on the importance of keeping in the differential of such patients a perforated Meckel's diverticulum.
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Affiliation(s)
| | - Luis F Flores
- General Surgery, Univesidad Internacional del Ecuador, Axxis Hospital, Quito, ECU
| | - Álvaro Morillo Cox
- General Surgery, Univesidad Internacional del Ecuador, Axxis Hospital, Quito, ECU
| | - Estefanie S Otanez
- General Surgery, Univesidad Internacional del Ecuador, Axxis Hospital, Quito, ECU
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8
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Tree K, Kotecha K, Reeves J, Aitchison L, Noeline Chui J, Gill AJ, Mittal A, Samra JS. Meckel's diverticulectomy: a multi-centre 19-year retrospective study. ANZ J Surg 2023; 93:1280-1286. [PMID: 36821518 DOI: 10.1111/ans.18351] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Meckels diverticulum (MD) causes a number of acute surgical pathologies and can contain ectopic tissue with the surgical aim to resect all ectopic mucosa. This has traditionally implied a small bowel resection (BR); though contemporary literature has demonstrated Meckel's diverticulectomy to be safe. The aim of this study was to determine optimal resection strategy, and assess MD histopathological features and their relationship to outcomes. METHODS A 19-year retrospective review of patient medical records across seven hospitals was conducted with demographic, clinical and pathological data collected. Analysis was conducted using a student's t-test for continuous variables and chi-squared test for categorical variables. Univariate regression was performed to identify risk factors. P < 0.05 was considered statistically significant. RESULTS One hundred and sixty patients underwent resection of MD, 70 (44%) had Meckel's diverticulectomy and 90 (56%) had BR. No significant difference in length (P = 0.486), width (P = 0.238), or ratio (P = 0.188) of diverticulectomy compared to BR, with fewer complications in diverticulectomy. In all, 24 (15.3%) MD were perforated, of whom 5 had gastric mucosa, 2 had mixed ectopic mucosa and 1 carcinoid tissue. There were no cases of ectopic mucosa in the resection margin requiring re-operation, or causing base perforation. MD specimen with greater length: width ratio was a risk factor for perforation OR 1.437 P = 0.042 but not for malignancy P = 0.813 or ectopic tissue P = 0.185. CONCLUSION Meckel's diverticulectomy is safe via laparoscopic or open approach compared with BR. Despite higher perforation rates in MD with greater length: width ratio, no malignancy or ectopic risk was identified, supporting diverticulectomy as a safe operative approach.
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Affiliation(s)
- Kevin Tree
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jenna Reeves
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Lucy Aitchison
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Juanita Noeline Chui
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Baltes P, Dray X, Riccioni ME, Pérez-Cuadrado-Robles E, Fedorov E, Wiedbrauck F, Chetcuti Zammit S, Cadoni S, Bruno M, Rondonotti E, Johansson GW, Mussetto A, Beaumont H, Perrod G, McNamara D, Plevris J, Spada C, Pinho R, Rosa B, Hervas N, Leenhardt R, Marmo C, Esteban-Delgado P, Ivanova E, Keuchel M. Small-bowel capsule endoscopy in patients with Meckel's diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study. Gastrointest Endosc 2022; 97:917-926.e3. [PMID: 36572128 DOI: 10.1016/j.gie.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. METHODS This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. RESULTS Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB transit time for the first indicative image of MD was 57% of the total SB transit time. CONCLUSIONS Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.
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Affiliation(s)
- Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany.
| | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Evgeny Fedorov
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Felix Wiedbrauck
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | | | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
| | - Mauro Bruno
- University Division of Gastroenterology, University Hospital City of Science and Health Turin, Turin, Italy
| | | | | | | | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Guillaume Perrod
- Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital and School of Medicine Trinity College Dublin, Dublin, Ireland
| | - John Plevris
- Endoscopy Unit, The Royal Infirmary of Edinburgh, University of Edinburgh, Scotland
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Rolando Pinho
- Gastroenterology Department, Vila Nova de Gaia/Espinho-Hospital Centre, Vila Nova de Gaia, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Nerea Hervas
- Department of Gastroenterology, Complejo Hospitalario Navarra, Pamplona, Spain
| | - Romain Leenhardt
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Clelia Marmo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Ekaterina Ivanova
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany; Clinic for Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
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10
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Abstract
Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallstones, and incidental appendectomy.
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Affiliation(s)
- Keely Reidelberger
- University of Nebraska Medical Center College of Medicine, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA
| | - Abbey Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA.
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11
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Triple presentation of acute appendicitis, Meckel's diverticulum, and hemorrhagic ovarian cyst: A rare case report and literature review. Int J Surg Case Rep 2021; 87:106462. [PMID: 34607264 PMCID: PMC8497848 DOI: 10.1016/j.ijscr.2021.106462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance With 2% prevalence worldwide, Meckel's diverticulum is the most common congenital anomaly of the small intestine, which anatomically results from incomplete obliteration of the vitelline duct. It is usually difficult to differentiate clinically between acute appendicitis and Meckel's diverticulitis, thus in most clinical situations, it is asymptomatic and usually incidentally discovered intraoperatively. On the other hand, Acute appendicitis is one of the most common presentations in a surgical emergency with an 8.6% incidence in males and 6.7% in females. Triple presentation of acute appendicitis, Meckel's diverticulum, and a hemorrhagic ovarian cyst is a rare incidence in literature. Case presentation and clinical discussion A female patient 35 years old with no previous surgical history or known medical disease presented to our ER with right lower quadrant abdominal pain of one-day duration. On physical examination; there was right iliac fossa pain, tenderness, and rebound tenderness indicating acute appendicitis. Intraoperatively we operated appendectomy as usual through Gridiron incision. Upon opening of the parietal peritoneum, there was a hemorrhagic reaction with a catarrhal inflamed appendix. Ileal loops revealed a Meckel's diverticulum. With the peritoneal toilet, there was still a hemorrhagic reaction. Further exploration revealed a ruptured hemorrhagic ovarian cyst, which was managed using bipolar cautery and ligatures. Conclusion In the operative management of acute appendicitis, we recommend proper assessment for both the right ovary and at least two feet of ileum proximal to the ileocecal valve to exclude any ovarian abnormalities or Meckel's diverticulum respectively especially if the appendix was normal or just was catarrhal inflamed. Meckel’s diverticulum is the most common congenital anomaly of the small intestine-2% worldwide. Acute appendicitis is one of the most common presentations in a surgical emergency. The presentation of acute appendicitis, Meckel's, and an ovarian cyst is rare in literature In managing acute appendicitis, assess ileum proximal to the ileocecal valve to exclude ovarian abnormalities or Meckel's diverticulum.
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12
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Johnson GGRJ, Holden J, Helewa RM, Hochman D, Hyun E. A Strangulated Meckel's Diverticulum in an Inguinal Hernia: A Case Report and Literature Review. Int Med Case Rep J 2021; 14:605-609. [PMID: 34512042 PMCID: PMC8421327 DOI: 10.2147/imcrj.s325390] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Meckel's diverticulum is an embryologic remnant of the vitelline duct, occurring in approximately 2% of the adult population. A hernia containing a Meckel's diverticulum is called a Littré's hernia and is rarely reported in the medical literature. Clinically, a Littré's hernia is indistinguishable from a hernia containing small bowel and is often discovered incidentally during a repair. Case Presentation Herein, we report a rare case of strangulated Littré's hernia in a patient's right groin. The sac contained a long segment of small bowel in addition to a large Meckel's diverticulum. The bowel was irreducible through the groin incision, and a lower midline laparotomy was made. Necrotic bowel including the Meckel's diverticulum was resected. Given the presence of necrotic bowel and potential for infection, the hernia was repaired with a Bassini herniorrhaphy, reinforced with absorbable mesh. The patient recovered uneventfully. Conclusion Littré's hernia is a rare clinical entity. Treatment is similar to any bowel-containing hernia. Repair of the hernia defect with permanent mesh should be weighed against the risk of implant infection.
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Affiliation(s)
- Garrett G R J Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Clinician Investigator Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Holden
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Hochman
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Hyun
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and the most common cause of gastrointestinal bleeding in children. Although it usually follows the rule of 2's, exceptions to this rule are reported in the literature. Often asymptomatic, MD is commonly an incidental finding during surgical interventions. When symptomatic, the most common presentation of this condition is painless rectal bleeding. A myriad of other nonspecific symptoms are however possible, especially in adults, thus making this diagnosis difficult. Meckel diverticulum has been reported to mimic other abdominal pathologies like appendicitis, inflammatory bowel disease, and pancreatitis to name a few.We report a patient with acute abdomen in whom the more common causes of acute abdomen were ruled out and a diagnosis of MD was established on exploratory laparoscopy, only after he developed perforation. This report emphasizes the need for maintaining a high index of suspicion towards a possibility of a complicated MD in patients presenting with an acute abdomen, once other causes of acute abdomen are ruled out.
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Sex differences in surgically correctable congenital anomalies: A systematic review. J Pediatr Surg 2020; 55:811-820. [PMID: 32061363 DOI: 10.1016/j.jpedsurg.2020.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aims to compare the prevalence and outcomes of surgically correctable congenital anomalies between sexes. METHODS Upon registration on PROSPERO (CRD42019120165), a librarian aided in conducting a systematic review using PRISMA guidelines. The five largest relevant studies were included for each anomaly. Cumulative prevalence differences and confidence intervals were calculated, and the Cochran-Mantel-Haenszel test was performed. RESULTS Of 42,722 identified studies, 68 were included in our analysis. All included anomalies had greater than 1000 patients except duodenal atresia (n = 787) and intestinal duplication (n = 148). Males had a significantly higher prevalence than females in 10/14 anomalies (Hirschsprung's disease, omphalomesenteric duct, congenital diaphragmatic hernia, anorectal malformation, malrotation, esophageal atresia, congenital pulmonary airway malformation, intestinal atresia, omphalocele, and gastroschisis; p < 0.001). There was no difference in the prevalence of duodenal atresia or intestinal duplication between sexes (p = 0.88 and 0.65, respectively). Females had a significantly higher prevalence of biliary anomalies (atresia and choledochal cyst). CONCLUSION Our study indicates that males have higher prevalence rates of most congenital anomalies. Further investigations are required to illuminate the embryology underlying this sex distribution and whether sex influences outcomes. TYPE OF STUDY Systematic review and meta-analysis. LEVEL OF EVIDENCE Prognostic study, level II.
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15
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Case report: Diverticulitis complicating a giant Meckel’s divertuculum. Int J Surg Case Rep 2019; 65:209-212. [PMID: 31731084 PMCID: PMC6920320 DOI: 10.1016/j.ijscr.2019.10.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 11/24/2022] Open
Abstract
Meckel’s diverticulitis is a rare condition which may need surgical approach. It is uncommon that Meckel’s diverticulum causes symptomatic disease in adults. Although early detection is often challenging, an abdominal CT-scan may establish a certain diagnosis in giant diverticula. Emergency surgery is mandatory in patients with complicated Meckel’s diverticulum. Segmental resection is the approach of choice when a giant diverticulum has inflammatory signs.
Introduction In this paper, we discuss a unique case of diverticulitis in which the patient presented a giant Meckel’s diverticulum. Presentation of case The patient was a 44 year old male whose medical history included a laparoscopic gastric bypass four years before the finding, and chronical high blood pressure. The patient came to the emergency department with an abdominal pain and elevated acute-phase reactants. An abdominal CT revealed a 17 cm long Meckel’s diverticulum with signs of severe inflammation. The patient was then taken to the operating room, and subjected to a 4 cm ileum resection, including the entire diverticulum, with a manual end-to-end anastomosis. Discussion Although Meckel’s diverticulum is the most common congenital abnormality of the intestinal tract, it is unusual for it to cause symptoms in adults. However, when a patient arrives at the emergency department with a complicated Meckel’s diverticulum, an early diagnosis is essential to prevent serious complications, such as perforation of the diverticulum and subsequent peritonitis. The presence of a giant diverticulum is an extremely rare condition. There are few publications to date, but these diverticula are associated with more complications, presenting a higher risk of torsion, volvulus or intestinal obstruction. This paper include a bibliographic review of existing studies on etiopathogenesis, and the diagnosis and treatment of complicated Meckel’s diverticulum, particularly in its giant variant. Conclusion Although Meckel’s diverticulitis is a rare entity, it can appear as an acute abdomen. An early diagnosis and treatment to prevent subsequent complications is essential to ensure an optimal recovery.
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Fraser AA, Opie DD, Gnecco J, Nashed B, Johnson DC. Spontaneous perforation of Meckel's diverticulum in an adult female with literature review. Surg Case Rep 2018; 4:129. [PMID: 30382419 PMCID: PMC6211145 DOI: 10.1186/s40792-018-0536-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perforated Meckel's diverticulum is a rare complication of an already rare disease process, which often mimics a perforated appendix on presentation and diagnosis. The majority of case reports for perforation involve either a foreign body or fecalith. CASE PRESENTATION We report the case of a 54-year-old female who initially presented at another institution with signs and symptoms of acute appendicitis and underwent appendectomy with a drain left in place. Subsequently, she underwent exploratory laparotomy at our institution for a perceived stump leak or incidental perforation and was found to have a perforated Meckel's, with no evidence of foreign body or fecalith. CONCLUSION The literature of Meckel's diverticulum is reviewed, and we discuss the difficulty in diagnosis as well as the quandary of incidental resection.
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Affiliation(s)
- Andrew A Fraser
- General Surgery Department, Mountain Vista Medical Center, 1301 S Crismon, Mesa, AZ, 85209, USA.
| | - Douglas D Opie
- General Surgery Department, Mountain Vista Medical Center, 1301 S Crismon, Mesa, AZ, 85209, USA
| | - James Gnecco
- General Surgery Department, Mountain Vista Medical Center, 1301 S Crismon, Mesa, AZ, 85209, USA.,, Glendale, USA
| | - Beshoy Nashed
- General Surgery Department, Mountain Vista Medical Center, 1301 S Crismon, Mesa, AZ, 85209, USA
| | - David C Johnson
- General Surgery Department, Mountain Vista Medical Center, 1301 S Crismon, Mesa, AZ, 85209, USA.,, Mesa, USA
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17
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Wei MT, Tu CH, Chiu HM, Tseng PH, Lee YC, Chen CC, Wang HP, Wu MS. Diagnostic features of Meckel's diverticulum using single-balloon enteroscopy: A case series. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mike Tzuhen Wei
- Department of Internal Medicine; Weill Cornell Medical College; New York New York
| | - Chia-Hung Tu
- Graduate Institute of Clinical Medicine, College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ping-Huei Tseng
- Graduate Institute of Clinical Medicine, College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Chien-Chuan Chen
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ming-Shiang Wu
- Graduate Institute of Clinical Medicine, College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
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18
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Hansen CC, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century. Medicine (Baltimore) 2018; 97:e12154. [PMID: 30170459 PMCID: PMC6392637 DOI: 10.1097/md.0000000000012154] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The contemporary demographics and prevalence of Meckel's diverticulum, clinical presentation and management is not well described. Thus, this article aims to review the recent literature concerning Meckel's diverticulum. METHODS A systematic PubMed/Medline database search using the terms "Meckel" and "Meckel's" combined with "diverticulum." English language articles published from January 1, 2000 to July 31, 2017 were considered. Studies reporting on the epidemiology of Meckel's diverticulum were included. RESULTS Of 857 articles meeting the initial search criteria, 92 articles were selected. Only 4 studies were prospective. The prevalence is reported between 0.3% and 2.9% in the general population. Meckels' diverticulum is located 7 to 200 cm proximal to the ileocecal valve (mean 52.4 cm), it is 0.4 to 11.0 cm long (mean 3.05 cm), 0.3 to 7.0 cm in diameter (mean 1.58 cm), and presents with symptoms in 4% to 9% of patients. The male-to-female (M:F 1.5-4:1) gender distribution is reported up to 4 times more frequent in men. Symptomatic patients are usually young. Of the pediatric symptomatic patients, 46.7% have obstruction, 25.3% have hemorrhage, and 19.5% have inflammation as presenting symptom. Corresponding values for adults are 35.6%, 27.3%, and 29.4%. Ectopic gastric tissue is present in 24.2% to 71.0% of symptomatic Meckel's diverticulum, is associated with hemorrhage and is the most common form of ectopic tissue, followed by ectopic pancreatic tissue present in 0% to 12.0%. CONCLUSION The epidemiological patterns and clinical presentation appears stable in the 21st century. A symptomatic Meckel's diverticulum is managed by resection. The issue of prophylactic in incidental Meckel's diverticulum resection remains controversial.
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Affiliation(s)
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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19
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Abstract
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.
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Affiliation(s)
- Jayesh Sagar
- Department of Surgery, Royal Free Hospital, London, UK.
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20
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Reminiscing on Remnants: Imaging of Meckel Diverticulum and Its Complications in Adults. AJR Am J Roentgenol 2017; 209:W287-W296. [PMID: 28834452 DOI: 10.2214/ajr.17.18088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Meckel diverticulum may become symptomatic if it is complicated by hemorrhage, intestinal obstruction, diverticulitis, or tumor. Although classically described in children, it is often missed in adults because of lack of suspicion and difficulty in detection. The purpose of this article is to review the imaging findings and management of Meckel diverticulum and its complications. CONCLUSION Although it is infrequently encountered incidentally, Meckel diverticulum should be considered especially when interpreting examinations for abdominal pain, small-bowel obstruction, and gastrointestinal bleeding.
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21
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Chauhan A, Suggett N, Guest P, Goh J. Meckel's diverticulum: new solutions for an old problem? Frontline Gastroenterol 2016; 7:118-121. [PMID: 28839845 PMCID: PMC5369507 DOI: 10.1136/flgastro-2015-100624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/18/2015] [Accepted: 09/29/2015] [Indexed: 02/04/2023] Open
Abstract
Meckel's diverticulum (MD) is the most commonly encountered true diverticulum in the small bowel. Although overall a rare cause of gastrointestinal bleeding, it remains an important differential in a child/young adult presenting with lower gastrointestinal bleeding. We present two MD cases, one associated with brisk bleeding resulting in haemodynamic instability and the other in insidious blood loss causing symptoms of chronic iron deficiency. These cases illustrate the heterogeneous nature of the clinical picture associated with Meckel's diverticulae, a condition most gastroenterological and surgical units will encounter. We subsequently discuss the diagnostic and management dilemma Meckel's diverticulae pose and appraise the latest evidence and management strategies in this regard.
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Affiliation(s)
- Abhishek Chauhan
- Department of Gastroenterology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Nigel Suggett
- Department of Colorectal Surgery, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Peter Guest
- Department of Radiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Jason Goh
- Department of Gastroenterology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
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22
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Alemayehu H, Stringel G, Lo IJ, Golden J, Pandya S, McBride W, Muensterer O. Laparoscopy and complicated meckel diverticulum in children. JSLS 2016; 18:JSLS-D-14-00015. [PMID: 25392652 PMCID: PMC4208888 DOI: 10.4293/jsls.2014.00015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy. Methods: A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum. Results: Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications. Conclusions: Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.
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Affiliation(s)
- Hanna Alemayehu
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Gustavo Stringel
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY
| | - Irene J Lo
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Jamie Golden
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
| | - Samir Pandya
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
| | - Whitney McBride
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
| | - Oliver Muensterer
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
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23
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Internal hernia associated with perforated Meckel's diverticulum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2015.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Right lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel diseaseRight lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel disease.
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Affiliation(s)
- Neel B Patel
- Jupiter Imaging Associates, Sheridan Healthcorp, Jupiter, FL, USA.
| | - Daniel R Wenzke
- NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, 2650 Ridge Avenue, Evanston, IL 60201, USA
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Bagade S, Khanna G. Imaging of omphalomesenteric duct remnants and related pathologies in children. Curr Probl Diagn Radiol 2015; 44:246-55. [PMID: 25823549 DOI: 10.1067/j.cpradiol.2014.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 01/01/2023]
Abstract
The omphalomesenteric duct (OMD) or the vitelline duct (VD) is the embryologic communication between the yolk sac and the primitive midgut. OMD or VD anomalies are a group of defects resulting from failure of involution of the OMD. Meckel diverticulum is the most common anomaly that results from failure of resorption of the OMD. Other less common anomalies seen in children include OMD fibrous band, fistula, sinus tract, cyst, and umbilical polyps. These OMD remnants can have variable clinical manifestations such as umbilical discharge, small bowel obstruction, gastrointestinal tract bleeding, or acute abdomen. This pictorial essay reviews the clinical presentation and imaging findings of the common and not so common complications of OMD remnants in the pediatric population.
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Affiliation(s)
- Swapnil Bagade
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO.
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO
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26
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Altaf A, Aref H. A case report: Cecal volvulus caused by Meckel's diverticulum. Int J Surg Case Rep 2014; 5:1200-2. [PMID: 25460488 PMCID: PMC4275830 DOI: 10.1016/j.ijscr.2014.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 11/29/2022] Open
Abstract
Although, MD is the most common congenital condition of the GI tract, the clinical diagnosis of MD is difficult to make. Most cases of MD are found incidentally during a surgical procedure for another reason. The mainstay treatment would be resection of the diverticulum or the segment of the bowel affected by the pathology.
INTRODUCTION Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to Meckel's diverticulum include hemorrhage, intestinal obstruction and inflammation. Acute large bowel obstruction is a rare complication of Meckel's diverticulum and in the presented case it is caused by volvulus. PRESENTATION OF CASE We report a 39 year old female who presented with the diagnosis of a large bowel obstruction occurring as a result of cecal volvulus caused by adhesions of a perforated diverticulum. DISCUSSION The reported case presents one of the rare complications of MD, which is volvulus. The case described above presented with signs and symptoms suggestive of acute intestinal obstruction and radiological findings suggestive of cecal volvulus. The patient was taken to the operation room for exploration and we discovered the presence of a perforated MD. The main treatment of such case is to perform diverticulectomy in all symptomatic patients. CONCLUSION MD is mostly identified intraoperatively. Knowledge of the pathophysiologies by which MD can cause complications such as volvulus is important in order to plan management.
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Affiliation(s)
- Abdulmalik Altaf
- Department of Surgery, Faculty of Medicine King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Hager Aref
- Department of Surgery, Faculty of Medicine King Abdulaziz University, Jeddah, Saudi Arabia.
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27
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Clark JK, Paz DA, Ghahremani GG. Imaging of Meckel's diverticulum in adults: pictorial essay. Clin Imaging 2014; 38:557-64. [PMID: 24998882 DOI: 10.1016/j.clinimag.2014.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 02/26/2014] [Accepted: 04/28/2014] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- James K Clark
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
| | - David A Paz
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Gary G Ghahremani
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA
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28
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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
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Abstract
Simultaneous diagnoses of intussusception and appendicitis in the same patient have rarely been described in the pediatric literature. A case of a 30-month-old boy is presented with an initial diagnosis of intussusception that was successfully reduced by air contrast enema. When the patient's condition deteriorated, a diagnostic search surprisingly revealed a missed perforated appendicitis with an appendicolith that had been part of the intussusception. The patient's hospitalization and surgical course is described along with a discussion of the intermingling of intussusception and appendicitis in a young child. This case illustrates the need to consider alternative diagnoses when a patient's course takes an unexpected and confusing turn.
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30
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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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31
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Surgical Treatment of Meckel's Diverticulum. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Blanc B, Pocard M. [Surgical techniques of appendectomy for acute appendicitis]. ACTA ACUST UNITED AC 2009; 146 Spec No 1:22-31. [PMID: 19846093 DOI: 10.1016/j.jchir.2009.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Over the last 20 years, the treatment of acute appendicitis has been transformed by the development of the laparoscopic approach. And yet the net value of this approach continues to be debated. Laparoscopic appendectomy is associated with a lower complication rate and a shorter period of disability in the general population. While operative costs are higher, the global cost of laparoscopic appendectomy is lower than for open appendectomy. There is a somewhat higher rate of abdominal abscess for the laparoscopic route. Laparoscopic appendectomy shows clear advantages in obese patients and in those with gangrenous or ruptured appendicitis. The laparoscopic approach is contra-indicated during pregnancy due to a higher incidence of miscarriage. Treatment of the appendiceal stump by ligature decreases the expense associated with the use of a surgical stapler. When Meckel's diverticulum is encountered during appendectomy, it should be removed in all pediatric patients; in adults, Meckel's diverticulectomy in adults should be performed only for clear-cut pathology. Surgeons continue to innovate and refine appendectomy techniques but many questions remain to be answered.
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Affiliation(s)
- B Blanc
- Service de chirurgie digestive, hôpital Lariboisière, université Paris Diderot-Paris 7, 2, rue Ambroise-Paré, 75010 Paris, France
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Incarcerated femoral Littre's hernia-transperitoneal preperitoneal hernia repair (TAPP) and laparoscopic resection of the necrotic diverticulum. Surg Laparosc Endosc Percutan Tech 2008; 18:409-13. [PMID: 18716546 DOI: 10.1097/sle.0b013e31816f7742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Littre's hernias in the region of a femoral hernial orifice have been described in numerous cases in the literature. Open inguinal or femoral access was selected for all surgical procedures. We are describing the first case of an incarcerated Littre's hernia in the region of a femoral hernial orifice treated by means of transperitoneal preperitoneal hernia repair with simultaneous laparoscopic resection of the diverticulum. On the basis of the example, it is shown that the laparoscopic procedure is safe and efficient when performed by an experienced laparoscopic surgeon, even for treating incarcerated hernias, including the resection of necrotic tissue.
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Abstract
BACKGROUND Management of incidentally detected Meckel diverticulum (MD) remains controversial. Our aims were to establish: (1) the prevalence of MD; (2) the morbidity and (3) mortality due to MD. METHODS Systematic review: A total of 244 papers meeting defined criteria were included; there were no prospective or randomized studies. MD prevalence and mortality from autopsy studies, postoperative complications, and outcome of incidentally detected MD were extracted. Population-based data: Data were obtained from national databases on MD as cause of death, and on number of MD resections per year. RESULTS The prevalence of MD is 1.2% and historical mortality of MD was 0.01%. The current mortality from MD is 0.001%. The number of MD resections per year per 100,000 population decreased significantly after the pediatric age range (P < 0.001). Resection of incidentally detected MD has a significantly higher postoperative complication rate than leaving it in situ (P < 0.0001). The long-term outcome of patients with incidentally detected MD left in situ showed no complications. Seven-hundred fifty-eight patients would require incidentally detected MD resection to prevent 1 death from MD. CONCLUSIONS MD is present in 1.2% of the population, it is a very rare cause of mortality, and it is primarily a disease of the young. Leaving an incidentally detected MD in situ reduces the risk of postoperative complications without increasing late complications. A large number of MD resections would need to be performed to prevent 1 death from MD. The above evidence does not support the resection of incidentally detected MD.
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36
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Abstract
Prenatally, the umbilicus is of paramount importance, providing the gateway between the mother and the fetus. As the fetus becomes increasingly autonomous at the end of the second month of fetal life, the connections (vitelline, urachal) diminish in significance and involute. Disturbances in this process can result in a wide variety of abnormalities, ranging from relatively minor defects identified at birth (umbilical granulation tissue) to life-threatening complications quiescent until late adulthood (urachal carcinoma). This section will review the 'state of the art' in evaluation and management of these umbilical and related abnormalities.
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Affiliation(s)
- Charles L Snyder
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
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Sagar J, Kumar V, Shah DK, Bhatnagar A. Meckel's diverticulum: a systematic review. J R Soc Med 2006; 6:7. [PMID: 17034631 PMCID: PMC1618827 DOI: 10.1186/1471-2326-6-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 10/11/2006] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Jayesh Sagar
- Department of Surgery, Royal Free Hospital, London, UK
| | - Vikas Kumar
- Department of Orthopaedics, Princess Alexandra Hospital, Harlow, UK
| | | | - Ashok Bhatnagar
- Department of Surgery, Government Medical College, Surat, India
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Abstract
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.
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Affiliation(s)
- Jayesh Sagar
- Department of Surgery, Royal Free Hospital, London, UK.
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