Meckel's diverticulum associated with ileal volvulus in a neonate

Intermittent Volvulus with Obstruction Due to a Meckel's Diverticulum and Band Presenting as Feeding Intolerance in a Neonate with Trisomy 13

Individuals born with trisomy 13 tend to be susceptible to Meckel’s diverticulum. It is rarely symptomatic and reported cases are extremely rare. We describe here a neonate with feeding intolerance and bilious aspirates as a result of Meckel’s diverticulum and peritoneal band which caused intermittent volvulus with obstruction.

Acute abdomen in children due to different presentations of complicated Meckel’s diverticulum: a case series

Background

Meckel’s diverticulum (MD) is the commonest congenital abnormality of the gastrointestinal tract that occurs in 2% of general population. It remains asymptomatic, but it may lead to life-threatening complications. These complications may be misdiagnosed with other gastrointestinal disorders like acute appendicitis, making its diagnosis challenging among pediatricians and pediatric surgeons. In this study, we reported five cases with different presentations of complicated MD in children.

Results

Five patients with different presentations of MD were reported during the period from January 2016 to January 2020. Patients’ demographics, clinical presentations, investigations, operative data, and postoperative outcome were recorded and analyzed.

Conclusions

The present study highlights different presentations of MD. Surgical interference is the main key of treatment of symptomatic MD either by wedge resection of a small base diverticulum or by resection anastomosis of the small intestine in wide base and inflamed diverticulum.

Meckel's diverticulum causing intestinal obstruction in the newborn

The causes of neonatal bowel obstruction are variable and dominated by malformations and the Meckel diverticulum must remain exceptional. We report a case of neonatal bowel obstruction in a six day old male neonate admitted on account of inability to pass stool, abdominal distension and bilious vomiting. The radiologic additional examinations are non-specific. Exploratory laparotomy found obstruction at the site of a Meckel's diverticulum.

Male predominance in Meckel's diverticulum: A hyperacidity hypotheses

The symptomatic presentation of Meckel's diverticulum (MD) depends on a person's age, sex, and presence or absence of ectopic gastric tissue. There are no differences in the prevalence of asymptomatic MD between males and females; however, symptomatic MD has a distinct male predominance with a male-to-female ratio ranging from 2:1 to 5:1 in children. Furthermore, if the ectopic tissue contains gastric mucosa, MD has a greater chance of becoming symptomatic. Studies have shown that acid secretion is more likely to occur in male infants compared to female infants. In adults, men are known to have a higher level of acid production compared to women. Peptic ulcers (PU) are more common in males due to high acid secretion, and gastric tissues are affected by gastrin secretion in both conditions. MD is typically accompanied by ectopic gastric tissue, and could therefore be affected by gastrin and acid secretion in a similar manner to PU. Some of the major complications of MD are diverticulitis, ulcers, and bleeding from adjacent ectopic gastric tissue, and such complications resemble PU. PU also have male to female ratios ranging from 2:1 to 5:1, which is again similar to MD. Since the secretion of both gastrin and acid decrease with age, symptomatic presentation of MD also declines with age. Therefore, we hypothesize that higher gastrin and acid levels in males affect the ectopic gastric mucosa and lead to an increase in MD symptoms, which result an increased incidence of MD in males.

A rare cause of intestinal obstruction in a newborn: Congenital band compression

Congenital band compression syndrome should be considered in cases diagnosed prenatally or postnatally as intestinal obstruction. Presently described is a report of newborn admitted to hospital with abdominal distension and bilious vomiting. A suspected intestinal obstruction had been diagnosed in prenatal examination. Surgery revealed congenital band compressing ileal segments and preventing transmission of intestinal content. Band was successfully removed and intestinal integrity is intact.

Vitelline duct pathologies in neonates

OBJECTIVE

The aim of this study was to review the management of pediatric cases of vitelline duct pathology (VDP) detected surgically or incidentally during the neonatal period and the outcomes.

METHODS

The data of newborns who were symptomatic and underwent VDP resection or who were incidentally diagnosed with VDP at a single institution between 1985 and 2015 were retrospectively analyzed in terms of age, sex, clinical features, treatment, perioperative findings, ectopic tissue pathology, and postoperative follow-up information.

RESULTS

Among the 36 newborns enrolled in this study, 26 were male and 10 were female (2.6:1). The median weight was 2400 g (range: 800-3090 g). In 16 cases (14 males and 2 females; 7:1) the VDP was surgically repaired. Pathological evaluation indicated that 43% (n=7) of the cases had ectopic gastric mucosa. VDP was incidentally discovered in 12 males and 8 females (1.5:1). VDP was removed in 10 cases (50%) and left intact in others. Ectopic gastric mucosa was observed in 10% of the VDP removal cases. Ectopic gastric tissue was more prevalent in the surgical VDP cases than in the incidentally discovered and VDP removal cases (p<0.05). Male predominance was greater in the surgically repaired cases than in the incidentally discovered cases (p<0.05). One patient whose VDP was discovered incidentally was admitted 3 years later with obstruction due to intussusception caused by Meckel's diverticulum, and 1 patient was admitted with rectal bleeding at 11 years of age.

CONCLUSION

Symptomatic VDP in the newborn demonstrates a significant gender difference. Symptomatic cases are more likely to have ectopic gastric tissue than non-symptomatic cases. Incidentally detected cases without removal should be followed closely for future complications.

Perforated Meckel's Diverticulum in a 3-day-old Neonate; A Case Report

Perforation of Meckel’s diverticulum is a rare complication in neonatal period. A 3-dayold term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel’s diverticulum was detected. Pathological report of the tissue showed inflamed diverticulum with heterotopic gastric mucosa. This is the first report of Meckel’s diverticulum perforation in a neonate in our country

Intestinal obstruction in a premature baby: Endoscopic diagnosis and management by minimal access surgery

Neonatal intestinal obstruction is the most common surgical emergency in a newborn. Although, large numbers of newborns are operated in our country, limited published literature is available on advances in diagnosis, and management of this problem with outcome analysis in newborns. We report a premature (32 weeks) newborn who developed acute onset symptoms of small bowel obstruction in 3^rdweek of life, and discuss the approach to diagnosis and management with the minimal access surgery and successful outcome.

Symptomatic Meckel's diverticulum in newborn: two interesting additional cases and review of literature

OBJECTIVES

This study aimed to review the literature about symptomatic Meckel's diverticulum (MD) in the neonatal period with 2 additional uncommon cases.

METHODS

The authors describe 2 interesting neonatal cases of symptomatic MD and analyze the literature on this topic, with particular reference to the prevalence of sex, age at presentation, most common signs and symptoms, treatment, histology, associated anomalies, and outcome.

RESULTS

The first patient was a term newborn with bowel obstruction by a pseudocystic MD. The second patient was a preterm infant with double perforation of the MD and ileum. Literature search for published case reports and case series on this topic reveals only 18 cases of neonatal symptomatic MD. Males are more frequently involved than females, and even preterm infants may be affected. Bowel obstruction (58.3%) and pneumoperitoneum (33.3%) are the most frequent clinical manifestation. Acute inflammation of the MD is the prominent histopathological finding (75%), although it does not seem to be related with the presence of heterotopic tissue within the MD. Surgical treatment is essential. The association of neonatal symptomatic MD with other anomalies is exceptional but is otherwise life threatening despite surgery.

CONCLUSIONS

Bowel obstruction and pneumoperitoneum are the most frequent clinical manifestations of symptomatic MD in the newborn. Surgery is required for a definitive diagnosis and successful outcome.

Neonatal Meckel's diverticulum: spectrum of presentation

Symptomatic neonatal Meckel's diverticulum is rare. We describe 2 interesting presentations of neonatal Meckel's diverticulum with review of the literature. Our first patient presented with massive bleeding per rectum in the first week of life, which is the only case reported so far. The second case presented with milk curd obstruction in the Meckel's diverticulum. We could find only one similar case in the literature.

Late-onset volvulus without malrotation in preterm infants

PURPOSE

The aim of the study was to report a new observation of late-onset volvulus without malrotation (VWM) in preterm infants.

METHODS

The study used medical note review of infants with VWM identified at a single regional centre between 1996 and 2007.

RESULTS

Ten patients were identified. Group 1 includes 4 patients (gestation, 28-38 weeks; median, 32) who presented within 4 days of age (range, 1-4; median, 3). Group 2 includes 6 patients (gestation, 25-33 weeks; median, 27), who presented later (range, 22-57 days; median, 45). Characteristics of group 2 patients included recurrent episodes of abdominal distension and bile vomiting (6/6), long-term continuous positive airway pressure requirement (5/6), and sudden, severe deterioration with acute abdominal signs (6/6). Small bowel volvulus was found at laparotomy requiring resection (30%-70% of total small bowel) and either primary anastomosis (4) or stoma formation (2). All babies survived.

CONCLUSIONS

There appear to be 2 clinical groups with VWM-one presenting within the first few days of life and the other presenting after the first month of life associated with a specific clinical history. This latter group has not been described before.

Emergency surgery for Meckel's diverticulum

The current work attempts to highlight the various life threatening complications of Meckel's diverticulum and to present the surgical strategies used in the emergency conditions so far in the form of a review of the works presented in the literature. Our aim behind this presentation is to cover the possible indications, methods, their complications and the outcome of these surgical techniques. For this, we made an extensive literature search using Google and Pubmed with the words-"Meckel's diverticulum", "Complications", "Management" and "Emergency surgery". All the relevant articles containing the surgical aspects of symptomatic Meckel's diverticulum till May 2008 were collected and analyzed. Meckel's diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications.

Perforation of Meckel's diverticulum manifesting as aseptic peritonitis in a neonate: report of a case

We report a case of perforated Meckel's diverticulum with aseptic peritonitis in a 17-day-old neonate. The baby had been brought to the hospital with fever and abdominal distention. Abdominal computed tomography showed a 5-cm abscess in the lower abdomen, and emergency laparotomy was performed for suspected perforated appendicitis. However, we found a perforated Meckel's diverticulum. No bacteria were detected in the purulent ascites from the peritoneal cavity. We speculate that the narrow lumen between the small intestine and the diverticulum, accompanied by poor self-emptying had caused acute inflammation resulting in perforation of Meckel's diverticulum. The anatomic limitations in "walling off" the perforated Meckel's diverticulum by the surrounding loops of small intestine prevented the bowel contents from spreading within the peritoneal cavity.

Hirschsprung's disease, a rare precipitating factor in neonatal perforated Meckel's diverticulum

Perforation of Meckel's diverticulum (MD) during the neonatal period may occur in the presence of distal colon obstruction. Herein, we describe a unique case of a 2-day-old infant that presented with pneumoperitoneum, in which a perforated MD was induced by distal intestinal obstruction secondary to total colonic aganglionosis. In the setting of neonatal perforated MD found intraoperatively, the determination of the possible precipitating etiology is necessary. The clinical history of delayed passage of meconium is emphasized, and either a rectal or colon biopsy is recommended intraoperatively to avoid overlooking the associated presence of Hirschsprung's disease.