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Common Conditions II. Surg Clin North Am 2022; 102:797-808. [PMID: 36209746 DOI: 10.1016/j.suc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Roh S. Foregut Diverticula. Korean J Fam Med 2021; 42:191-196. [PMID: 31658807 PMCID: PMC8164925 DOI: 10.4082/kjfm.18.0092] [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: 06/22/2018] [Revised: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022] Open
Abstract
Diverticular disease can present anywhere along the gastrointestinal (GI) tract. It can result from various pathologies such as abnormal contraction within the GI tract or inflammation causing scar tissue and the resulting forces surrounding the GI tract. Its clinical presentation can vary from asymptomatic to severe symptoms, with significant decrease in quality of life. The treatment for various diverticula along the GI tract can also vary, depending on the severity of symptoms. This article describes diverticular disease occurring within the foregut, with emphasis on pathophysiology, clinical presentation, and treatment.
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Affiliation(s)
- Simon Roh
- Division of Interventional Radiology, New York Presbyterian Hospital–Weill Cornell Medical Center, New York, NY, USA
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Brungardt JG, Cummiskey BR, Schropp KP. Meckel's Diverticulum: A National Surgical Quality Improvement Program Survey in Adults Comparing Diverticulectomy and Small Bowel Resection. Am Surg 2020; 87:892-896. [PMID: 33284028 DOI: 10.1177/0003134820954820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Meckel's diverticulum is a congenital abnormality often associated with the pediatric population. When seen in the adult population, management is controversial. This study sought to determine demographic and outcome differences between diverticulectomy and small bowel resection in adults diagnosed with Meckel's diverticulum. METHODS An analysis of the American College of Surgeons National Surgical Quality Improvement database (2015-2018) was performed, capturing patients with a postoperative diagnosis of Meckel's diverticulum. Inclusion criteria included diverticulectomy or small bowel resection, and exclusion criteria included other major procedures such as colectomy or concomitant diverticulectomy and a small bowel resection. Demographics and outcomes were analyzed between those receiving diverticulectomy or resection. RESULTS 506 patients undergoing surgical treatment of Meckel's diverticulum were captured. The majority of these patients were white (79.05%), male (68.77%), and averaged 46 years old. The 2 populations were homogenous, with no significant differences in demographics or comorbidities between populations. Mean operative time was shorter in the diverticulectomy group than the resection group (68.92 ± 35.89 vs. 89.33 ± 40.16 minutes, P < .0001). There were no deaths at 30 days. Length of stay, readmission rate, wound infection, and discharge destination were similar among both groups. DISCUSSION Our analysis of a national database reveals no difference in outcomes between patients receiving a diverticulectomy or resection for Meckel's diverticulum. Operating time may be slightly increased for resection. However, decision to excise the diverticulum vs. the segment of small bowel should be individualized to each patient, their pathology, and clinical picture.
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Affiliation(s)
| | | | - Kurt P Schropp
- Department of Surgery, 21638The University of Kansas, USA
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Mariani A, Siddiqui M, Boulard N, Berrebi D, Bonnard A. Laparoscopic Management of Mechanical Small Bowel Obstruction Secondary to Meckel's Diverticulum with a Double Basis. A Rare Anatomic Presentation. European J Pediatr Surg Rep 2020; 8:e59-e61. [PMID: 33244449 PMCID: PMC7684991 DOI: 10.1055/s-0040-1713902] [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: 02/12/2020] [Accepted: 05/16/2020] [Indexed: 11/30/2022] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. Intestinal occlusion due to MD is a commonly observed consequence of intussusception or volvulus. Here, we report a case of an 11-year-old boy who presented to the emergency department with acute abdominal pain, bilious vomiting, and abdominal rebound tenderness. Computed tomography scan concluded a diagnosis of intestinal occlusion with no apparent cause. The patient was submitted to diagnostic laparoscopy, and mechanical occlusion by the permeable Meckel with double base was identified. A diverticulectomy by staplers was performed, and occlusion was alleviated. MD is a rare disease (for only 0.3–2.9% of the general population), and only 4.2 to 9% of patients diagnosed with MD have associated complications. MD can be a large base or a narrow base, with a mesodiverticular band but the diverticulum is usually a blind recess. In our case, the tube connected two intestinal segments. To the best of our knowledge, we have reported the first case of an MD-like permeable tube with a double basis.
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Affiliation(s)
- Aurora Mariani
- Department of Paediatric Surgery, Hopital Femme Mere Enfant, Bron, Auvergne-Rhône-Alpes, France
| | - Mohammed Siddiqui
- Department of Pediatric Surgery, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
| | - Nicolas Boulard
- Department of Pediatric Surgery, Hopital Jean Minjoz, Besancon, France
| | - Dominique Berrebi
- Department of Pediatric Pathology, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Sorbonne Paris Cité, Universite Paris Diderot, UMR 1149 Inserm, Paris, Île-de-France, France
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Kloth C, Roßkopf J, Schmidt SA, Wowra T, Gems R, Beck A, Vogele D. [Abdominal pain and anaemia in a young patient]. Radiologe 2020; 60:1169-1171. [PMID: 32886160 DOI: 10.1007/s00117-020-00740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - J Roßkopf
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - S A Schmidt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T Wowra
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - R Gems
- Klinik für Allgemein- und Viszeralchirurgie, Sektion Kinderchirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - A Beck
- Klinik für Pathologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - D Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
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Redman EP, Mishra PR, Stringer MD. Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review. Pediatr Surg Int 2020; 36:869-874. [PMID: 32436063 DOI: 10.1007/s00383-020-04673-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
Recent reports have recommended laparoscopic diverticulectomy for symptomatic Meckel diverticulum (MD) rather than laparoscopic-assisted extracorporeal resection. This technique may risk leaving residual ectopic mucosa leading to complications. This systematic review attempts to quantify the relative risks of both approaches. A systematic review was conducted according to PRISMA guidelines. Articles were eligible for inclusion if they reported data on the laparoscopic management of symptomatic MD in children. Eleven reports were identified, all of which were institutional retrospective studies. Pooled outcome data on 248 children showed no statistically significant difference in complications between laparoscopic diverticulectomy (n = 133) and laparoscopic-assisted segmental resection (n = 115) (3% vs. 6.1%, p = 0.39). One patient from the diverticulectomy group re-presented with recurrent bleeding necessitating segmental small bowel resection. Conclusions are limited by the number of patients and variable follow up. Short, wide MD with a height:base ratio of < 2; diverticula with thickening or ischemia at the base and those complicated by volvulus or small bowel obstruction are probably best treated by laparoscopic-assisted extracorporeal resection. For other symptomatic diverticula laparoscopic diverticulectomy is a reasonable approach with a less than 1% risk of leaving residual ectopic gastric mucosa.
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Affiliation(s)
- E P Redman
- Department of Paediatric Surgery, Level 3 CSB, Wellington Children's Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand
| | - P R Mishra
- Department of Paediatric Surgery, Level 3 CSB, Wellington Children's Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand
| | - M D Stringer
- Department of Paediatric Surgery, Level 3 CSB, Wellington Children's Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand.
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, 6021, New Zealand.
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The Many Faces of Meckel's Diverticulum: Update on Management in Incidental and Symptomatic Patients. Curr Gastroenterol Rep 2020; 22:3. [PMID: 31930430 DOI: 10.1007/s11894-019-0742-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Meckel's diverticulum may be detected incidentally or present with symptoms from infancy and to old age. The presentation may be acute, with several complications associated with the condition. We aim to review the many faces with which a Meckel's diverticulum may present, either symptomatically or as an incidental finding. RECENT FINDINGS Due to its rarity, recent studies mainly include small retrospective series or case reports. Emphasis in the recent literature is on clinical presentation, the pathology of symptomatic cases, management options and risks of neoplasia. Symptoms are mainly caused by obstruction, bleeding or diverticulitis. Cross-sectional imaging is unspecific, although capsule endoscopy is reported of use in case series. Meckel's diverticulum presents with clinical features that are age-specific. Complicated Meckel's diverticulum is treated by resection. Optimal treatment of incidental cases remains debated. Meckel's diverticulum usually stays asymptomatic, and decision-making for management should be based on patient-specific factors. Use of minimal invasive techniques mandates refinement of the optimal treatment.
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Blouhos K, Boulas KA, Tsalis K, Barettas N, Paraskeva A, Kariotis I, Keskinis C, Hatzigeorgiadis A. Meckel's Diverticulum in Adults: Surgical Concerns. Front Surg 2018; 5:55. [PMID: 30234126 PMCID: PMC6129587 DOI: 10.3389/fsurg.2018.00055] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022] Open
Abstract
Since Meckel's diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Treatment of symptomatic MD is definitive surgery, including diverticulectomy, wedge, and segmental resection. The type of procedure depends on: (a) the integrity of diverticulum base and adjacent ileum; (b) the presence and location of ectopic tissue within MD. The presence of ectopic tissue cannot be accurately predicted intraoperatively by palpation and macroscopic appearance. When present, its location can be predicted based on height-to-diameter ratio. Long diverticula (height-to-diameter ratio >2) have ectopic tissue located at the body and tip, whereas short diverticula have wide distribution of ectopic tissue including the base. When indication of surgery is simple diverticulitis, diverticulectomy should be performed for long and wedge resection for short MD. When indication of surgery is complicated diverticulitis with perforated base, complicated intestinal obstruction and tumor, wedge, or segmental resection should be performed. When the indication of surgery is bleeding, wedge and segmental resection are the preferred methods for resection. Regarding management of incidentally discovered MD, routine resection is not indicated. The decision making should be based on risk factors for developing future complications, such as: (1) patient age younger than 50 years; (2) male sex; (3) diverticulum length >2 cm; and (4) ectopic or abnormal features within a diverticulum. In this case, diverticulectomy should be performed for long and wedge resection for short MD.
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Affiliation(s)
| | | | - Konstantinos Tsalis
- Fourth Surgical Department, George Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | | | - Ioannis Kariotis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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