Computed tomography of complicated Meckel's diverticulum in adults: a pictorial review

Acute intestinal obstruction due to meckel's diverticulum: A case report and literature review

Introduction

and Importance: Meckel's diverticulum is a rare congenital condition often detected incidentally. Meckel's diverticulum, a rare disease, may result in acute intestinal obstruction and is frequently misdiagnosed. This study aims to report a case of acute intestinal obstruction due to Meckel's diverticulum.

Case presentation

A 61-year-old Javanese man was admitted to the emergency room with a history of constipation, nausea, vomiting, and abdominal pain. Physical examination showed abdomen distention, tenderness in the lower quadrant, and hyperactive bowel sound. Rectal examination found that the rectal ampulla was collapsed. A plain abdominal Radiograph showed small bowel dilatation and air-fluid levels. The patient was diagnosed with small bowel obstruction due to suspected left-sided colon cancer and taken up for exploratory laparotomy.

Clinical discussion

On exploration, Meckel's diverticulum measuring 3.5 cm in length and with a 2 cm base was found about 70 cm proximal to the Bauhin valve; the thin part formed a band that entangled the small bowel. Ileo-ileal resection anastomosis was performed.

Clinical discussion

Meckel's diverticulum is an intestinal pouch caused by incomplete obliteration of the vitelline duct during gestation. This condition affects 2 % of the population and is within 2 feet of the Bauhin valve. The mesodiverticular band was found to be the source of the bowel obstruction. Surgical resection is required for complicated diverticulum.

Conclusion

Meckel's diverticulum can be difficult to diagnose and require a higher level of suspicion. Although Meckel's diverticulum is uncommon in adults, it should be considered a cause of small bowel obstruction.

Bezoar in Meckel's diverticulum: Case report and narrative review

INTRODUCTION

Bezoars are a known cause of complications in Meckel's diverticulum. We present a case in which a bezoar in a Meckel's diverticulum resulted in intestinal obstruction. In addition, we conducted a narrative review to explore the association between Meckel's diverticulum and bezoars.

CASE PRESENTATION

We present the case of a 22-year-old patient admitted for bowel obstruction persisting for three days and periumbilical tenderness. Abdominal CT tomography revealed a hyper dense circular structure with a diameter of 2 cm, small bowel distension of 41 mm, and free fluid. During surgical exploration, a Meckel diverticulum was found between the antimesenteric border of the small bowel and posterior wall of the umbilicus. The Meckel diverticulum was resected, and upon examination, it was found to contain a calcified phytobezoar. The postoperative course was uneventful.

DISCUSSION

The clinical and paraclinical presentation of bezoars in Meckel's diverticulum is nonspecific and diagnosis remains challenging despite improved diagnostic modalities. The association between Meckel's diverticulum and bezoars is often identified during surgery, as it is difficult to diagnose using CT scans. The choice between laparoscopic and open surgery depends on the patient's situation.

CONCLUSION

Diagnosing a bezoar in a Meckel's diverticulum remains challenging. Treatment involves surgery, and the choice of surgical approach depends on the context.

Spontaneous Perforation of Meckel's Diverticulum in a Young Adult Male: A Case Report and Review of the Literature

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.

Meckel's diverticulum: analysis of 27 cases in an adult population

Background

Meckel's diverticulum is a rare congenital pathology among newborns. Nevertheless, it is an uncommon abdominal pathology in the adult population. Therefore, we aim to provide a detailed account of our surgical approach in treating 27 cases of Meckel's diverticulum.

Methods

This study is a cross-sectional analysis that utilized a database with prospectively collected data from 2004 to 2022. All patients under the age of 18 were excluded from the population. We described the population's demographic characteristics, symptoms, anatomopathological study, surgical technique, complications, morbidity, and mortality. A subgroup analysis was performed between the symptomatic and asymptomatic patients.

Results

A total of 27 patients who underwent surgical resection for a posteriorly diagnosed Meckel's diverticulum were included. The male population accounted for 81.4% (n = 22) of the sample size. The symptomatic group consisted of 18 male and four female patients. Abdominal pain was the predominant symptom in 85% of the patients. Out of the 22 symptomatic patients, only 9% had a positive perioperative diagnosis of Meckel's diverticulum. All 27 patients with diverticulum diagnosis received the resection through diverticulectomy (n = 6), small bowel resection with end-to-end anastomosis (n = 6), and small bowel resection with lateral to lateral anastomosis (n = 15). The mean distance between the diverticulum and the ileocecal valve was 63.4 cm. The symptomatic group had an average diverticulum length of 3.54 cm, with an average base width of 2.47 cm. In the other group, the values were 2.75 and 1.61 cm. The average length of hospital stay in the symptomatic group was 7.3 days.

Conclusions

Meckel's diverticulum is a rare pathology in the adult population. Its presentation varies from asymptomatic to symptomatic patients, and surgery is the cornerstone treatment for this pathology.

Case report: Emergency presentation of Meckel's diverticulum in the 3rd trimester of pregnancy

Background

Symptomatic Meckel's diverticulum (MD) is easily neglected in the acute abdomen during pregnancy. MD is the most common congenitally anomalous development of the intestines, with an incidence of 2% in the general population, although it is not easily diagnosed because of variable clinical features. Especially when complicated with pregnancy, doctors can easily overlook this disease, which directly threatens maternal and foetal life.

Case Presentation

We report the case of a 25-year-old at 32 + 2 weeks of gestation complicated with MD volvulus who presented with progressive abdominal pain and finally peritonitis. She underwent exploratory laparotomy and small-bowel resection. The mother and the baby successfully recovered.

Conclusions

MD-complicated pregnancy is not easily diagnosed. Once highly suspiciously diagnosed, especially with peritonitis, surgery should be arranged, which helps preserve maternal and foetal life.

Imaging congenital anomalies of the ileum in adults:a pictorial review

The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.

Axially torsional Meckel's diverticulum accompanied by small bowel volvulus: a case report

Small bowel volvulus secondary to Meckel’s diverticulum is rare, and a delayed diagnosis results in disastrous outcomes. Computed tomography is conducive to early differential diagnosis. In particular, a blind-ending pouch structure on CT always indicates Meckel’s diverticulum. Diverticulectomy with or without adjacent partial small intestinal resection is the standard treatment for symptomatic Meckel’s diverticulum. However, the therapy for asymptomatic Meckel’s diverticulum is controversial. Here, we report the case of a 20-year-old man who suffered intestinal obstruction secondary to small bowel volvulus caused by an axially torsional, gangrenous, and giant Meckel’s diverticulum. Diverticulectomy with partial intestinal resection was performed.

The magnetic resonance enterography imaging features of symptomatic Meckel's diverticulum in pediatric patients: a retrospective observational study of 31 cases

BACKGROUND

The aim of this study was to explore the magnetic resonance enterography (MRE) imaging manifestations of a symptomatic Meckel's diverticulum (MD) in pediatric patients in order to provide a reference for the diagnosis of the condition.

METHODS

The medical records of 31 pediatric patients with MD from May 2014 to October 2020 were retrospectively analyzed. The inclusion criteria were patients with MD accompanied by unexplained gastrointestinal bleeding, anemia (except hematological diseases), chronic persistent abdominal pain, repeated intussusception, or intussusception in older pediatric patients during surgery. The clinical variables (age, sex, and hemoglobin) and imaging, surgical, and pathological findings were recorded.

RESULTS

MD was definitively identified in 28 patients, with the following characteristics: a blind-ending fluid-filled and/or gas-filled structure (n=23), an elongated shape (n=1), a dumbbell shape (n=1), and a solid mass (n=3). The diverticula were located in the right lower quadrant (n=16), the right abdomen at the level of the umbilicus (n=3), the right upper quadrant (n=2), the left upper quadrant (n=2), and the midline lower abdomen (n=5). Supply arteries were visualized in nine cases. In all cases, mural enhancement was comparable to that of the adjacent small-bowel (SB). Extravasation of the intravascular contrast medium was seen in two cases. Peripheral structural abnormalities included mesenteric fat stranding (n=7), hemorrhage in the adjacent lumen (n=3), free intraperitoneal gas (n=1), abnormal fluid retention (n=2), intestinal obstruction (n=1), and lymph node enlargement (n=7). A normal appendix was identified in 18 cases.

CONCLUSIONS

MRE is an appropriate method of diagnosing symptomatic MD in pediatric patients and is particularly useful in the assessment of complications.

Double intussusception secondary to Meckel's diverticulum in a seventeen-year-old female: a case report

Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract. It rarely presents in adults and is usually asymptomatic. Attention to clinical history, examination and imaging studies are crucial for a successful diagnosis. A 17-year-old female presented with vomiting and acute peri-umbilical abdominal pain. Ultrasound examination showed an intussusception measuring 3.2cm in diameter and over 8cm in length. Exploratory laparoscopy showed two ileal intussusceptions. The first was reduced via laparoscopy; the second appeared suspicious for MD and ultimately required a mini-laparotomy for reduction and resection of the MD. Ultrasonography is a useful modality in the presence of perforation, occlusion, hemorrhage, neoplasia, or fistula and avoids exposure to radiation. Laparoscopic or laparoscopic-assisted mini-laparotomy is the route for the resection of MD. The choice depends on the clinical presentation and surgeon expertise. A careful history and physical examination are vital factors in diagnosis and treatment MD.

Bleeding Meckel Diverticulum: A Retrospective Analysis of Computed Tomography Enterography Findings

OBJECTIVE

The aim of this study was to evaluate the computed tomography enterography (CTE) characteristics of bleeding Meckel diverticulum.

METHODS

The CTE images of 35 patients with Meckel diverticulum and gastrointestinal bleeding were retrospectively evaluated.

RESULTS

Meckel diverticulum was visualized in 33 of 35 patients and located in the right lower abdomen (20/33), midline lower abdomen (8/33), left lower abdomen (3/33), or paramedially near the umbilicus (2/33). The Meckel diverticulum was visualized on the antimesenteric side of the ileum in 16 patients (48.5%) and pointed toward the umbilicus in 10 (30.3%). The diverticulum appeared as a blind-ended tubular (22/33 [66.7%]) or saccular (11/33 [33.3%]) bowel segment. Separated supplying vessel was identified in 15 patients (45.5%) and associated with diverticulum (P = 0.037). The ectopic tissue was pathologically confirmed in 11 (33.3%) of 33 patients and was associated with diverticular nodules (P = 0.002).

CONCLUSIONS

Awareness of CTE features could aid in the preoperative assessment of bleeding Meckel diverticulum.

Littre hernia in children: A clinical aspect

BACKGROUND/AIMS

Littre hernia (LH) is difficult to distinguish from other hernias until complications arise. In this research, we present the details of diagnosis, treatment, and frequency of LH cases with differentiated clinical properties.

MATERIALS AND METHODS

Littre hernia prevalence, clinical properties, and treatment details of cases diagnosed as incarceration/strangulation (I/S) of hernias between December 1996 and December 2017 were retrospectively investigated.

RESULTS

Incarceration/strangulation was detected in 403 out of 3758 hernias within 21 years. Four cases were detected as LH (0.09%) in 403 I/S patients. Partly reduced 2 cases were treated by resection/anastomosis with the abdominal approach.

CONCLUSION

The possibility of LH in strangulated or partly reduced hernias should be considered. The abdominal approach may be necessary in nonreducible hernia with possible LH patients.

Perforated Meckel's Diverticulum in an Adult

Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract. Its complications have an extensive variety of clinical and imaging manifestations, extending from benign and indolent findings to acute life-threatening conditions. Complicated Meckel's diverticulum often constitutes a challenging diagnosis for both the clinician and the radiologist. Therefore, imaging techniques play an important role in this condition in evaluating its complications, determining decision making. We describe a case of a 49-year-old man suffering from right abdominal pain with fever and constipation, during the past 5 days. Laboratory data revealed C-reactive protein of 306 mg/L and leukocytosis. Contrast-enhanced CT features were highly suggestive of perforated Meckel's diverticulum. The purpose of this article is to emphasize that besides its rarity, Meckel's diverticulum complications can occur in adult patients.

Computed Tomography of Spontaneous Perforated Meckel's Diverticulum in an Elderly Adult: A Case Report

Spontaneous perforated Meckel's diverticulum is a rare complication and mimics appendicitis or diverticulitis in elderly adults. We report the case of a 51-year-old man who presented to the emergency department with abdominal pain that had progressively increased over the previous two hours. The provisional diagnosis was appendicitis or diverticulitis, and we recommended computed tomography for further evaluation. Computed tomography of the abdomen showed an outpouching, blind-ending, fluidfilled structure in continuity with the distal ileum that depicted wall perforation and extraluminal air bubbles, consistent with perforated Meckel's diverticulum. In this case report, computed tomography provided a clear imaging diagnosis of perforated Meckel's diverticulum preoperatively. Thus, in patients with acute abdomen, complicated Meckel's diverticulum should be included in the differential diagnosis.

A faster and simpler way of operation for Meckel's diverticulum: basal ligation combined with intraoperative frozen section

BACKGROUND

The key step in Meckel's diverticulectomy (MD) is to achieve complete resection of MD along with the ectopic epithelium. Currently main treatment methods for Meckel's diverticulum are either intestinal resection and anastomosis or wedge resection. Here we introduced a new method to treat MD. The goal of this study was to investigate the clinical effects and advantages of a new operation method for Meckel's diverticulum: basal ligation combined with intraoperative frozen section.

METHODS

262 cases of Meckel's diverticulum were resected with simple basal ligation operation. Intraoperative frozen pathological section was performed to determine surgery strategies. Based on the existence of basal residual ectopic mucosa, surgery was either terminated or further wedge intestinal resection or bowel resection was performed.

RESULTS

All 262 surgeries were successfully completed. Additional wedge resection or bowel resection was performed in only 23 of them due to the presence of ectopic basal residual gastric mucosa. No ectopic mucosa was found for the other cases, and the operation ended after basal ligation. All patients had no complications such as intestinal fistula, bleeding for 6 months-7.6 years after surgery.

CONCLUSIONS

Intraoperative frozen pathological examination can well determine whether ectopic Meckel's diverticulum mucosa locates at the basal part. Basal ligation is a safe and effective operation method, and it can significantly shorten the operation time and postoperative fasting time.

Meckel's diverticulum in the adult

Meckel's diverticulum (MD) is the most common gastro-intestinal congenital malformation (approximately 2% in the overall population). The lifetime risk of related complications is estimated at 4%. These include gastro-intestinal bleeding, obstruction or diverticular inflammation. Diagnosis is difficult and rarely made, and imaging, especially in the case of complicated disease, is often not helpful; however exploratory laparoscopy is an important diagnostic tool. The probability of onset of complication decreases with age, and the diagnosis of MD in the adult is therefore often incidental. Resection is indicated in case of complications but remains debatable when MD is found incidentally. According to an analysis of large series in the literature, surgery is not indicated in the absence of risk factors for complications: these include male gender, age younger than 40, diverticulum longer than two centimetres and the presence of macroscopically mucosal alteration noted at surgery. Resection followed by anastomosis seems preferable to wedge resection or tangential mechanical stapling because of the risk of leaving behind abnormal heterotopic mucosa.

Laparoscopic approach to symptomatic meckel diverticulum in adults

Background:

Meckel diverticulum (MD) is the most common congenital gastrointestinal malformation found in approximately 2% of the general population. MD manifests in adults as gastrointestinal bleeding, bowel obstruction, intussusception, or perforation in <5% of cases. There is no consensus on the ideal management strategy in symptomatic MD. Therefore, we searched the literature to highlight the role of laparoscopy in diagnosing and treating symptomatic MD.

Method:

We used PubMed, Medline, Google Scholar, Ovid, and Cochrane data search engines looking for articles containing terms such as Meckel diverticulum, ectopic gastric mucosa, laparoscopic, technetium 99m pertechnetate, and acute management. We included articles reporting on case series in the English language on adult patients only and reporting on laparoscopic approach in the management of symptomatic MD.

Results:

A total of 5 articles reporting on 35 cases were found. We report on the pooled data from these series with emphasis on number of patients, age, male to female ratio, length of stay, conversion to open procedure, method of resection, complications, first presentation, and confirmation of diagnosis preoperatively. We also compare the results of laparoscopic versus open approaches mentioned in the literature.

Conclusions:

The laparoscopic approach was found to be effective as a diagnostic and therapeutic modality in patients with symptomatic MD; however, its adoption as the gold standard still needs further studies with larger patient numbers.

Laparoscopic surgery for small-bowel obstruction caused by Meckel’s diverticulum

A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrast-enhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band connecting the mesentery to the top of the bowel, suggestive of Meckel’s diverticulum (MD) and a mesodiverticular band (MDB). After intestinal decompression, elective laparoscopic surgery was carried out. Using three 5-mm ports, MD was dissected from the surrounding adhesion and MDB was divided intracorporeally. And subsequent Meckel’s diverticulectomy was performed. The presence of heterotopic gastric mucosa was confirmed histologically. The patient had an uneventful postoperative course and was discharged 5 d after the operation. She has remained healthy and symptom-free during 4 years of follow-up. This was considered to be an unusual case of preoperatively diagnosed and laparoscopically treated small-bowel obstruction due to MD in a young adult woman.

BWH emergency radiology-surgical correlation: torsion of Meckel's diverticulum

We present the radiologic findings and intraoperative correlation of a torsed Meckel's diverticulum leading to small-bowel obstruction in a 65-year-old male without prior abdominal surgery. As this is a rare entity and difficult to diagnose, an understanding of the clinical presentation and radiologic findings correlated with this pathology can help to expedite diagnosis and treatment.

Perforated Littre's hernia diagnosed on imaging: case report and review of literature

We report the clinical details and imaging findings of a case of perforated Littre's hernia presenting as lower abdominal wall cellulitis in a 50-year-old male. Findings included herniation of an oral contrast opacified blind-ending pouch arising from the anti-mesenteric border of the distal ileum into the right inguinal canal, with extravasation of oral contrast. There were adjacent inflammatory changes with subcutaneous emphysema extending up to the right anterior chest wall. Meckel's diverticulum is rarely diagnosed preoperatively on imaging. We highlight the importance of computed tomography in imaging Meckel's diverticulum.

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

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