Intussusception of the Meckel's diverticulum within its own lumen: Unknown complication

Intussusception in Adults: A Retrospective Review from a Single Institution

Purpose

Intussusception is uncommon in adults and often manifests as nonspecific symptoms. Owing to its low incidence and the lack of knowledge on the symptoms, causes, and treatment of adult intussusception (AI), many surgeons may have limited experience in the diagnosis and treatment of intussusception. This study aimed to describe the experience of AI and discuss its clinical presentation, etiology, and management.

Material and Methods

I retrospectively reviewed patients aged 19 years and older who were diagnosed with intussusception at a single institution between March 2010 and December 2019.

Results

Among 28 patients who were finally analyzed, abdominal pain was the most commonly observed symptom. Ileocolic and ileoileal intussusceptions were the most common locations, and a lead point was observed in 19 cases (68%), of which malignancy was observed in six (21%). Bowel resection was performed in 27 cases. According to the pathological findings of the tissue from the resected section, nine and three cases of small bowel intussusception (SBI) were benign and malignant, respectively, whereas 13 and three cases of colonic intussusception (CI) were benign and malignant, respectively. On comparing SBI and CI, it was observed that most variables did not significantly differ, except for the duration of symptoms.

Conclusion

SBI had a higher lead point than CI. The rate of malignancy in CI cases in this study was lower than that reported in other studies. En-bloc resection can be considered the first option for the treatment of AI.

The Clinical Manifestation Variety and Management Choice of Meckel's Diverticulum with Complication: A Single Center Experience

Background

The study was to analyze the clinical manifestation variety and management choices of symptomatic Meckel's diverticulum in children.

Methods

From July 2008 to October 2018, 28 cases of Meckel's diverticulum with a variety of complications were admitted to our hospital. The clinical data included age, gender, symptoms and signs, investigations, intraoperative and pathological findings, and outcome.

Results

The ratio of males to females was 2.5 : 1. The diagnoses were made by ^99mTc-pertechnetate scan (in 5 cases) and by exploratory laparotomy (in 2 cases). The initial diagnosis in the other cases includes intussusception (in 4 cases), acute appendicitis (in 5 cases), intestinal obstruction (unknown origin), peritonitis, and even shock in 12 cases. Laparoscopic surgery was performed in 8 cases; 18 cases underwent open surgery. Excision of partial bowel segment with diverticulum and primary anastomosis was done in 22 cases and wedge resection of diverticulum in 4 cases. Two other cases received nonoperative therapy and went to other hospitals to receive surgical management. Ectopic gastric mucosa in the diverticulum was found in 9 cases, including 6 cases with lower gastrointestinal bleeding.

Conclusion

The clinical characteristics of Meckel's diverticulum varied. Children with hematochezia, peritonitis, and intestinal obstruction without history of prior abdominal operation should be suspected with this disease until proven otherwise. Hematochezia is often associated with ectopic gastric mucosa in the diverticulum. Laparoscopic surgery should be one of the choices for the diagnosis and treatment of Meckel's diverticulum with complications.

Jejunal Intussusception in Adolescent Crohn's Disease: An Extremely Rare Complication

Proximal small bowel intussusception occurring in an adolescent Crohn's disease patient is an extremely rare entity. It is usually primary without a lead point and quite often a transient phenomenon. We report such transient and intermittent jejunal intussusception in a 16-year-old male, developing immediately in a postoperative period after a stoma reversal for jejunal stricture perforation peritonitis.

Laparoscopic treatment of small bowel strangulation caused by an intramesosigmoid hernia and review of literature

An internal hernia is defined as a protrusion of an abdominal viscera through the defects of the gastrointestinal mesentery or peritoneum-lined fossa. Sigmoid mesocolic hernias are an uncommon type of internal hernias, accounting for only 6% of all internal hernias. Furthermore, intramesosigmoid hernia is one of the three subtypes of the sigmoid mesocolic hernias. Internal hernias are potentially fatal conditions with diagnostic challenges. Patients presenting with acute obstruction, no surgical history and no external hernia should receive an urgent CT scan to facilitate early surgery and to minimise the risk of strangulation and bowel resection. Here, we report a case of strangulated small bowel obstruction secondary to an intramesosigmoid hernia with a successful laparoscopic repair. We also present a literature review of all reported cases so far and give an up-to-date perspective on intramesosigmoid hernia.

A diagnostic dilemma: Pedunculated mesenteric lipodystrophy mimicking Meckel’s diverticulum. A case report and literature review

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Mesenteric lipodystrophy is a rare fibroinflammatory disease of unknown origin.

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The detection of mesenteric lipodystrophy is challenging and requires early clinical suspicion.

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Clinical and imaging findings can mimick other pathological conditions affecting the mesenteric fat tissue.

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Contrast enhanced CT is the most accurate imaging technique for diagnosing mesenteric lipodystrophy.

Introduction

Mesenteric lipodystrophy is a rare fibroinflammatory disease of unknown origin with clinical and radiological non specific findings.

Presentation of the case

The case of a 42-years-old man affected by a pedunculated mesenteric lipodystrophy mimicking Meckel’s diverticulum is reported. Clinical, imaging and histological findings are discussed.

Discussion

Mesenteric lipodystrophy affects the mesenteric fat of the abdomen with a typical diffuse thickening of the mesentery, nodular thickening of the mesenteric root and presence of mass-like lesions. Ultrasound (US) and Multiphasic Computed Tomography (CT) represent the main imaging tools used for diagnosis. Clinical and imaging findings can mimick other pathological conditions affecting the mesenteric fat tissue. Contrast enhanced CT is the most accurate imaging technique for diagnosing mesenteric lipodystrophy due to the high panoramicity and accuracy with multiplanar imaging. Multiphasic technique helps to characterize the lesion and to recognize vascular anatomy. Oral administration of iodinated contrast medium may help to assess the relationship with bowel loops. All these diagnostic elements are crucial for the surgical timing and approach.

Conclusions

Due to the heterogeneous mesenteric involvement, the nonspecific CT findings and the high number of diseases for differential diagnosis, the detection of mesenteric lipodystrophy is challenging and requires early clinical suspicion. An histological examination is always necessary.

Fishbone Perforated Appendicitis

Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author's knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature.

Modified tension-free mesh repair used in rare case of Littre's hernia

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A rare case of Littre’s hernia.

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We used modified tension-free mesh repair.

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77-year-old man with inguinal hernia containing Meckel’s diverticulum.

Introduction

Meckel’s diverticulum is found at the antimesenteric border of the ileum, usually located from 30 to 90 cm from the ileocecal valve. Meckel’s diverticulum complications, such as bowel obstruction, diverticulitis, hemorrhage and rarely, hernias containing a Meckel’s diverticulum (Littre’s Hernia) required surgical intervention.

Case presentation

We introduce the case report of 77-year-old man with inguinal hernia containing Meckel’s diverticulum operated by the modified tension-free mesh repair.

Discussion

Although Meckel’s diverticulum is a relatively common anomaly, herniation of these embryological remnants is an exceedingly rare event. It can be difficult to diagnose Littre’s hernia before operation.

Conclusion

The important thing is not to hesitate to perform diverticulectomy, to avoid complications of the patient in the future.

Caecal tumor biopsy with a rigid sigmoidoscope - Ileorectal intussusception

INTRODUCTION

Ileorectal intussusception is a rare condition in adults in which the distal ileum, caecum, variable lengths of ascending and transvers colon, and associated mesentery invaginate into the rectum.

PRESENTATION OF CASE

We present the case of a 56 year old man who presented to our hospital for investigation of vague symptoms including small volumes of bright red rectal bleeding and colicky abdominal pain. He was found on CT scanning to have an extensive ileorectal intussusception and extensive liver metastasis. An emergency laparotomy was performed due to the concern of bowel ischaemia. No evidence of bowel ischaemia was found. The intussusceptum was carefully reduced and an extended right hemicolectomy with a primary anastomosis was performed. The patient recovered well and was discharged home six days post operatively.

DISCUSSION

Intussusceptions are rare in the adult population. They may not present with the classical triad of crampy abdominal pain, vomiting, and bloody stools and radiological imaging plays a key role in diagnosis. Intussusception in adults is usually secondary to malignancy and operative management needs to take into account the risk of upstaging the disease. In the face of pre-existing metastasis, preserving bowel length should be considered; however, there is no high level evidence to guide decision-making.

CONCLUSION

Intussusception is a diagnosis that needs to be considered in the adult population. Diagnosis largely depends on radiological imaging, especially CT scanning. The operative management is variable and should be determined on a case by case basis.