1
|
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.
Collapse
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
| |
Collapse
|
2
|
Lochbühler N, Bölle P, Müller-Abt P. Acute abdomen in pediatric radiology. ROFO-FORTSCHR RONTG 2024; 196:451-462. [PMID: 38134901 DOI: 10.1055/a-2193-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND Imaging is a common part of the workup for acute abdomen in childhood and adolescence. Rapid diagnosis is crucial for adequate therapy, especially in young children. METHOD This review is intended to provide an overview of the typical causes of acute abdomen in children and adolescents and is specifically aimed at radiologists who do not regularly work in pediatric radiology. RESULTS AND CONCLUSION Age-specific peculiarities make a division into three age groups useful: Newborns, infants and toddlers, and schoolchildren. Possible causes of acute abdomen in children range from congenital lesions, particularly in newborns, to entities well known in adult radiology, more commonly in school-aged children. Since younger children have a higher sensitivity to radiation and often a limited ability to cooperate, sonography and conventional X-ray are the primary imaging modalities used. Decisive advantages of sonography, especially in younger children, include its widespread availability, the lack of need for sedation, and the possibility of bedside examination. Supplementary cross-sectional imaging, usually MRI, is reserved for special clinical questions. Close interdisciplinary cooperation between attending clinicians and radiologists is essential for efficient diagnostics in this patient group. KEY POINTS · Age-specific features must be observed. · Sonography and radiography are the most important modalities. · Both congenital and acquired pathologies play a role. · Good interdisciplinary cooperation is essential in this patient group. CITATION FORMAT · Lochbühler N, Bölle P, Müller-Abt P. Acute abdomen in pediatric radiology. Fortschr Röntgenstr 2024; 196: 451 - 462.
Collapse
Affiliation(s)
- Nina Lochbühler
- Department of Pediatric Radiology Olgahospital, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany
| | - Petra Bölle
- Department of Pediatric Radiology Olgahospital, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany
| | - Peter Müller-Abt
- Department of Pediatric Radiology Olgahospital, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Yan L, Zhou B, Wu P, Tian Y, Lou Y. Meckel's diverticulum mimicking acute appendicitis in children: a retrospective cohort study. BMC Surg 2024; 24:40. [PMID: 38291433 PMCID: PMC10829168 DOI: 10.1186/s12893-024-02323-4] [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] [Received: 10/09/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children. MATERIALS AND METHODS We retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel's diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded. RESULTS A total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1-13 years). Perforated Meckel's diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix. CONCLUSIONS The most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.
Collapse
Affiliation(s)
- Ling Yan
- Department of Pediatrics, Hangzhou Normal University, Hangzhou, China
| | - Bi Zhou
- Department of Pediatrics, Suzhou Hospital of Anhui Medical University, Suzhou, Anhui, China
| | - Peng Wu
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi, China
| | - You Tian
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, 310014, Zhejiang, China
| | - Yi Lou
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, 310014, Zhejiang, China.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Yan P, Jiang S. Tc-99m scan for pediatric bleeding Meckel diverticulum:a systematic review and meta-analysis. J Pediatr (Rio J) 2023; 99:425-431. [PMID: 37277097 PMCID: PMC10492155 DOI: 10.1016/j.jped.2023.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE Meckel diverticulum (MD) is a common malformation of the digestive tract, often accompanied by serious complications. It is important to find safe and effective diagnostic methods for screening MD. The aim of this study was to evaluate the effectiveness of a technetium-99m (Tc-99m) scan for pediatric bleeding MD. METHODS The authors conducted a systematic review of studies published in PubMed, Embase, and Web of Science before 1 January 2023. Studies based on PICOS were included in this systematic review. The flow chart was made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software. RESULTS Sixteen studies with 1115 children were included in this systematic review. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.80 [Confidence Interval (95% CI, 0.73-0.86) and 0.95 (95% CI, 0.86-0.98)], respectively. The area under the curve (AUC) was 0.88 (95% CI, 0.85-0.90). Publication bias (Begg's test p = 0.053) was observed. CONCLUSION Tc-99m scan has high specificity, but moderate sensitivity, which is always influenced by some factors. Hence, the Tc-99m scan has some limitations in the diagnosis of pediatric bleeding MD.
Collapse
Affiliation(s)
- Ping Yan
- Sichuan University, West China Hospital, Department of Gastroenterology, Sichuan, China
| | - Shouliang Jiang
- Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Department of Pediatrics, Chengdu, China.
| |
Collapse
|
8
|
Williamson JK, Passarello S, Kwong RC. Vomiting and Abdominal Pain in a 5-Year-Old Male. Glob Pediatr Health 2023; 10:2333794X221150708. [PMID: 36762371 PMCID: PMC9903033 DOI: 10.1177/2333794x221150708] [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: 11/06/2022] [Accepted: 12/23/2022] [Indexed: 01/30/2023] Open
Abstract
This case describes small bowel obstruction secondary to a Meckel's Diverticulum in a 5-year-old male patient with a chief complain of abdominal pain and vomiting. We review the pathophysiology, diagnosis, and management of Meckel's Diverticulum. This case report highlights the importance of considering a broad differential diagnosis during a clinical workup.
Collapse
Affiliation(s)
- Jonathan K. Williamson
- Arkansas Children’s Hospital, Little Rock, AR, USA,University of Arkansas for Medical Sciences, Little Rock, AR, USA,Jonathan Williamson, Department of Pediatrics, Arkansas Children’s Hospital, 1 Children’s Way, Slot 512-19A, Little Rock, AR 72202, USA.
| | - Sarah Passarello
- Arkansas Children’s Hospital, Little Rock, AR, USA,University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ryan C. Kwong
- Arkansas Children’s Hospital, Little Rock, AR, USA,University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
9
|
Kafshgari R, Rezaei Majd A, Taherinezhad Ledari A. Meckel's diverticulum axial torsion: A rare complication case report of a 5-year-old girl. Int J Surg Case Rep 2023; 103:107883. [PMID: 36630762 PMCID: PMC9841019 DOI: 10.1016/j.ijscr.2023.107883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. Axial torsion of the diverticulum followed by gangrene is the rarest complication that can occur mainly in children. CASE PRESENTATION A 5-year-old girl complaining of vomiting, fever and abdominal pain came to hospital. In Laboratory findings, leukocytosis (WBC = 22.5 ∗ 103/μl) was observed and mild interloop fluid with a whirlpool-like structure which suggests volvulus like obstruction was seen in sonography. The patient underwent emergency laparotomy. A necrotic congested Meckel's diverticulum was found during the surgery, which was axially twisted. After the operation, the patient recovered and was discharged six days later. DISCUSSION Axial twisting of Meckel's diverticulum is known as one of the rarest related complications, and it is caused by the rotation of the diverticulum around its axis. Among the factors that can make Meckel's diverticulum prone to twisting are its connection to the intestinal mesentery or the umbilical cord, or the presence of mesodiverticular bands. One of the appropriate diagnostic methods is the use of technetium-99. In Cases of small bowel obstruction, diverticulectomy and segmental or wedge resection have been introduced as suitable surgical methods. The delay in diagnosing a complex Meckel's diverticulum can lead to complications and mortality. CONCLUSION Rapid management of Meckel's diverticulum, which has become challenging due to its difficult diagnosis, is very important to obtain acceptable results.
Collapse
Affiliation(s)
- Ramin Kafshgari
- Assistant Professor of Pediatric Surgery, Department of Pediatrics, Amirkola Hospital, Babol University of Medical Sciences, Babol, Iran
| | | | | |
Collapse
|
10
|
Laezza N, Gião N, Borges C, Knoblich M. Rare paediatric case of agenesis of the vermiform appendix, ileal duplication and sickle cell disease. BMJ Case Rep 2022; 15:e248181. [PMID: 35580950 PMCID: PMC9114869 DOI: 10.1136/bcr-2021-248181] [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] [Accepted: 04/24/2022] [Indexed: 11/04/2022] Open
Abstract
This study reports an exceptional case of a 14-year-old girl with sickle cell disease that was diagnosed with agenesis of the vermiform appendix and ileal duplication. Both consist of extremely rare gastrointestinal malformations whose association has never been described. The preadolescent girl presented with abdominal pain and vomiting, and the ultrasound was suggestive of acute appendicitis. Surgical findings were agenesis of the vermiform appendix and a T-shaped ileal malformation with inflammatory changes. The patient underwent resection and ileal end-to-end anastomosis. Histopathological evaluation identified an ileal duplication, with small bowel and colonic mucosa, no communication to the adjacent ileum and ischaemic changes. At 8-month follow-up, the patient was asymptomatic.
Collapse
Affiliation(s)
- Nadia Laezza
- Department of Pediatric Surgery, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Nuno Gião
- Pathological Anatomy Department, Hospital de São José, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Cristina Borges
- Department of Pediatric Surgery, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Maria Knoblich
- Department of Pediatric Surgery, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| |
Collapse
|
11
|
Honig J, Figueroa A, Castro R, Lotakis D, Bamji M, Wallack M, Cooper A. Meckel's Diverticulum, A Rare Presentation in a Neonate. Am Surg 2022:31348211060431. [PMID: 35302395 DOI: 10.1177/00031348211060431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Meckel's diverticulum is commonly symptomatic the first 2 years of life. Complications associated with Meckel's diverticulum are due to gastrointestinal (GI) bleeding or obstruction. A 5-day-old male presented to the emergency department (ED) with an episode of bright red blood per rectum (BRBPR) associated with emesis. Vital signs were normal and abdomen soft and non-distended. Serial abdominal radiographs progressed to show distention of small bowel and air fluid levels. Operative intervention was undertaken with diagnosis of intestinal obstruction. On exploratory laparotomy, 24 cm of a fibrosed, ischemic closed-loop ileal segment densely adherent to the tip of a Meckel's diverticulum was identified and resected, followed by primary reanastamosis. Histologic findings confirmed ectopic gastric tissue. Symptomatic Meckel's diverticulum is often secondary to intestinal obstruction and hematochezia, findings which are caused by incarcerated inguinal hernia or ileocolic intussusception. Our patient presented with a closed loop, which has not been previously reported.
Collapse
Affiliation(s)
- Jesse Honig
- Departments of Surgery and Pediatrics, New York City Health+ Hospitals, 8137New York Medical College Academic, Valhalla, NY, USA
| | | | - Rebecca Castro
- Departments of Surgery and Pediatrics, New York City Health+ Hospitals, 8137New York Medical College Academic, Valhalla, NY, USA
| | | | | | | | | |
Collapse
|
12
|
Leader H, Polott E, Pinto JM, Staab VS, Girgis W, Sun X, Naganathan S. Perforated Meckel's diverticulum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
13
|
Fusco JC, Achey MA, Upperman JS. Meckel's diverticulum: Evaluation and management. Semin Pediatr Surg 2022; 31:151142. [PMID: 35305798 DOI: 10.1016/j.sempedsurg.2022.151142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Joseph C Fusco
- Department of Pediatric Surgery, Vanderbilt Monroe Carrell Children's Hospital, Nashville, TN
| | - Meredith A Achey
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey S Upperman
- Department of Pediatric Surgery, Vanderbilt Monroe Carrell Children's Hospital, Nashville, TN
| |
Collapse
|
14
|
The diagnostic accuracy of ultrasound and upper gastrointestinal contrast studies for locating atresia/stenosis and intestinal malrotation and detecting annular pancreas in pediatric patients with duodenal atresia/stenosis. J Med Ultrason (2001) 2022; 49:299-309. [PMID: 34988762 DOI: 10.1007/s10396-021-01176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to evaluate the diagnostic performance of ultrasound to locate atresia/stenosis and other abdominal anomalies in pediatric patients with duodenal atresia/stenosis, including intestinal malrotation and annular pancreas. METHODS We classified 36 retrospective cases of duodenal atresia/stenosis based on intestinal malrotation status, and evaluated the diagnostic performance of ultrasound/upper gastrointestinal contrast studies to locate atresia/stenosis and intestinal malrotation, as well as ultrasound for detecting additional anomalies such as annular pancreas. The incidence of annular pancreas was compared between groups using Fisher's exact test. RESULTS Atresia/stenosis was correctly located by ultrasound in 33 (91.7%) cases and by upper gastrointestinal contrast study in 36 (100%) cases. Of the eight cases with intestinal malrotation, five and two were correctly diagnosed by ultrasound and upper gastrointestinal contrast study, respectively. Ultrasound correctly diagnosed annular pancreas in 6/14 cases. The incidence of annular pancreas was significantly different between the groups (present/absent in groups with vs. without intestinal malrotation: 6/2 vs. 8/20, P = 0.036). CONCLUSIONS Ultrasound has a relatively high capability in locating atresia/stenosis. However, some cases are misdiagnosed. In clinical practice, upper gastrointestinal contrast studies should be used complementarily during diagnosis. Additional anomalies may not be detected by preoperative examinations; therefore, surgeons should carefully evaluate for additional anomalies during surgery, especially coexisting intestinal malrotation and annular pancreas.
Collapse
|
15
|
Nissen M, Sander V, Rogge P, Alrefai M, Tröbs RB. Meckel’s Diverticulum in Children: A Monocentric Experience and Mini-Review of Literature. CHILDREN 2022; 9:children9010035. [PMID: 35053658 PMCID: PMC8774297 DOI: 10.3390/children9010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
Vitelline duct anomalies (VDA, including Meckel’s diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic versus asymptomatic VDA, analyzing clinico-laboratory data from 73 children, aged 1 day to 17 years, treated at a tertiary Pediatric Surgery Institution from 2002–2017. A male preponderance was obtained (ratio 3.6:1). MD accounted for 85% of VDA. Incidence of symptomatic VDA decreased with older age. Leading symptoms were intestinal obstruction and hemorrhage. Mucosal heterotopia (present in 39% of symptomatic MD) was associated with anemia and lowered CRP-levels. On ROC-analysis, hemoglobin < 8.6 g/dL, CRP < 0.6 mg/dL and MD distance to ileocecal valve >40 cm were predictors of ectopic tissue in symptomatic MD. Our data confirmed known characteristics as male preponderance, declined incidence of symptomatic cases with age and predominance of gastric ectopia in symptomatic MD. Moreover, anemia and prolonged distance of MD to ileocecal valve were predictors of ectopic mucosa in symptomatic MD.
Collapse
Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
- Correspondence: ; Tel.: +49-23021733709; Fax: +49-23021731699
| | - Volker Sander
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
| | - Phillip Rogge
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
| | - Mohamad Alrefai
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
| | - Ralf-Bodo Tröbs
- Department of Pediatric Surgery, St. Johannes Hospital, Helios Group, An der Abtei 7 bis 11, D-47166 Duisburg, Germany;
| |
Collapse
|
16
|
Kang A, Kim SH, Cho YH, Kim HY. Surgical perspectives of symptomatic omphalomesenteric duct remnants: Differences between infancy and beyond. World J Clin Cases 2021; 9:11228-11236. [PMID: 35071553 PMCID: PMC8717527 DOI: 10.12998/wjcc.v9.i36.11228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical manifestations of omphalomesenteric duct remnant (OMDR) can vary with the age at diagnosis, from asymptomatic incidental findings to symptoms related to gastrointestinal complications. The lifelong complication rates are reported as 4%-34%, and complications are more common in patients younger than 2 years of age. The authors attempted to identify different clinical features and management for the various pediatric age groups.
AIM To find surgical perspectives for the pediatric age-related variants of OMDR and make recommendations for optimal management.
METHODS The medical records of pediatric patients diagnosed with OMDR were reviewed retrospectively. Fifteen patients diagnosed based on incidental findings during other surgeries were excluded. The patients were divided into two groups based on age: < 12 mo (infants) and > 12 mo (beyond infancy). We analyzed the demographic characteristics, clinical manifestations, diagnostic tools, surgical procedures, and clinical outcomes of the patients and compared them for the age groups. Chi-squared and Fisher's exact tests were used for nominal scales and a Mann-Whitney test was used for ratio scales.
RESULTS A total of 35 patients (7 infants, 28 children beyond infancy) were finally included. In both groups, Meckel's diverticulum (MD) was the most common type of OMDR, while umbilical lesions were more common in the infant group (P = 0.006). Hematochezia and abdominal pain were common in the beyond infancy group, while umbilical lesions were the most frequent symptoms in the infant group. Several diagnostic tools were used, but Meckel's scan was most useful in diagnosing OMDR in patients with painless rectal bleeding. Minimally invasive surgery was more commonly performed for children than for infants (P = 0.016). Single-incision laparoscopic surgery (SILS) was performed for fifteen patients who underwent laparoscopic surgery. There were only three cases of postoperative complications, and all patients survived in good condition.
CONCLUSION The clinical type of OMDR varies with age, umbilical lesions in infants, and MD beyond infancy. SILS is effective for managing children with MD regardless of age.
Collapse
Affiliation(s)
- Ayoung Kang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Soo-Hong Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Yong-Hoon Cho
- Department of Surgery, Pusan National University School of Medicine, Yangsan 50612, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Hae-Young Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| |
Collapse
|
17
|
Chang YC, Lai JN, Chiu LT, Wu MC, Wei JCC. Epidemiology of Meckel's diverticulum: A nationwide population-based study in Taiwan: Characteristics of the cases from surgery between 1996 and 2013. Medicine (Baltimore) 2021; 100:e28338. [PMID: 34918715 PMCID: PMC8678020 DOI: 10.1097/md.0000000000028338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
The diverse presentation of Meckel's diverticulum (MD) is a diagnostic challenge for clinicians and most previous studies consist of single institutional case series. The aim of this study was to review the related diagnoses of MD and to investigate the epidemiological characteristics using Taiwan's National Health Insurance Research Database.We conducted an observational study using a population-based database. Patients diagnosed with MD who concurrently received intestinal surgery were identified. We analyzed the patients' demographic characteristics and relevant diagnoses using χ2 test and 2-sample t test.We identified 2453 newly diagnosed MD patients from 1996 to 2013 and 1227 patients (50%) with intestinal obstruction, gastrointestinal bleeding, and acute appendicitis (acute abdominal pain) were defined as symptomatic. The male to female ratio was 2.4:1 with half of the patients experiencing symptomatic MD before the age of 20 years' old. The age-specific and annual incidence were calculated for all MD and symptomatic MD. Among the symptomatic MD patients, intestinal obstruction was present in 583 (48%), acute appendicitis was present in 464 (38%), and gastrointestinal bleeding was present in 283 (23%) patients. Intestinal obstruction was the most common preoperative diagnosis in the 0 to 10 years and >20 years' age groups, and acute appendicitis (acute abdominal pain) was the most common diagnosis in the 11 to 20 years' age group.This population-based 18 years' epidemiologic study described the distributions of MD symptoms among different age groups, which may help clinicians gain a better understanding of this diagnostically challenging gastrointestinal anomaly.
Collapse
Affiliation(s)
- Yu-Chuan Chang
- Department of Pediatrics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Lu-Ting Chiu
- Management office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Meng-Che Wu
- Division of Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
18
|
Ghritlaharey RK. Management of Symptomatic Meckel's Diverticulum in Infants and Children. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2021. [DOI: 10.1055/s-0041-1739190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objectives The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome.
Materials and Methods This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum. This study was conducted at the author's department of pediatric surgery, and it was performed for 21 years from January 1, 2000 to December 31, 2020.
Results Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period of 21 years. The ratio for males to females was 3:1. This study consisted of infants, (n = 22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n = 43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n = 59, 70.23%), (2) perforation peritonitis (n = 17, 20.23%), (3) lower gastrointestinal bleeding (n = 4, 4.76%), and (4) incidental finding (n = 4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n = 17) of Meckel's diverticulum was responsible for the secondary intussusception. In children (n = 84), for Meckel's diverticulum, surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n = 36, 42.85%); (2) Meckel's diverticulectomy (n = 32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n = 12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n = 4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period.
Conclusion Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.
Collapse
Affiliation(s)
- Rajendra K. Ghritlaharey
- Department of Paediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India
| |
Collapse
|
19
|
Inarejos Clemente EJ, Navarro OM, Navallas Irujo M, Ladera E, Colombo C, Suñol M, Sousa P, Barber Martínez de la Torre I. Omphalomesenteric Duct Anomalies in Children: A Multimodality Overview. Radiographics 2021; 41:2090-2110. [PMID: 34723700 DOI: 10.1148/rg.2021210048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The omphalomesenteric duct is an embryologic structure that connects the yolk sac with the primitive midgut of the developing fetus. Omphalomesenteric duct anomalies include a group of entities that result from failed resorption of the omphalomesenteric duct. These anomalies include Meckel diverticulum, omphalomesenteric fistula, fibrous bands, cysts, and umbilical polyps. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic. Symptoms develop when Meckel diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. Hemorrhage is the most common complication of Meckel diverticulum, and technetium 99m-pertechnetate scintigraphy is the imaging modality of choice for detecting acute bleeding. US and CT are commonly used for the evaluation of patients with other complications such as obstruction and inflammation. Nevertheless, the diagnosis of these complications can be challenging, as their clinical manifestations are usually nonspecific and can masquerade as other acute intraabdominal entities such as appendicitis, inflammatory bowel disease, or other causes of bowel obstruction. There are other umbilical disorders, such as urachal remnants and umbilical granuloma, that may present with symptoms and imaging findings similar to those of omphalomesenteric duct anomalies. An accurate preoperative diagnosis of omphalomesenteric duct anomaly is crucial for appropriate management and a better outcome, particularly when these anomalies manifest as a life-threatening condition. The authors review the anatomy, clinical features, and complications of omphalomesenteric duct anomalies in children, describing the relevant differential diagnoses and associated imaging findings seen with different imaging modalities. ©RSNA, 2021.
Collapse
Affiliation(s)
- Emilio J Inarejos Clemente
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - María Navallas Irujo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Enrique Ladera
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Cecilia Colombo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Mariona Suñol
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Paulino Sousa
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Ignasi Barber Martínez de la Torre
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| |
Collapse
|
20
|
Tracy M, Weil BR, Verhave M. Where Did the Blood Go?: A Meckel's Diverticulum Bleed Without Hematochezia or Melena. JPGN REPORTS 2021; 2:e119. [PMID: 37206468 PMCID: PMC10191587 DOI: 10.1097/pg9.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/16/2021] [Indexed: 05/21/2023]
Abstract
A 2-year-old patient with chronic abdominal pain presented with acutely worsening abdominal pain and acute anemia. The patient had no stigmata of bleeding including no hematemesis, melena or hematochezia, but had falling hemoglobin and hematocrit over the course of 24 hours. Abdominal ultrasound and computerized tomography showed a large cystic, fluid filled mass in the right midabdomen. The patient was taken to the operating room and a blood-filled mass arising from the ileum was identified and resected by the surgical team. Pathology was consistent with Meckel's diverticulum with heterotopic gastric mucosa. This is an atypical presentation of Meckel's diverticulum with bleeding contained within the diverticulum rather than bleeding in the intestinal lumen. Gastroenterologists must consider this unusual presentation when encountering progressive, acute anemia even in the absence of overt gastrointestinal blood loss.
Collapse
Affiliation(s)
- Michaela Tracy
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Brent R. Weil
- Division of Pediatric Surgery, Department of Surgery, Boston Children’s Hospital, Boston, MA
| | - Menno Verhave
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| |
Collapse
|
21
|
Dirim AB, Ozyazici S. Giant Meckel's Diverticulitis Perforation Due to Necrosis. Cureus 2021; 13:e17997. [PMID: 34667673 PMCID: PMC8519317 DOI: 10.7759/cureus.17997] [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] [Accepted: 09/15/2021] [Indexed: 11/05/2022] Open
Abstract
Although Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, its prevalence is approximately 2% in the general population. Most diverticula remain asymptomatic and can be diagnosed with obstruction, perforation, inflammation, and gastrointestinal hemorrhage. The treatment of complicated MD is surgery, but there is no clear treatment recommendation yet for incidentally detected cases. As in the case we present here, the development of perforation due to Giant Meckel's diverticulitis in an adult female patient is a very rare complication of a disease that can be diagnosed very rarely.
Collapse
Affiliation(s)
- Ahmet Baris Dirim
- Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, TUR
| | - Sefa Ozyazici
- Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, TUR
| |
Collapse
|
22
|
Abstract
ABSTRACT Children with abdominal pain are frequently seen in emergency departments. Physicians and parents worry about appendicitis; physicians are also concerned about intussusception and bowel obstruction in patients with previous surgical procedures. Sometimes the patient is ill, and the diagnosis is elusive. In a 6-month period at our pediatric emergency department with an annual census of 57,400 patients, we cared for 4 patients who presented with abdominal pain due to complications of Meckel's diverticulum. None presented with painless rectal bleeding, the complication of which physicians are most aware. We are reporting these patients to raise awareness of Meckel's diverticulum as a cause of acute abdomen in children. Meckel's diverticulum may masquerade as appendicitis, an abdominal mass, intussusception, or a complication of severe constipation.
Collapse
Affiliation(s)
- Deborah L Callanan
- From the Division of Emergency Medicine, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX
| | | |
Collapse
|
23
|
Dourado JC, Fischer A. Small bowel heterotopic gastric mucosa as a lead point for recurring intussusception. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
24
|
Stefanopol IA, Miulescu M, Baroiu L, Anghele AD, Danila DM, Tiron Z. An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst. ACTA ACUST UNITED AC 2021; 57:medicina57050495. [PMID: 34068430 PMCID: PMC8153632 DOI: 10.3390/medicina57050495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/09/2023]
Abstract
Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.
Collapse
Affiliation(s)
- Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800216 Galați, Romania;
| | - Magdalena Miulescu
- Cardiorespiratory and Neuromotor Functional Exploration Laboratory, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800216 Galați, Romania
- Correspondence: ; Tel.: +40-746608771
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800216 Galați, Romania; (L.B.); (Z.T.)
| | - Aurelian-Dumitrache Anghele
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800216 Galați, Romania; (A.-D.A.); (D.M.D.)
| | - Dumitru Marius Danila
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800216 Galați, Romania; (A.-D.A.); (D.M.D.)
| | - Zina Tiron
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800216 Galați, Romania; (L.B.); (Z.T.)
| |
Collapse
|
25
|
Azhar M, Zamir N, Taqvi SR, Shaikh M. Spectrum of Omphalomesenteric Duct Related Anomalies and Their Surgical Management in Children. Cureus 2021; 13:e13898. [PMID: 33880254 PMCID: PMC8046167 DOI: 10.7759/cureus.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to evaluate the clinical presentation and surgical management of omphalomesenteric duct (OMD) remnants in children. Material and methods A descriptive retrospective study was conducted at the Department of Paediatric Surgery of the National Institute of Child Health, Karachi, Pakistan, from April 2017 to January 2020. Children below 12 years of age with various OMD remnants were included in the study. Data regarding age of presentation, type of anomaly, and management collected during this period were reviewed and analyzed using SPSS Version 22 (IBM Corp., Armonk, NY, USA). Results A total of 86 patients, 47 males and 39 females, were managed during the study period. Intestinal obstruction was observed in 44 (51.16%) cases followed by OMD-related umbilical anomalies in 14 (16.27%) cases, acute abdominal pain in 12 (13.95%), rectal bleeding in 3 (3.48%) patients. In 13 (15.16%) cases, Meckel’s diverticulum was discovered incidentally. In 21 cases, wedge resection and ileal repair was performed, whereas 32 required segmental resection and end-to-end anastomosis, and in 32 cases ileostomy was created after resection. Histopathology showed the presence of ectopic mucosa in five cases. Conclusion Patients with OMD remnants had various presentations. The surgical procedure has to be tailored according to the clinical and surgical findings.
Collapse
Affiliation(s)
- Muhammad Azhar
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK.,Paediatric Surgery, Jinnah Sindh Medical University, Karachi, PAK
| | - Naima Zamir
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
| | - Syed R Taqvi
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
| | - Mishraz Shaikh
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
| |
Collapse
|
26
|
Rahmat S, Sangle P, Sandhu O, Aftab Z, Khan S. Does an Incidental Meckel's Diverticulum Warrant Resection? Cureus 2020; 12:e10307. [PMID: 32923303 PMCID: PMC7480780 DOI: 10.7759/cureus.10307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Meckel's diverticulum (MD) is the most common gastrointestinal malformation. The management of symptomatic Meckel's diverticulum has been undecidedly resection; however, the management of incidental Meckel's diverticulum has been fraught in comparison. As a systematic literature review, PubMed, PubMed Central (PMC), and MEDLINE were used. The search phrase utilized was "Meckel Diverticulum/Surgery [Mesh]" and resection incidental. The search was completed on July 18, 2020 and was limited to 1980 until the day of the search. Searches resulted in 62 initial articles on PubMed. On initial screening, 23 of these articles met the criteria. The references of these 23 articles were screened for relevant studies, yielding a total of 31 studies of which all were assessed for quality. Four articles made a recommendation for no resection. Twelve studies made a recommendation for resection. Ten studies concluded that resection should be completed in the presence of risk factors. Lastly, five studies made no clear recommendation. In recent literature, there has been a shift towards resection for all or in those with high-risk factors. In the future, it will be necessary for researchers to determine if resection is recommended for all patients with incidental MD or in those with risk factors. If only in those with risk factors, it will be important that research is completed to create evidence-based guidelines to support the risk factors.
Collapse
Affiliation(s)
- Shermeen Rahmat
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Prerna Sangle
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Osama Sandhu
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Zarmeena Aftab
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| |
Collapse
|
27
|
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.
Collapse
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.
| |
Collapse
|
28
|
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.
Collapse
|
29
|
Spangler H, Fisher J. The rule of two's didn't work: Meckel's diverticulum with hemorrhagic shock in an adolescent. Am J Emerg Med 2020; 38:1541.e1-1541.e2. [PMID: 32224041 DOI: 10.1016/j.ajem.2020.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/22/2020] [Indexed: 11/19/2022] Open
Abstract
Meckel's diverticulum classically follows the rule of two's; presenting before the age of two years, found 2 ft. from the ileocecal valve, approximately 2 in. in length, and present in roughly 2% of the population. To our knowledge, there are few cases detailing emergent medicine management of hemorrhagic shock in patients with acute blood loss from a Meckel's diverticulum. We report the case of a 13-year-old male presenting in hemorrhagic shock secondary to an undifferentiated gastrointestinal bleed who was effectively resuscitated in a children's emergency department. Meckel's scan revealed abnormal tracer uptake consistent with Meckel's diverticulum and the patient underwent surgical resection of the diverticulum. This case report details the importance of prompt recognition and appropriate volume resuscitation in a pediatric patient suffering from hemorrhagic shock. Emergency medicine physicians should maintain an index of suspicion for Meckel's diverticulum in any pediatric patient presenting with undifferentiated gastrointestinal hemorrhage.
Collapse
Affiliation(s)
- Hillary Spangler
- Department of Internal Medicine and Pediatrics, UNC Hospitals, Chapel Hill, NC, United States of America.
| | - Joseph Fisher
- Department of Emergency Medicine, UNC Hospitals, Chapel Hill, NC, United States of America
| |
Collapse
|
30
|
Abstract
Johann Friedrich Meckel (1781-1833) was a 19th century anatomist born into an eminent dynasty. He was a professor of anatomy, pathology, and zoology at the University of Halle, in Central Germany. The diverticulum, a congenital remnant of the vitellointestinal duct was named after him. Other eponyms include Meckel's cartilage, Meckel syndrome, and Meckel-Serres law of recapitulation. His concepts in comparative anatomy, embryology, and teratology anticipated Darwin. This review is a short tribute to this legend and his prolific contributions. LEVEL: Historic review, level V.
Collapse
|
31
|
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.
Collapse
|
32
|
Charki MT, Oukhouya MA, Benmassaoud Z, Mahmoudi A, Khattala K, Bouabdallah Y. [Complications of Meckel's diverticulum in children: about 18 cases]. Pan Afr Med J 2019; 33:113. [PMID: 31489091 PMCID: PMC6711690 DOI: 10.11604/pamj.2019.33.113.18756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
Meckel's diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel's diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient's outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.
Collapse
Affiliation(s)
- Mohammed Tazi Charki
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Mohammed-Amine Oukhouya
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Zineb Benmassaoud
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Abdelhalim Mahmoudi
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Khalid Khattala
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Youssef Bouabdallah
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| |
Collapse
|
33
|
Keese D, Rolle U, Gfroerer S, Fiegel H. Symptomatic Meckel's Diverticulum in Pediatric Patients-Case Reports and Systematic Review of the Literature. Front Pediatr 2019; 7:267. [PMID: 31294008 PMCID: PMC6606722 DOI: 10.3389/fped.2019.00267] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction: Our aim was to highlight the characteristics of pediatric Meckel's diverticulum with a special focus on its complications. Methods: We report a group of seven patients with Meckel's diverticulum and its resection from the Department of Pediatric Surgery between 2012 and 2017. We reviewed all patient records, clinical presentation, and intraoperative findings. The diagnosis was confirmed by surgery and pathology. For a systematic literature review, we used PubMed, Medline and Google Scholar search engines to locate articles containing terms such as Meckel's diverticulum, children, pediatric, complications and symptomatic. We included article reporting on case series in English and German on pediatric patients only. Results: All included patients (n = 7) were symptomatic. Some patients showed isolated symptoms, and others presented with a combination of symptoms that consisted of abdominal pain, bloody stool or vomiting. The median age of our seven cases was 3.5 years, including 4 male and 3 female patients. Intestinal obstruction was the most common complication; it was seen in 5 out of 7 patients (intussusception in 4 cases, volvulus in 1 case). Ectopic gastric tissue was identified in 3 cases, and inclusion of pancreatic tissue was observed in 1 case. The literature review identified 8 articles for a total of 641 patients aged between 1 day and 17 years and a male:female ratio of 2.6:1. From this group, 528 patients showed clinical symptoms related to Meckel's diverticulum. The most common symptom was abdominal pain and bloody stool. The most common surgical finding in symptomatic patients was intestinal obstruction (41%), followed by intestinal hemorrhage (34%). Complications such as perforation (10%) and diverticulitis (13%) were less frequently reported. Heterotopic tissue was confirmed on histopathology in 53% of all patients enclosing gastric, pancreatic, and both gastric and pancreatic mucosae. In one case, large intestine tissue could be found. Overall, one death was reported. Conclusion: The presented case series and literature review found similar clinical presentations and complications of Meckel's diverticulum in children. Intestinal obstruction and bleeding are more frequent than inflammation in pediatric Meckel's diverticulum. Bowel obstruction is the leading cause for complicated Meckel's diverticulum in patients younger than 12 years.
Collapse
Affiliation(s)
- Daniel Keese
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Udo Rolle
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Stefan Gfroerer
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Henning Fiegel
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Lecigne R, Protin-Catteau L, Caby-Mac G, François C, Hoeffel C. Meckel's diverticulum leiomyoma presenting as a mobile abdominal mass. Diagn Interv Imaging 2018; 99:769-771. [PMID: 29910173 DOI: 10.1016/j.diii.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Affiliation(s)
- R Lecigne
- Department of Radiology, Centre Hospitalier Universitaire, Pôle d'imagerie, 47, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - L Protin-Catteau
- Department of Radiology, Centre Hospitalier Universitaire, Pôle d'imagerie, 47, rue Cognacq-Jay, 51092 Reims cedex, France
| | - G Caby-Mac
- Department of Radiology, Centre Hospitalier Universitaire, Pôle d'imagerie, 47, rue Cognacq-Jay, 51092 Reims cedex, France
| | - C François
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, 47, rue Cognacq-Jay, 51092 Reims cedex, France
| | - C Hoeffel
- Department of Radiology, Centre Hospitalier Universitaire, Pôle d'imagerie, 47, rue Cognacq-Jay, 51092 Reims cedex, France
| |
Collapse
|