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De la Cruz Ku G, Nelson E, Calderon R, Hemmati P, Kim B. Meckel's Enterolith Causing Small Bowel Obstruction: A Useful Solution to a Unique Problem. Cureus 2021; 13:e15934. [PMID: 34336435 PMCID: PMC8312179 DOI: 10.7759/cureus.15934] [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: 06/26/2021] [Indexed: 11/05/2022] Open
Abstract
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its course is usually benign but may also result in complications requiring surgical intervention. A diverticulum may also permit the removal of intraluminal objects without bowel resection and anastomosis. A woman in her 50s was found to have a mechanical small bowel obstruction secondary to an intraluminal mass within the terminal ileum. On exploration, an MD was encountered proximal to the mass. A diverticulectomy was performed after maneuvering the enterolith into the diverticulum. Meckel’s diverticulum with an associated enterolith is a rare cause of small bowel obstruction. Historic imaging may show long-standing stones in the bowel lumen and provide a diagnostic clue. Diverticulectomy may be performed to reduce the risks of small bowel resection and anastomosis. This technique can be used for other intraluminal objects requiring removal in the presence of an MD.
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Affiliation(s)
| | - Erek Nelson
- General Surgery, Mayo Clinic, Rochester, USA
| | | | | | - Brian Kim
- Trauma and Acute Care Surgery, Mayo Clinic, Rochester, USA
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Tanabe H, Tanaka K, Goto M, Sato T, Sato K, Fujiya M, Okumura T. Rare case of fecal impaction caused by a fecalith originating in a large colonic diverticulum: A case report. World J Clin Cases 2021; 9:416-421. [PMID: 33521110 PMCID: PMC7812877 DOI: 10.12998/wjcc.v9.i2.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fecal impaction is defined as a large mass of compacted feces in the colon and has the potential to induce a serious medical condition in elderly individuals. Fecal impaction is generally preventable, and early recognition of the typical radiological findings is important for making an early diagnosis. The factors that lead to fecal impaction are usually similar to those causing constipation. Few cases with fecal impaction associated with a diverticulum have been reported.
CASE SUMMARY We present the case of a 62-year-old woman who suffered from abdominal pain and vomiting, had a medical history of repeated acute abdomen and was diagnosed with fecal impaction in the descending colon based on X-ray and computed tomography (CT) imaging. After examination by gastrografin-enhanced colonography following colonoscopy and CT colonography, the fecalith was suspected to have been produced at the site of a large diverticulum in the transverse colon. The fecalith was surgically resected, and a histological diagnosis of pseudodiverticulum was made. There was no recurrence during 33 mo of follow-up.
CONCLUSION This case highlights the importance of accurate identification and treatment of a fecal impaction. This case indicated that the endoscopic evacuation and subsequent colonography were effective for identifying a diverticulum that might have caused fecal impaction. A fecal impaction was associated with the diverticulum. Consequently, the planned diverticulectomy was performed. Appropriate emergency medical treatment and maintenance treatments should be selected in such cases to prevent recurrence.
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Affiliation(s)
- Hiroki Tanabe
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Kazuyuki Tanaka
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Mitsuru Goto
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Tomonobu Sato
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Keisuke Sato
- Department of Pathology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
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A Calcium Enterolith in a Patient with Crohn's Disease and Its In Vitro Dissolubility in Citric Acid. Case Rep Gastrointest Med 2017; 2017:2951547. [PMID: 29082049 PMCID: PMC5610872 DOI: 10.1155/2017/2951547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022] Open
Abstract
The microstructure and dissolubility of a calcified enterolith and enterolith pieces removed from a 26-year-old Japanese woman with Crohn's disease were analyzed using scanning electron microscopy and energy dispersive X-ray spectroscopy. The enterolith showed a multilayered structure with fatty acid calcium and magnesium phosphate. The amount of calcium, magnesium, and phosphate decreased after they were immersed in a citric acid solution, suggesting a potential contribution of acidic aqueous solution to elute inorganic substances contained in calcified enteroliths. This is the first study to investigate the in vitro dissolubility of calcified enteroliths induced by citric acid solution.
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O’Connor E, Jackson R, Tran L, Lakshminarayanan B. WITHDRAWN: A late diagnosis of a complicated Meckel’s diverticulum - The first case of an enterocolic fistula secondary to a Meckel’s diverticulum in a paediatric patient and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Morão S, Knoblich M, Alves F, Alves R, Pascoal J. Torsion and inflammation of Meckel's diverticulum: Rare cause of acute abdominal pain. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Huang CC, Lai MW, Hwang FM, Yeh YC, Chen SY, Kong MS, Lai JY, Chen JC, Ming YC. Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol 2014; 55:369-75. [PMID: 24685339 DOI: 10.1016/j.pedneo.2013.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/13/2013] [Accepted: 12/09/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients. METHODS This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed. RESULTS One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001). CONCLUSION Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.
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Affiliation(s)
- Chen-Chuan Huang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Fang-Ming Hwang
- Department of Education, National Chiayi University, Chiayi, Taiwan
| | - Yu-Chen Yeh
- Institute of Education, National Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jeng-Chang Chen
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Ching Ming
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Nishikawa T, Takei Y, Tsuno NH, Maeda M. Perforation of Meckel's diverticulum with enteroliths. Clin J Gastroenterol 2012; 5:298-301. [PMID: 26182397 DOI: 10.1007/s12328-012-0313-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with enteroliths, which could be accurately diagnosed by the preoperative computed tomography (CT). A 46-year-old man with acute onset of severe abdominal pain, and a localized muscle guarding in the right hypochondrium, had a solitary stone detected in the right abdomen by the radiography. The abdominal CT revealed a saclike outpouching of the small intestine, containing air/fluid levels and an enterolith, with surrounding free air and mesenteric inflammatory change in the right paraumbilical area. He was diagnosed as the perforation of Meckel's diverticulum with enterolith, and the emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 90 cm proximal to the ileocecal valve. The diverticulum was transected at the base, and removed. The patient's postoperative course was uneventful. This case strongly suggested the ability of CT enterography to accurately diagnose pathologies involving the small intestine, such as the perforation of Meckel's diverticulum, which open premises for its use in the diagnosis of acute abdomen preoperatively.
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Affiliation(s)
- Takeshi Nishikawa
- Department of Surgery, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan.
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
| | - Yoshiki Takei
- Department of Surgery, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Nelson H Tsuno
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Mamoru Maeda
- Department of Surgery, The Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
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Gadhia U, Raju D, Kapoor R. Large enterolith in a meckels diverticulum causing perforation and bowel obstruction: an interesting case with review of literature. Indian J Surg 2012; 75:177-9. [PMID: 24426556 DOI: 10.1007/s12262-012-0558-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 06/04/2012] [Indexed: 12/15/2022] Open
Abstract
Enteroliths are a rare complication of Meckel's diverticula, with perforation of the diverticulum being an even rarer occurrence. Bowel obstruction secondary to a Meckel's enterolith, albeit uncommon, occurs due to inflammation, intussusception, or impaction after extrusion from the diverticulum. We report an unusual case of Meckel's enterolithiasis causing perforation and bowel obstruction.
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Affiliation(s)
- Umesh Gadhia
- Lyell McEwin Health Service, Elizabethvale, South Australia 5112 Australia
| | - Devinder Raju
- Lyell McEwin Health Service, Elizabethvale, South Australia 5112 Australia ; Department of Surgery, Lyell McEwin Health Service, Elizabethvale, South Australia 5112 Australia
| | - Rajeev Kapoor
- Lyell McEwin Health Service, Elizabethvale, South Australia 5112 Australia
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Ramírez-Cervantes KL, Gámez-Varela AK, Garibay-López JL, Remes-Troche JM. Enterolithiasis associated with sigmoid stenosis caused by foreign body introduction. Colorectal Dis 2011; 13:e310-1. [PMID: 20958911 DOI: 10.1111/j.1463-1318.2010.02458.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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