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Saab MA, Jacobson E, Hanson K, Kruciak B, Miramontes D, Harper S. Prehospital Whole Blood Administration for Pediatric Gastrointestinal Hemorrhage: A Case Report. PREHOSP EMERG CARE 2024:1-4. [PMID: 38940756 DOI: 10.1080/10903127.2024.2372808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
The management of gastrointestinal (GI) hemorrhage in a prehospital setting presents significant challenges, particularly in arresting the hemorrhage and initiating resuscitation. This case report introduces a novel instance of prehospital whole blood transfusion to an 8-year-old male with severe lower GI hemorrhage, marking a shift in prehospital pediatric care. The patient, with no previous significant medical history, presented with acute rectal bleeding, severe hypotension (systolic/diastolic blood pressure [BP] 50/30 mmHg), and tachycardia (148 bpm). Early intervention by Emergency Medical Services (EMS), including the administration of 500 mL (16 mL/kg) of whole blood, led to marked improvement in vital signs (BP 97/64 mmHg and heart rate 93 bpm), physiology, and physical appearance, underscoring the potential effectiveness of prehospital whole blood transfusion in pediatric GI hemorrhage. Upon hospital admission, a Meckel's diverticulum was identified as the bleeding source, and it was successfully surgically resected. The patient's recovery was ultimately favorable, highlighting the importance of rapid, prehospital intervention and the potential role of whole blood transfusion in managing acute pediatric GI hemorrhage. This case supports the notion of advancing EMS protocols to include interventions historically reserved for the hospital setting that may significantly impact patient outcomes from the field.
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Affiliation(s)
- Mathew A Saab
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Eric Jacobson
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Kip Hanson
- San Antonio Fire Department, San Antonio, Texas
| | | | - David Miramontes
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Stephen Harper
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
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2
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Pan L, Zhang P, Wang G. Symptomatic Meckel's diverticulum: Another cause of lower gastrointestinal bleeding in adults. Asian J Surg 2024:S1015-9584(24)00998-9. [PMID: 38772826 DOI: 10.1016/j.asjsur.2024.05.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024] Open
Affiliation(s)
- Li Pan
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Peng Zhang
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Gang Wang
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, Sichuan, People's Republic of China.
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3
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Zhou J, Zhang H, Xiang Q, Dong F, Sun L. Heterotopic pancreas in Meckel's diverticulum causing perforation in an infant: a case report. J Surg Case Rep 2024; 2024:rjae375. [PMID: 38826858 PMCID: PMC11141289 DOI: 10.1093/jscr/rjae375] [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: 03/18/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024] Open
Abstract
Perforation of Meckel's diverticulum caused by heterotopic pancreas is a rare condition. Despite recent improvements in imaging studies, Meckel"'s diverticulitis and heterotopic pancreas are difficult to diagnose preoperatively and are often diagnosed during autopsy or laparotomy. Symptomatic patients are typically >1 year, and cases of infants displaying symptoms are rarely reported. We report a rare case of heterotopic pancreas in Meckel's diverticulum causing perforation in an infant. In cases of infants presenting with unexplained acute abdominal pain, there should be a high index of suspicion for congenital gastrointestinal malformations. Prompt action in the form of exploratory laparotomy or laparoscopy is crucial to prevent the escalation of complications and to definitively confirm the diagnosis.
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Affiliation(s)
- Junjie Zhou
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Hongbin Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Qianming Xiang
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Fabiao Dong
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Luyun Sun
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
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Sun YM, Xin W, Liu YF, Guan ZM, Du HW, Sun NN, Liu YD. Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case reports. World J Clin Cases 2024; 12:865-871. [PMID: 38322683 PMCID: PMC10841135 DOI: 10.12998/wjcc.v12.i4.865] [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: 11/26/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding. CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided. CONCLUSION Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.
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Affiliation(s)
- Yi-Meng Sun
- School of Clinical Medicine, Weifang Medical University, Weifang 261000, Shandong Province, China
| | - Wang Xin
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yu-Fang Liu
- Department of Burn Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Zhe-Ming Guan
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Hao-Wen Du
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Ning-Ning Sun
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yong-Dong Liu
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
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Gambardella M, Smaldone M, Iazzetta F, Corbisiero MC, Graviero G, Coppola GM. Preoperative CT diagnosis of perforated Meckel's diverticulitis in a young patient: a case report. J Basic Clin Physiol Pharmacol 2024; 35:93-97. [PMID: 38015811 DOI: 10.1515/jbcpp-2023-0237] [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: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Meckel's diverticulum (MD) is a common asymptomatic congenital intestinal anomaly. Clinical manifestations of MD can occur in about 4 % of cases by the presentation of its complications, generally intestinal occlusion, bleeding, and diverticular inflammation. MD's complications are challenging preoperative diagnoses, as manifest with clinical symptoms that overlap with those of other acute non-traumatic abdominal diseases. Thus, in the emergency setting, abdominal computed tomography (CT) represents an essential tool for the correct diagnosis of complicated MD. CASE PRESENTATION We present a case of a preoperative CT diagnosis of perforated Meckel's diverticulitis in a young patient admitted to our Emergency Department complaining of acute abdominal pain. CONCLUSIONS The case highlights the importance of evaluating Meckel's diverticulum complications among the differential diagnoses of acute non-traumatic abdominal pain and the high sensitivity of CT in assessing their presence in the proper clinical setting.
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Sun B, Liu J, Li S, Lovell JF, Zhang Y. Imaging of Gastrointestinal Tract Ailments. J Imaging 2023; 9:115. [PMID: 37367463 DOI: 10.3390/jimaging9060115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Gastrointestinal (GI) disorders comprise a diverse range of conditions that can significantly reduce the quality of life and can even be life-threatening in serious cases. The development of accurate and rapid detection approaches is of essential importance for early diagnosis and timely management of GI diseases. This review mainly focuses on the imaging of several representative gastrointestinal ailments, such as inflammatory bowel disease, tumors, appendicitis, Meckel's diverticulum, and others. Various imaging modalities commonly used for the gastrointestinal tract, including magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT), and photoacoustic tomography (PAT) and multimodal imaging with mode overlap are summarized. These achievements in single and multimodal imaging provide useful guidance for improved diagnosis, staging, and treatment of the corresponding gastrointestinal diseases. The review evaluates the strengths and weaknesses of different imaging techniques and summarizes the development of imaging techniques used for diagnosing gastrointestinal ailments.
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Affiliation(s)
- Boyang Sun
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
| | - Jingang Liu
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
| | - Silu Li
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
| | - Jonathan F Lovell
- Department of Biomedical Engineering, The State University of New York at Buffalo, Buffalo, NY 14260, USA
| | - Yumiao Zhang
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
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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.
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Affiliation(s)
- Ramin Kafshgari
- Assistant Professor of Pediatric Surgery, Department of Pediatrics, Amirkola Hospital, Babol University of Medical Sciences, Babol, Iran
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Baltes P, Dray X, Riccioni ME, Pérez-Cuadrado-Robles E, Fedorov E, Wiedbrauck F, Chetcuti Zammit S, Cadoni S, Bruno M, Rondonotti E, Johansson GW, Mussetto A, Beaumont H, Perrod G, McNamara D, Plevris J, Spada C, Pinho R, Rosa B, Hervas N, Leenhardt R, Marmo C, Esteban-Delgado P, Ivanova E, Keuchel M. Small-bowel capsule endoscopy in patients with Meckel's diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study. Gastrointest Endosc 2022; 97:917-926.e3. [PMID: 36572128 DOI: 10.1016/j.gie.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. METHODS This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. RESULTS Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB transit time for the first indicative image of MD was 57% of the total SB transit time. CONCLUSIONS Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.
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Affiliation(s)
- Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany.
| | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Evgeny Fedorov
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Felix Wiedbrauck
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | | | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
| | - Mauro Bruno
- University Division of Gastroenterology, University Hospital City of Science and Health Turin, Turin, Italy
| | | | | | | | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Guillaume Perrod
- Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital and School of Medicine Trinity College Dublin, Dublin, Ireland
| | - John Plevris
- Endoscopy Unit, The Royal Infirmary of Edinburgh, University of Edinburgh, Scotland
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Rolando Pinho
- Gastroenterology Department, Vila Nova de Gaia/Espinho-Hospital Centre, Vila Nova de Gaia, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Nerea Hervas
- Department of Gastroenterology, Complejo Hospitalario Navarra, Pamplona, Spain
| | - Romain Leenhardt
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Clelia Marmo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Ekaterina Ivanova
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany; Clinic for Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
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Bagaria M, Magtibay PM, Wasson MN. Meckel's Diverticulum: Role of Small Bowel Exploration in Patient Presenting with Abdominal Pain. J Minim Invasive Gynecol 2022; 29:1201-1202. [PMID: 35718321 DOI: 10.1016/j.jmig.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Madhu Bagaria
- Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona (all authors).
| | - Paul M Magtibay
- Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona (all authors)
| | - Megan N Wasson
- Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona (all authors)
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Dos Santos Villalaz E, Rios Rodriguez JE, Rodrigues Seixas Nunes Z, de Souza Bivaqua VB, Moreira Printes TR, Façanha Neto CD. Obstructive acute abdomen due to Meckel's diverticulum in adult: Case report. Int J Surg Case Rep 2022; 99:107717. [PMID: 36261951 PMCID: PMC9568863 DOI: 10.1016/j.ijscr.2022.107717] [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: 08/20/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum is anatomically considered as a true diverticulum, with its embryological origins arising from a persistent omphalomesenteric duct. In adults, the disease is usually asymptomatic, often being accidentally diagnosed during imaging tests or surgery to treat other diseases, or due to further complications. PRESENTATION OF THE CASE We report the case of a 26-year-old female patient was admitted to the emergency room complaining of pain and abdominal distension for 3 days, progressing to cessation of the elimination of gas for 1 day together with nausea and vomiting. Since the cause of the obstruction was not clearly identified, the patient's clinical status did not improve with non-operative measures and laparoscopy was not available, an exploratory laparotomy was conducted. In the cavity inventory, an approximately 20 cm wide MD was found in the terminal ileum adhered to the distal portion of the anterior abdominal wall. DISCUSSION MD is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of between 0.3 % and 2.9 % in the general population. The clinical picture is usually asymptomatic, with the diagnosis made either via imaging tests performed to investigate other diseases, or during surgery to treat complications. CONCLUSION MD is the most common anomaly of the digestive tract, despite its low prevalence. It presents even rarer complications, including obstruction, digestive bleeding, or diverticulitis. It is important to consider the diverticulum as a diagnostic hypothesis in cases of obstruction without apparent causes, but it does not alter the initial management of the patient.
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Halabi M, Abid G, Zenilman ME, Moussa H. Treatment of an unusual case of Meckel's diverticulum with a new robotic platform. Int J Surg Case Rep 2022; 99:107613. [PMID: 36103757 PMCID: PMC9568712 DOI: 10.1016/j.ijscr.2022.107613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Meckel's diverticulum (MD) is a common congenital anomaly of the digestive tract that affects around 4 % of the population. Although it is relatively common, diagnosis still remains very challenging; it requires an astute clinician with a high clinical index of suspicion to achieve the diagnosis. Once a diagnosis is reached, treatment is almost always surgical. This case report provides evidence of the effectiveness of a new robotic surgical system for resection of MD in the elderly. Case presentation 61 year old male presented to the emergency room with recurrent hematochezia. After multiple diagnostic techniques, he was finally diagnosed with MD using Meckel's scan. After diagnosis, surgical resection using the Cambridge Medical Robotics (CMR) Versius robotic system was performed, which yielded good results. Clinical discussion This case highlights the use of a new robotic system for the treatment of Meckel's Diverticulum. Conclusion Our initial experience with the CMR Versius surgical system in small bowel resection was successful; however, further studies are needed to demonstrate the safety and efficacy of such a system. Meckel's diverticulum can persist in the elderly, thus ruling out the disease based on age is not reasonable. Many diagnostic techniques can be used to investigate Meckel's diverticulum, however the most reliable is the Meckel's scan. Once Meckel's is diagnosed surgical treatment is usually curative. Small bowel resection can be done with this new robotic platform.
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Affiliation(s)
- Mouhammad Halabi
- The Department of Surgery, American Hospital in Dubai, United Arab Emirates; School of Medicine, Royal College of Surgeons in Ireland - Bahrain, Kingdom of Bahrain
| | - Ghita Abid
- Mohammed VI University of Health Sciences, Morocco
| | - Michael E Zenilman
- Department of Surgery, Weill Cornell Medicine, New York, United States of America
| | - Hatem Moussa
- The Department of Surgery, American Hospital in Dubai, United Arab Emirates.
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Bejiga G, Ahmed Z. Gangrenous Meckel's diverticulum with small bowel obstruction mimicking complicated appendicitis: 'Case report'. Int J Surg Case Rep 2022; 97:107419. [PMID: 35863288 PMCID: PMC9403201 DOI: 10.1016/j.ijscr.2022.107419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Though Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is uncommon in the general population and rare in adults. Its preoperative diagnosis is challenging. While obstruction is the commonest complication, its occurrence with gangrenous Meckel's diverticulum is rare. The aim of this presentation is to report this combination and to create awareness among surgeons and radiologists to increase preoperative diagnosis of Meckel's diverticulum preventing morbidity and mortality from delay in intervention. PRESENTATION OF THE CASE A twenty-years-old male presented with periumblical pain that later shifted to lower abdomen, vomiting and fever of 10 h durations. He has no history of smoking or diabetes. Physical examination showed tachycardia, fever, and lower abdominal tenderness. Exploratory laparotomy revealed gangrenous Meckel's diverticulum and ileal obstruction by a band arising from the tip of diverticulum to ileal mesentery. We did segmental resection of the ileum containing Meckel's diverticulum and end-to-end anastomosis with the excellent outcome. DISCUSSION Preoperative diagnosis of Meckel's diverticulum is challenging because of non-specific clinical presentations and less sensitivity and specificity of imaging investigations. A high index of suspicion can improve its diagnosis. Axial torsion with gangrenous Meckel's diverticulum is the rarest complication. Management of symptomatic Meckel's diverticulum is surgery. Treatment of silent Meckel's diverticulum is controversial with no strong evidence to treat or not to treat. CONCLUSION Gangrenous Meckel's diverticulum causing small bowel obstruction is rare. Surgeons must have a high index of suspicion to increase preoperative diagnosis of complicated Meckel's diverticulum.
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Affiliation(s)
- Gosa Bejiga
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia.
| | - Zubeyri Ahmed
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia
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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
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Meckel's diverticulum abscess in the elderly population: A case report. Ann Med Surg (Lond) 2022; 74:103317. [PMID: 35127075 PMCID: PMC8807966 DOI: 10.1016/j.amsu.2022.103317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/21/2022] Open
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Żytkowski A, Clarke E, Mazurek A, Golberg M, Derlatka A, Iwanaga J, Tubbs RS, Wysiadecki G. Meckel's diverticulum found in human fetus: An anatomical case report with commentaries on arterial supply and a concise literature review. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100182] [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
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Camacho Baca P, Caballero-Alvarado J, Centurión-Jáuregui G, Del Castillo Soberón G, Lozano KP, Corvera CZ. [Perforation of Meckel's diverticulum by a fishbone]. Khirurgiia (Mosk) 2022:78-80. [PMID: 36562677 DOI: 10.17116/hirurgia202212278] [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: 12/24/2022]
Abstract
Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.
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Affiliation(s)
| | | | | | | | - K P Lozano
- Antenor Orrego Private University, Piura, Peru
| | - C Z Corvera
- Antenor Orrego Private University, Piura, Peru
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17
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Ahmed M, Elkahly M, Gorski T, Mahmoud A, Essien F. Meckel's Diverticulum Strangulation. Cureus 2021; 13:e14817. [PMID: 34094771 PMCID: PMC8171988 DOI: 10.7759/cureus.14817] [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: 05/03/2021] [Indexed: 11/05/2022] Open
Abstract
Meckel's diverticulum is the most common congenital anomaly of the small intestine. It is a true diverticulum containing all layers of the intestinal wall and results from the incomplete resolution of the omphalomesenteric duct. The majority of the cases are asymptomatic; however, diagnostic challenges arise when it becomes inflamed, causes gastrointestinal hemorrhage, intestinal obstruction, or when it protrudes through a potential abdominal opening (Littre's hernia). We present a rare case of strangulated Meckel's diverticulum as a result of axial torsion presenting with right lower quadrant abdominal pain.
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Affiliation(s)
| | | | - Tito Gorski
- Surgery, Southwest Healthcare System, Murrieta, USA
| | - Ahmed Mahmoud
- Surgery, Riverside Community Hospital, Riverside, USA
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18
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Internal Hernia and Volvulus in an Adult Male Caused by Meckel's Diverticulum: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57050443. [PMID: 34063707 PMCID: PMC8147769 DOI: 10.3390/medicina57050443] [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: 04/06/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Meckel’s diverticulum is a common congenital abnormality of the gastrointestinal tract encountered in about 1–3% of the general population. Although most patients remain asymptomatic, a minority will experience serious complications such as acute abdomen, haemorrhage or obstructive ileus. Of all patients presenting with symptoms of obstruction due to Meckel’s diverticulum 7–18% is due to volvulus. Case Report: A 39-year-old male with multiple previous episodes of obstructive ileus presented with an acute abdomen. An exploratory laparotomy was performed in order to reveal the cause of the obstruction. An internal hernia with ileal volvulus and a Meckel’s diverticulum was found, which was later confirmed by histopathological examination. Conclusion: Meckel’s diverticulum is a rare cause of acute abdomen and obstructive ileus which should be considered when the symptoms date back to childhood. The difficulty of preoperative diagnosis dictates the need for exploratory laparoscopy or laparotomy as diagnostic tools.
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Alves JR, Justino GB, Justino LB, Ternes CMP, Rech JVT, Graffunder FP. Meckel's Diverticulum Perforation by Foreign Body: A Case Report. Bull Emerg Trauma 2021; 9:101-104. [PMID: 34150921 PMCID: PMC8195832 DOI: 10.30476/beat.2021.86253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/10/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
Meckel's diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 reported cases of Meckel's diverticulum perforation by chicken bone. We report a case of a 24-year-old man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel's diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged after 5 days. Although rare, its clinical presentation might be similar to acute appendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel in order to investigate a possible Meckel's diverticulum complication in the differential diagnosis.
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Affiliation(s)
- José Roberto Alves
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Gustavo Busch Justino
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Leonardo Busch Justino
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Caique Martins Pereira Ternes
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - João Vítor Ternes Rech
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Fabrissio Portelinha Graffunder
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
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20
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Vaabengaard S, Andersen L, Qvist N, Rasmussen L, Ifaoui I, Knudsen K, Ellebæk M. Complicated Meckel's Diverticulum in Children: Clinical Presentation, Diagnostic Work-Out, Surgical Approach and Postoperative Complications. Cureus 2020; 12:e12354. [PMID: 33520549 PMCID: PMC7839805 DOI: 10.7759/cureus.12354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of cases are asymptomatic and in cases with complications, the diagnosis may be a challenge and the surgical approach is not obvious. The primary aim of the present study was to evaluate the diagnostic process and surgical approach in relation to clinical presentation. The secondary aim was to evaluate the severity of postoperative complications. Methods A two-center, retrospective analysis of all children below the age of 15 years, operated for complications to MD during the period from January 2003 to December 2016. Results A total of 58 patients were included. In the 40 patients presenting with an acute abdomen an average of 2.3 preoperative diagnostic investigations was performed. In only five cases an MD was recognized preoperatively. In the 18 patients presenting with rectal bleeding or melaena an average of 3.2 preoperative investigations were performed and in only one case the MD was recognized preoperatively. Laparoscopy was the surgical approach in 36 patients (62%) with a conversion in 8. Postoperative complications were seen in two patients (Clavien-Dindo II and IIIb). Conclusion Despite extensive diagnostic work-out an MD was recognized in only a few patients preoperatively. Laparoscopy was the surgical approach in two-thirds of the patients.
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Affiliation(s)
| | - Line Andersen
- Surgical Department, Odense University Hospital, Odense, DNK
| | - Niels Qvist
- Surgical Department, Odense University Hospital, Odense, DNK
| | - Lars Rasmussen
- Surgical Department, Odense University Hospital, Odense, DNK
| | - Inge Ifaoui
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen, DNK
| | - Kristine Knudsen
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen, DNK
| | - Mark Ellebæk
- Surgical Department, Odense University Hospital, Odense, DNK
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21
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Pouli S, Kozana A, Papakitsou I, Daskalogiannaki M, Raissaki M. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging 2020; 11:31. [PMID: 32086627 PMCID: PMC7035412 DOI: 10.1186/s13244-019-0823-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022] Open
Abstract
Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to follow a slower progression course with secondary bacterial peritonitis or localised abscesses. A subset of patients may present with delayed symptoms, abscess mimicking an abdominal mass, or with sepsis. Direct multidetector computed tomography (MDCT) findings support the diagnosis and localise the perforation site while ancillary findings may suggest underlying conditions that need further investigation following primary repair of ruptured bowel. MDCT findings include extraluminal gas, visible bowel wall discontinuity, extraluminal contrast, bowel wall thickening, abnormal mural enhancement, localised fat stranding and/or free fluid, as well as localised phlegmon or abscess in contained perforations. The purpose of this article is to review the spectrum of MDCT findings encountered in GIT perforation and emphasise the MDCT and clinical clues suggestive of the underlying aetiology and localisation of perforation site.
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Affiliation(s)
- Styliani Pouli
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Androniki Kozana
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Ioanna Papakitsou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Daskalogiannaki
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece.
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22
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Ichikawa S, Onishi H, Motosugi U. Imaging Findings of Acute Abdomen due to Complications of Meckel Diverticulum. Can Assoc Radiol J 2020; 71:149-153. [DOI: 10.1177/0846537119899537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Meckel diverticulum is the most common and well-known congenital anomaly of the digestive system. Although most cases are asymptomatic, Meckel diverticulum can have a variety of complications, including gastrointestinal bleeding as a result of peptic ulceration, diverticulitis, and small bowel obstruction. Although the radiologic findings of these complications have been reported, they are difficult to diagnose preoperatively because Meckel diverticulum is a small entity. Computed tomography and scintigraphy play an important role in the diagnosis of Meckel diverticulum and its complications. It is important to be familiar with the radiologic features of acute abdomen due to complications of Meckel diverticulum to be able to manage the condition appropriately.
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Affiliation(s)
- Shintaro Ichikawa
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan
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23
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Ajmal HB, Majid Z, Tahir F, Sagheer S. Axial Torsion and Gangrene: An Unusual Complication of Meckel's Diverticulum. Cureus 2020; 12:e6702. [PMID: 32117653 PMCID: PMC7029826 DOI: 10.7759/cureus.6702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Meckel’s diverticulum (MD), a congenital abnormality of the gastrointestinal tract, is usually found in the pediatric population younger than two years of age; hence, its incidence in adults is rare. Although MD is mostly clinically silent, in adults, it may present with intestinal obstruction and diverticulitis. The complications of MD include hemorrhage, perforation, enterolith formation, torsion, Littre’s hernia, ulceration and neoplasm. Among these, torsion is one of the rarely reported complications of MD. MD being attached to the ileal mesentery or umbilicus, presence of mesodiverticular band, and the length, breadth and base diameter of the diverticulum contribute as a risk factor for torsion. A similar clinical picture of acute appendicitis must be excluded. We report a case of a 25-year-old male who presented with signs of intestinal obstruction in whom intraoperative finding of a torted MD with necrotic and twisted base was found upon emergency exploratory laparotomy.
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Affiliation(s)
- Hassan Bin Ajmal
- General Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Zainab Majid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Faryal Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Saima Sagheer
- Breast and General Surgery, Civil Hospital, Dow University of Health Sciences, Karachi, PAK
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Brackett WJ, Khullar-Gupta S. “Learning from my experience”: Acute abdomen - Perforated Meckel's diverticulitis. Eur J Radiol Open 2019; 6:165-168. [PMID: 31061851 PMCID: PMC6488711 DOI: 10.1016/j.ejro.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 11/27/2022] Open
Abstract
Acute surgical abdomen has a limited differential in pediatric population. Meckel’s diverticulum can mimic the clinical findings of acute appendicitis. Careful radiographic review to identify the appendix in the pediatric population with acute abdomen. Surgical pathology of a normal appendix and a perforated Meckel’s Diverticulitis, with a retrospective view of the appendix.
This is a case report documenting the risk in imaging misinterpretation of a pediatric patient that presented with an acute abdomen. Computed Tomography (CT) demonstrated an inflamed blind ending loop of bowel in the pelvis without an obvious cecal connection. The patient was taken to the operative theater, a normal appendix and perforated Meckel’s diverticulitis were resected. Meckel’s diverticulum is the most common small bowel abnormality and can have complications. We will emphasize that imaging studies in a pediatric patient with Meckel’s diverticulum are easily subject to errors radiologists make. This is such a cautionary and learning tale.
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25
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Blouhos K, Boulas KA, Tsalis K, Barettas N, Paraskeva A, Kariotis I, Keskinis C, Hatzigeorgiadis A. Meckel's Diverticulum in Adults: Surgical Concerns. Front Surg 2018; 5:55. [PMID: 30234126 PMCID: PMC6129587 DOI: 10.3389/fsurg.2018.00055] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022] Open
Abstract
Since Meckel's diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Treatment of symptomatic MD is definitive surgery, including diverticulectomy, wedge, and segmental resection. The type of procedure depends on: (a) the integrity of diverticulum base and adjacent ileum; (b) the presence and location of ectopic tissue within MD. The presence of ectopic tissue cannot be accurately predicted intraoperatively by palpation and macroscopic appearance. When present, its location can be predicted based on height-to-diameter ratio. Long diverticula (height-to-diameter ratio >2) have ectopic tissue located at the body and tip, whereas short diverticula have wide distribution of ectopic tissue including the base. When indication of surgery is simple diverticulitis, diverticulectomy should be performed for long and wedge resection for short MD. When indication of surgery is complicated diverticulitis with perforated base, complicated intestinal obstruction and tumor, wedge, or segmental resection should be performed. When the indication of surgery is bleeding, wedge and segmental resection are the preferred methods for resection. Regarding management of incidentally discovered MD, routine resection is not indicated. The decision making should be based on risk factors for developing future complications, such as: (1) patient age younger than 50 years; (2) male sex; (3) diverticulum length >2 cm; and (4) ectopic or abnormal features within a diverticulum. In this case, diverticulectomy should be performed for long and wedge resection for short MD.
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Affiliation(s)
| | | | - Konstantinos Tsalis
- Fourth Surgical Department, George Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | | | - Ioannis Kariotis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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