Diagnosis please. Case 19: enteroliths in a Meckel diverticulum

Acute abdomen due to Meckel's enterolith: Case report and review of the literature

Meckel's diverticulum is a rare condition with an incidence of 1-3% in general population. It is usually asymptomatic and is incidentally detected during laparotomy/laparoscopy. Enterolith formation within Meckel's diverticulum is even rarer. Herein, we present the diagnosis and management of a 50-year old patient with Meckel's diverticulum enterolith and discuss this rare condition based on the literature.

CT Detection of Symptomatic and Asymptomatic Meckel Diverticulum

OBJECTIVE

The objective of our study was to determine how often symptomatic Meckel diverticulum and asymptomatic Meckel diverticulum are detected on CT in patients with known Meckel diverticulum and to evaluate factors that influence detection.

MATERIALS AND METHODS

A total of 85 CT examinations of 40 patients (eight pediatric patients and 32 adult patients; 29 male patients and 11 female patients; average age, 46.2 ± 23.7 [SD] years) with a pathologic diagnosis of Meckel diverticulum were retrospectively evaluated. These patients included 26 adult patients with incidentally found asymptomatic Meckel diverticulum and 14 patients (eight pediatric and six adult patients) with symptomatic Meckel diverticulum. The CT technical factors and patients' morphologic factors were compared with the detection of Meckel diverticulum using mixed-effect logistic regression models.

RESULTS

Meckel diverticulum was detected on at least one CT examination in eight of 14 (57.1%) symptomatic patients (two of four patients with bleeding, two of six patients with small-bowel obstruction, two of two patients with acute diverticulitis, one of one patient with incisional hernia, and one of one patient with inverted Meckel diverticulum) and in 13 of 23 (56.5%) total CT examinations. Asymptomatic Meckel diverticulum was detected on at least one CT examination in 11 of 26 (42.3%) patients and in 16 of 62 (25.8%) total CT examinations. The amount of peritoneal fat was related to the detection of Meckel diverticula (p = 0.02). Although not statistically significant, the subjective quality of axial CT (p = 0.05) tended to be related to detection, whereas the use of IV (p = 0.59) or positive oral (p = 0.41) contrast material was unrelated to detection. In the original CT reports, none of the asymptomatic cases of Meckel diverticulum was prospectively detected, whereas Meckel diverticulum was detected or mentioned as a possibility in 64% of the symptomatic cases.

CONCLUSION

In patients with known Meckel diverticulum, CT can detect Meckel diverticulum in up to 47.5% of all patients. Meckel diverticulum is more commonly detected in symptomatic patients than in asymptomatic patients, and detection is related to the amount of peritoneal fat.

Giant Meckel diverticulum with enteroliths: a case report of a patient presenting with low back and episodic right lower quadrant pain

OBJECTIVES

The purpose of this case report is to describe a patient who presented with low back pain and episodic right lower quadrant pain who had a long-standing giant Meckel diverticulum with enteroliths.

CLINICAL FEATURES

A 49-year-old woman presented to a chiropractic clinic with low back pain and history of intermittent right lower quadrant pain. Lumbar radiography demonstrated calcifications in the pelvic basin that changed position with changes in patient posture. The patient was referred to an abdominal surgeon for consultation and management.

INTERVENTION AND OUTCOME

Computed tomography identified calcifications in the small bowel in the region of the ileocecal valve. The patient underwent prophylactic diverticulectomy with no complications. Gross pathology revealed a giant Meckel diverticulum measuring 24 inches (60.9 cm) containing 6 enteroliths.

CONCLUSIONS

A timely diagnosis resulted in a favorable surgical outcome for this patient with long-standing giant Meckel diverticulum and enteroliths.

Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

Background

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children.

Methods

A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir.

Results

A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction.

Conclusion

Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal.

Intestinal obstruction due to Meckel's enterolith

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. The most common clinical presentation is intermittent and painless rectal bleeding, followed by intestinal obstruction. Intestinal obstruction due to Meckel's enterolith is rarely reported in children. We report a patient who presented with ileus secondary to fecalith impaction of Meckel's diverticulum, causing intestinal obstruction and diverticulitis.

Radiological features of Meckel's diverticulum and its complications

Meckel's diverticulum is the most common congenital abnormality of the small bowel. The majority of patients with this anomaly will remain asymptomatic; however, several complications may occur, including obstruction, intussusception, perforation, diverticulitis, and gastrointestinal haemorrhage. These complications may produce a variety of different clinical features and radiological appearances. The purpose of this article is to review the potential imaging manifestations of Meckel's diverticulum and its complications and discuss the advantages and disadvantages of the imaging techniques available.

CT diagnosis of Meckel diverticulum in a paracolic internal hernia

The autopsy incidence of internal hernia has been reported to be between 0.2% and 0.9%, and these hernias are usually diagnosed on imaging due to their complications or at surgery. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 1% to 3% of the population according to autopsy studies. The condition also is usually diagnosed at surgery, by barium studies or scintigraphy, or on cross-sectional imaging due to complications. We present an unusual case of a large Meckel diverticulum in a right paracolic hernia diagnosed on multidetector computed tomography. This diagnosis was made after attacks of subacute intestinal obstruction with the aid of multiplanar reconstructions. This case emphasizes the role of multidetector computed tomography and postprocessing techniques such as multiplanar reconstruction in the diagnosis of bowel pathology.

[Small bowel obstruction caused by enteroliths and Meckel's diverticulitis associated with internal paracecal hernia in an adult]

The Authors report a rare case of Meckel's diverticulum complicated by diverticulitis and a small bowel obstruction due to enteroliths, associated to a paracecal internal hernia. Computed tomography was useful for surgical planning.

Stromal tumour within a Meckel's diverticulum: CT and ultrasound findings

The incidence of tumours within a Meckel's diverticulum is 0.5-3.2%. Their pre-operative diagnosis is rare. We report a case of an incidentally found gastrointestinal stromal tumour within a Meckel's diverticulum in a patient presenting with acute appendicitis. The tumour was demonstrated pre-operatively by ultrasound and CT.