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Özbey H, Morozov DA. Inverted Meckel Diverticulum in a 13-Year-Old Boy. J Pediatr Gastroenterol Nutr 2023; 77:e48. [PMID: 37115951 DOI: 10.1097/mpg.0000000000003820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Hüseyin Özbey
- From the Department of Pediatric Surgery, Division of Pediatric Urology and Andrology, Sechenov First Moscow State Medical University, Moscow, Russia
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Lahham EE, Iwaiwi BI, Halteh S, Khaled H, AlQadi M. A unique case of inverted Meckel's diverticulum presented as an adult intussusception: a case report. J Surg Case Rep 2023; 2023:rjad288. [PMID: 37220592 PMCID: PMC10200354 DOI: 10.1093/jscr/rjad288] [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] [Received: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
Although Meckel's diverticulum (MD) is a relatively common asymptomatic gastrointestinal anomaly, an inverted MD is a rare entity that is challenging to diagnose prior to surgery and presents usually in the pediatric population with bleeding, anemia and abdominal pain. The most frequent adult presentation in non-inverted MD is intestinal obstruction, whereas bleeding and anemia are the most typical presenting complaints in inverted MD. Here, we report our experience with an adult female patient, who presented with 5 days duration of abdominal pain, nausea and vomiting. Imaging revealed signs of small bowel obstruction with bowel wall thickening in the terminal ileum and a double target appearance. This case describes a rare cause of adult intestinal intussusception because of inverted MD, which was successfully managed with surgery. The final pathology report confirms the diagnosis.
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Affiliation(s)
| | | | - Silvia Halteh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hala Khaled
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Mohammad AlQadi
- Department of General Surgery, Beit-Jala Hospital, Bethlehem, Palestine
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Endo Y, Jimbo K, Arai N, Ochi T, Suzuki M, Yamataka A, Shimizu T. A Pediatric Case of Inverted Meckel's Diverticulum Presenting with Cyclic Vomiting-like Symptoms: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121817. [PMID: 36553261 PMCID: PMC9776476 DOI: 10.3390/children9121817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Asymptomatic Meckel's diverticulum cases are not uncommon, leading to diagnostic difficulties in cases of atypical presentations with only gastrointestinal symptoms other than bloody stool. A nine-year-old boy diagnosed as having cyclic vomiting because of recurrent abdominal pain and vomiting for 6 months was referred to our institute and hospitalized due to worsening symptoms. After admission, abdominal ultrasonography showed the multiple concentric ring sign and a pseudokidney sign at the lower ileum, leading to the diagnosis of ileo-ileal intussusception, but the gastrointestinal symptoms and ultrasonic findings disappeared spontaneously. Transanal, double-balloon, intestinal endoscopy demonstrated a pedunculated polyp-like structure, and surgical resection was performed. An inverted diverticulum was found in the resected intestinal lumen, and ectopic gastric mucosa was identified histologically, leading to the diagnosis of inverted Meckel's diverticulum. In pediatric cases involving periodic attacks of vomiting and abdominal pain, unnecessary emergent surgery could be avoided by cautious imaging evaluation and consideration of ileo-ileal intussusception with advanced lesions of an inverted Meckel's diverticulum as a differential diagnosis, without facilely diagnosing cyclic vomiting. In addition, previous reports of inverted Meckel's diverticulum were reviewed, and the results were compared between adult and pediatric groups in each category.
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Affiliation(s)
- Yoshiko Endo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
- Correspondence: ; Tel.: +81-(0)3-3813-3111
| | - Nobuyasu Arai
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Mitsuyoshi Suzuki
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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Radiological and Clinical Characteristics of Intussuscepted, Inverting, and Inverted Meckel’s Diverticulum: A Case Series. Eur J Radiol 2022; 157:110611. [DOI: 10.1016/j.ejrad.2022.110611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
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Almas T, Alsubai AK, Ahmed D, Ullah M, Murad MF, Abdulkarim K, Alwheibi ES, Alansaari M, Abdullatif T, Hadeed S, Khan MO, Alsufyani M, Alzadjali E, Samy A, Oruk M, Kadom M, Alhajri FS, Barakat A, Alrawashdeh MM, Said M, AlDhaheri R, Mansoor E. Meckel's diverticulum causing acute intestinal obstruction: A case report and comprehensive review of the literature. Ann Med Surg (Lond) 2022; 78:103734. [PMID: 35592821 PMCID: PMC9110976 DOI: 10.1016/j.amsu.2022.103734] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Meckel's diverticulum is a congenital anomaly that is often detected incidentally. When it presents symptomatically, it causes painless gastrointestinal bleeding. Nevertheless, in rare instances, it can cause acute intestinal obstruction, often obscuring the true clinical picture. Case presentation A 31-year-old male presented to the emergency department with a 24-h history of unremitting nausea, biliary emesis, abdominal distension, and absolute constipation. After ruling out the most common etiologies of acute bowel obstruction, radiological imaging was obtained and was suggestive of meckel's diverticulum. Laparoscopic meckel's diverticulectomy was performed, with the subsequent histopathological analysis confirming ectopic gastric tissue. Discussion Meckel's diverticulum occurs consequent to incomplete obliteration of the vitelline or omphalomesenteric duct, which connects the developing intestines to the yolk sac. It is found in roughly 2% of the population, of which only about 4% may become symptomatic due to any number of complications. Specifically, small bowel obstruction (SBO) and diverticulitis secondary to ectopic gastric or pancreatic tissue are the most common presentations of symptomatic MD. Conclusion Although relatively rare in adults, MD should be considered in the list of differentials in patients with intussusception leading to SBO, especially on a background history unremarkable for the most common etiologies causing SBO including post-operative adhesions and hernias.
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Affiliation(s)
- Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Danyal Ahmed
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Muneeb Ullah
- Maroof International Hospital, Islamabad, Pakistan
| | | | | | | | | | | | | | | | | | | | - Arjun Samy
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mert Oruk
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mhmod Kadom
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Ahmed Barakat
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Mohammad Said
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Emad Mansoor
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Wang TY, Su YT, Ko PJ, Chen YL, Shih HH, Tsai CC. Chronic Nocturnal Abdominal Pain as the Presentation of Inverted Meckel Diverticulum: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010069. [PMID: 35053695 PMCID: PMC8774205 DOI: 10.3390/children9010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 04/15/2023]
Abstract
The common clinical manifestations of Meckel's diverticulum include painless lower gastrointestinal bleeding and intestinal obstruction due to intussusception. Intussusception induced by inverted Meckel's diverticulum has rarely been reported; furthermore, there is no report thus far of chronic nocturnal abdominal pain as a presenting symptom in children with Meckel's diverticulum. A 4-year-and-10-month-old girl with no significant history of previous illness presented with the sole complaint of chronic nocturnal abdominal pain for 3 months. The patient was reported to be asymptomatic during the day. A provisional diagnosis of chronic ileoileal intussusception was already under consideration in her previous hospital visits elsewhere. Physical examination revealed a soft, non-distended abdomen without tenderness. Imaging studies revealed ileoileal intussusception. Exploratory laparotomy showed ileoileal intussusception induced by an inverted Meckel's diverticulum with ulceration. The patient underwent successful surgery and made a full recovery. We report this case to remind physicians that Meckel's diverticulum should be considered in differential diagnosis of children presenting with the isolated symptom of chronic nocturnal abdominal pain.
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Affiliation(s)
- Ting-Yu Wang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- Department of Pediatrics, U-Sheng Hospital, Pingtung City 900023, Taiwan
| | - Yu-Tsun Su
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- School of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan
| | - Po-Jui Ko
- Department of Pediatric Surgery, E-Da Hospital, Kaohsiung City 824005, Taiwan;
| | - Yea-Ling Chen
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- School of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan
| | - Hsiang-Hung Shih
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 807387, Taiwan;
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- School of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan
- Correspondence: ; Tel.: +886-7-6150011 (ext. 251295); Fax: +886-7-6150950
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