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Moreno-Alfonso JC, Hernández Martín S, Molina Caballero A, Pérez Martínez A, Yárnoz Irazábal MC. The "rule of two" in Meckel's diverticulum - Does it truly apply to the pediatric population in our area? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 39364705 DOI: 10.17235/reed.2024.10798/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Meckel's Diverticulum (MD) originates from the incomplete obliteration of the omphalomesenteric duct during the seventh week of gestation. The classic clinical description of MD follows the "rule of two: 2% of the population, 2 inches in length, 2 feet from the ileocecal valve, a 2:1 ratio between males and females, and presentation at two years of age. This study evaluates to what extent the "rule of two" applies to a Spanish pediatric cohort.
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Shaikh FA, KA DV, Shaikh H, Oduoye MO. Recognizing perforated Meckel's diverticulum: A crucial differential in acute appendicitis imitation. Clin Case Rep 2024; 12:e9361. [PMID: 39206073 PMCID: PMC11348404 DOI: 10.1002/ccr3.9361] [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: 04/15/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Key Clinical Message Meckel's diverticulitis (MD) mimics acute appendicitis with right lower abdominal pain. Clinicians must consider MD in acute abdomen cases to avoid diagnostic delays. Perforated MD can lead to serious complications. Timely use of advanced imaging and surgical assessment is essential for accurate diagnosis and management. Abstract Meckel's diverticulum (MD) is a gastrointestinal congenital anomaly that signifies a persistent remnant of the omphalomesenteric duct. While frequently asymptomatic, its complications vary widely, ranging from mild and painless to potentially life-threatening conditions. This is a case of a 4-year-old female patient with sudden abdominal pain and tenderness, with an elusive cause before surgery. The definitive diagnosis of a perforated MD was established during diagnostic laparoscopy due to worsening symptoms. Detecting MD and its potential complications requires a high degree of suspicion. Once recognized, prompt management is essential to prevent further complications. Although perforation is uncommon in MD, its symptoms can mimic acute appendicitis, confusing emergency settings. This article underscores the significance of diagnosing MD, despite its rarity, and emphasizes the necessity for swift treatment upon identification.
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Affiliation(s)
| | - Dilip Vasant KA
- Department of General SurgerySVS Medical CollegeYenugondaIndia
| | - Humaira Shaikh
- Shadan Institute of Medical Science and ResearchHyderabadIndia
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Khalifa MB, Belaid AB, Ghannouchi M, Nacef K, Fodha M, Boudokhane M. Umbilical Littre hernia: A rare case report of an acute abdomen. Int J Surg Case Rep 2024; 114:109182. [PMID: 38157626 PMCID: PMC10800629 DOI: 10.1016/j.ijscr.2023.109182] [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: 11/01/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Littre's hernia (LH) is due to the presence of a Meckel's diverticulum (MD) in a hernial sac. It is an extremely rare condition in less than 1 % of all MD cases. It is often asymptomatic and is diagnosed incidentally during routine surgery for hernia repair. Surgery is the main treatment. Although the management of uncomplicated MD remains controversial, MD's management in the setting of either bowel obstruction or of Littre's hernia is done according to the clinical principles combined with the availability of local expertise. PRESENTATION OF CASE We report a case of an 11-year-old boy presented to the emergency room with a diagnosis of acute obstructive syndrome. Radiological exams were inconclusive. Intra-operatively findings showed a strangulated MD trapped in a small umbilical hernia. A simple wedge resection, followed by a primary closure of the remaining defect was performed. During 12 months of observation the patient remains in good condition. DISCUSSION LH is an uncommon type of abdominal wall hernia. Preoperative diagnosis is difficult. Even abdominal ultrasound and computed tomography (CT) cannot reveal the right diagnosis and it is generally performed intraoperatively. The main treatment is surgery. Repair of a Littre hernia requires both management of Meckel's diverticulum and repair of the hernia with sutures or mesh. CONCLUSION LH is a very rare type of hernia. Diagnosis is very difficult. All surgeons should be aware of this type of hernia to avoid life-threatening complications. The application of hernia repair recommendations for children may anticipate the happening of complicated LH.
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Affiliation(s)
- Mohamed Ben Khalifa
- General surgery Department Tahar sfar hospital Mahdia, Faculty of Medecine, University of Monastir Tunisia, Tunisia.
| | - Amel Ben Belaid
- General surgery Department Tahar sfar hospital Mahdia, Faculty of Medecine, University of Monastir Tunisia, Tunisia
| | - Mossaab Ghannouchi
- General surgery Department Tahar sfar hospital Mahdia, Faculty of Medecine, University of Monastir Tunisia, Tunisia
| | - Karim Nacef
- General surgery Department Tahar sfar hospital Mahdia, Faculty of Medecine, University of Monastir Tunisia, Tunisia
| | - Mahmoud Fodha
- General surgery Department Tahar sfar hospital Mahdia, Faculty of Medecine, University of Monastir Tunisia, Tunisia
| | - Moez Boudokhane
- General surgery Department Tahar sfar hospital Mahdia, Faculty of Medecine, University of Monastir Tunisia, Tunisia
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Smith JA, Tiller J, Lagomarsino E, Murphy J. A Febrile Infant With Abdominal Erythema and Irritability. Clin Pediatr (Phila) 2023; 62:1591-1594. [PMID: 36964685 PMCID: PMC10621025 DOI: 10.1177/00099228231162413] [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: 03/26/2023]
Affiliation(s)
- Jaron A. Smith
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Jennifer Tiller
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Elizabeth Lagomarsino
- Department of Radiology, Division of Pediatric Radiology, UT Southwestern, Dallas, TX, USA
| | - Joseph Murphy
- Department of Surgery, Division of Pediatric Surgery, UT Southwestern, Dallas, TX, USA
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Ali AY, Sarac A, Abdi AM, Mohamed AA. A strangulated umbilical hernia with perforated Meckel diverticulum: Case report. Int J Surg Case Rep 2023; 110:108681. [PMID: 37634437 PMCID: PMC10509809 DOI: 10.1016/j.ijscr.2023.108681] [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: 07/26/2023] [Revised: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Meckel's diverticulum (MD) is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. Strangulated umbilical hernia with a perforated Meckel diverticulum is an extremely rare event. CASE PRESENTATION We reported here a case of one year old boy of a strangulated umbilical hernia with perforated MD that operated at the Mogadishu hospital. A wedge resection of the MD and anastomosis was performed. CLINICAL DISCUSSION MD is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. About 60 % of cases come to medical attention before the age of ten, with the remainder of patients presenting in adolescence and adulthood. It is more difficult to diagnose in males, especially in adulthood. CONCLUSION Being aware of the likelihood that there could be a perforated Meckel's diverticulum in a sac of strangulated umbilical hernia has notable importance and may lead to innovative treatment and postoperative rehabilitation modalities.
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Affiliation(s)
- Abdullahi Yusuf Ali
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia.
| | - Ahmet Sarac
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia; Department of Pediatric Surgery, Samsun Training and Research Hospital, Turkey
| | - Abdishakur Mohamed Abdi
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Abdikafi Abdullahi Mohamed
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
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Mashlah Q, Zaher AM, Odah Bashi H, Zwaraa H, Dalati H. Torsion of the whole ileum and hemorrhagic necrosis because of a giant Meckel's diverticulum in a 9-month-old child. J Surg Case Rep 2023; 2023:rjad336. [PMID: 37293334 PMCID: PMC10247332 DOI: 10.1093/jscr/rjad336] [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: 01/17/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023] Open
Abstract
Intestinal ischemia caused by torsion of a freely hanging Meckel's diverticulum (MD) resulting in the need for resection is an uncommon complication. We present an extraordinary case of a 9-month-old male with acute abdominal symptoms because of intestinal ischemia and necrosis that necessitated resection of the entire ileum. This was caused by torsion around a particularly large MD.
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Affiliation(s)
- Qusai Mashlah
- Correspondence address. Department of Pediatric Surgery, Children Hospital, Damascus, Syria. E-mail:
| | - Ali M Zaher
- Department of Pediatric Surgery, Children Hospital, Damascus, Syria
| | - Hajar Odah Bashi
- Department of Pediatric Surgery, Children Hospital, Damascus, Syria
| | - Hanady Zwaraa
- Department of Pediatric Surgery, Children Hospital, Damascus, Syria
| | - Husam Dalati
- Department of Pediatric Surgery, Children Hospital, Damascus, Syria
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Bayissa BB, Yahya A. The uncommon complications of Meckel’s diverticulum: A single center case series study and literature review. INTERNATIONAL JOURNAL OF SURGERY OPEN 2023; 54:100613. [DOI: 10.1016/j.ijso.2023.100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2024]
Abstract
Abstract
Introduction and importance
Meckel’s diverticulum is the most common congenital true diverticula of the gastrointestinal tract with 4–9% life time risk of complications. It is difficult to diagnose preoperatively other than having high index of suspicion. Therefore, the aim of this case series is to present the rare presentation of this disease and create awareness for clinician to deliver early intervention so that associated mortality and morbidity will be minimized.
Case presentation
Here we present four cases of Meckel’s diverticulum managed in single center during a period of one year. Two cases were presented as isolated gangrenous Meckel’s diverticulum with small bowel obstruction. The remaining two were: an adult male patient operated for generalized peritonitis as a result of perforated Meckel’s diverticulitis and a child with intussusception in which Meckel’s diverticulum was secondarily obstructed.
Clinical discussion
The less frequent complications of Meckel’s diverticulum are more challenging to diagnose. It carries higher rate of morbidities since early diagnosis is difficult; especially, isolated axial torsion of the Meckel’s diverticulum that we are presenting in this case series. Therefore it is prudent to consider for a pain originating from central abdomen which gets diffuse in the meantime unlike symptoms of complicated appendicitis as symptomatic Meckel’s diverticulum.
Conclusion
The rare complications of Meckel’s diverticulum need high index of suspicion to diagnose as their symptoms mimic other pathologies which cause diffuse abdominal pain. Timely intervention can prevent hospital mortality, morbidity and decrease duration of hospital stay.
Highlights
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Mendoza Alvarez L, Rajderkar D, Beasley GL. An Unusual Case of a Perforated Meckel's Diverticulum. Case Rep Pediatr 2023; 2023:2289520. [PMID: 37122498 PMCID: PMC10147520 DOI: 10.1155/2023/2289520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Background Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract, typically presents in children with gastrointestinal bleeding. Case Presentation. An 11-year-old Caucasian male presented with a 6 week history of abdominal pain, vomiting, and diarrhea. He was found to have iron deficiency anemia, markedly elevated serum and fecal inflammatory markers, and imaging showing a contained bowel perforation. He was evaluated for infectious etiologies and later underwent extensive testing for inflammatory bowel disease. Ultimately, he was found to have a Meckel's diverticulum, which was successfully resected and led to resolution of his gastrointestinal complaints. Conclusions This case report highlights one of the more rare presentations in children, which is intestinal perforation. Symptoms of a Meckel's diverticulum can overlap with those of inflammatory bowel disease, as demonstrated by our patient. Clinicians should be familiar with criteria to establish diagnosis of inflammatory bowel disease, and if diagnosis isn't fully supported by testing, they should expand the differential and consider Meckel's diverticulum.
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Affiliation(s)
- Lybil Mendoza Alvarez
- University of Tennessee Health Science Center Pediatric Gastroenterology, Memphis, TN, USA
| | | | - Genie L. Beasley
- University of Florida Pediatric Gastroenterology, Gainesville, FL, USA
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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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Shen G, Jin B, Feng L, Fan Z. Meckel's Diverticulum with Multiple Sprouts at the Tip in a Child. Fetal Pediatr Pathol 2022; 42:488-491. [PMID: 36345052 DOI: 10.1080/15513815.2022.2142489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Meckel's diverticulum (MD) is usually a simple tubular-shaped diverticulum. Case report: We describe a MD with multiple complex terminal sprouts in a child found incidentally during an appendectomy for appendicitis. The MD was resected, and the child recovered well. Conclusion: MD may show multiple sprouts. There was no additional clinical consequence in this child with the malformed MD.
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Affiliation(s)
- Gang Shen
- Department of Pediatric Surgery, Dalian Women and Children's medical Center (Group), Dalian Medical University, Dalian, China
| | - Binghui Jin
- Department of General Surgery, the Third People's Hospital of Dalian, Dalian Medical University, Dalian, China.,Department of Central Laboratory, the Third People's Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Lu Feng
- Department of Pathology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Zhe Fan
- Department of General Surgery, the Third People's Hospital of Dalian, Dalian Medical University, Dalian, China.,Department of Central Laboratory, the Third People's Hospital of Dalian, Dalian Medical University, Dalian, China.,Liaoning Province Key Laboratory of Corneal and Ocular Surface Diseases Research Third People's Hospital of Dalian, Dalian, China
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11
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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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Takeyama J. Meckel's Diverticulum with Dieulafoy's Lesion: A Cause of Severe Hematochezia. Fetal Pediatr Pathol 2022; 41:865-870. [PMID: 34652969 DOI: 10.1080/15513815.2021.1989529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Meckel's diverticulum (MD) is a remnant of the omphalomesenteric duct. Although the majority of MD are asymptomatic, it can present with severe hematochezia. Hematochezia is generally considered to result from a peptic ulcer caused by ectopic gastric mucosa in MD. However, this hypothesis has not been proved. METHODS 10 cases of surgically resected MD initially presenting with severe hematochezia were histologically examined. RESULTS Ectopic gastric mucosa was present in 9 cases, two of which also contained ectopic pancreas. No ectopic tissue was found in one case, which shows that bleeding can occur in MD without ectopic gastric mucosa. In addition, a rupture of aberrant submucosal arterioles through the overlying mucosa, a vascular abnormality called Dieulafoy's lesion, was detected in all the 10 cases. CONCLUSION This study suggests that the actual cause of massive bleeding in MD is not a peptic ulcer, but Dieulafoy's lesion.
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Affiliation(s)
- Junji Takeyama
- Department of Pathology, Miyagi Children's Hospital, Sendai, Japan
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Munasinghe B, Dhanuksha D, Samarathunga R, Senevirathne P, Karunatileke C. Acute abdomen following axial torsion of a Giant Meckel's diverticulum in a young male: A case report. Int J Surg Case Rep 2022; 99:107631. [PMID: 36099772 PMCID: PMC9568704 DOI: 10.1016/j.ijscr.2022.107631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/17/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance Among Meckel's diverticulum (MD), the ‘Giant’ category is relatively rare. Most Giant MDs lead to complications such as torsion and diverticulitis. Presentation of case A 20-year-old South Asian male presented with a three-day history of vomiting and left-sided abdominal pain. X-ray and ultrasound scan of the abdomen illustrated features of small bowel obstruction. He underwent laparotomy under general anaesthesia. A gangrenous, axially torsed 25-cm Giant MD with concurrent ileal compression by a mesodiverticular band was detected and diverticulectomy and segmental resection with end-to-end anastomosis of the ileum was performed. Histology revealed ectopic gastric and pancreatic tissue. He had an uneventful postoperative stay and was devoid of any surgery-related complications at one-year follow-up. Clinical discussion Adults mainly present with bowel obstruction following complicated MDs. Multiple mechanisms have been elaborated as causalities of bowel obstruction where the presence of bands of congenital or inflammatory origin, intussusception, and enteroliths are relatively common. The presence of ectopic tissue in MDs is associated with increased complications. Symptomatic MDs need resection to abate future complications such as haemorrhage and obstruction. Conclusion Despite the low diagnostic potential of clinical examination and radiological studies, a high degree of suspicion is warranted in cases of probable MD-resultant complications, where more common aetiologies have been ruled out, as delay in diagnosis and definitive surgical therapy are invariably associated with worsened morbidity and mortality. It is high time to elucidate related demographics and clinical data on Giant MDs to identify high-risk categories and develop safer follow-up protocols. Giant Meckel's diverticulum (MD) is a rare entity. Complications such as torsion and diverticulitis are common complications of Giant MDs. Basic radiological studies lack sensitivity and specificity in detecting MDs. High degree of clinical suspicion is warranted whenever symptomatic MD is a probable diagnosis. Early surgical intervention with laparotomy or laparoscopy leads to favourable outcomes. Comprehensive data on Giant MDs are a necessity.
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Rout A, Morreau P, Bird H, Roberts A. Giant Meckel's Diverticulum in a 9-Year-Old Boy: An Unusual Presentation With Isolated Faltering Growth. JPGN REPORTS 2022; 3:e208. [PMID: 37168630 PMCID: PMC10158295 DOI: 10.1097/pg9.0000000000000208] [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: 01/28/2022] [Accepted: 04/07/2022] [Indexed: 05/13/2023]
Abstract
Meckel's diverticulum is the most common congenital gastrointestinal abnormality. Clinical presentation is normally in childhood with either hemorrhage or an acute surgical abdomen. The much rarer giant Meckel's diverticulum is associated with a more varied clinical presentation. In this case report, we provide a unique example of presentation with isolated faltering growth related to a giant Meckel's diverticulum in a young boy. We discuss the diagnostic process, imaging modalities, and subsequent surgical procedure.
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Affiliation(s)
- Alexandra Rout
- From the Department of Paediatric Surgery, Starship Child Health, Auckland, New Zealand
| | - Phil Morreau
- From the Department of Paediatric Surgery, Starship Child Health, Auckland, New Zealand
| | - Helen Bird
- Department of Paediatric Radiology, Starship Child Health, Auckland, New Zealand
| | - Amin Roberts
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
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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.
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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
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Devi GK, Goei AHY, Ragavendra K, Lim X, Choo CSC, Ong LY, Eu-Leong Teo HJ, Laksmi NK. Meckel's Diverticulum - Clinical Presentation and Pitfalls in Diagnosis in the Pediatric Age Group in Singapore. J Indian Assoc Pediatr Surg 2022; 27:340-344. [PMID: 35733589 PMCID: PMC9208684 DOI: 10.4103/jiaps.jiaps_392_20] [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: 12/30/2020] [Revised: 05/23/2021] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to study the presentation of patients who underwent Meckel's diverticulectomy (MD) and utility of pertechnetate Meckel's scan in the diagnosis of MD. Methods The clinical presentation of a retrospective cohort of patients who underwent MD from January 2007 to December 2019 was studied. The modes of presentation, treatment, and the diagnostic utility of pertechnetate Meckel's scans were evaluated. False-positive and false-negative scans were reviewed. The presence of gastric mucosa on histology of Meckel's was correlated with presentation as gastrointestinal bleeding and positive scan results. Results Ninety-nine patients underwent MD. Thirty-five out of 263 (13.3%) Meckel's scans done were positive. There was a male preponderance (86.9%). The peak age of presentation was 0-4 years (rectal bleeding or intestinal obstruction). Only a third of the patients with Meckel's diverticulum Meckel's had a preoperative diagnosis of Meckel's. The sensitivity/specificity of Meckel's scan was higher in patients presenting with painless rectal bleeding. Seven patients were false positive (weak tracer uptake or ectopic uptake) and five were false negative. Two patients with false-negative Meckel's scan, having gastrointestinal bleeding had gastric mucosa on histology of Meckel's. Conclusion Meckel's diverticulum has a male predominance. Meckel's scan has a high sensitivity in the children presenting with fresh painless rectal bleeding but is of limited use in the diagnosis of Meckel's diverticulum in other forms of presentations. False-positive scans can be anticipated in the presence of weak or ectopic uptake. False-negative scans can occur even in the presence of bleeding and in spite of the presence of gastric mucosa in the Meckel's diverticulum. Laparoscopy is a useful tool in diagnosis and treatment.
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Affiliation(s)
| | - Anne Hui Yi Goei
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | | | - Xuxin Lim
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Candy S. C. Choo
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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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.
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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
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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
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19
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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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Sagoe R, Seidu AS, Assim AO, Amoah M, Davor A, Galley F, Ayodeji EK, Kelechi IK, Yifieyeh A, Nimako B. Ruptured Meckel's diverticulum coexisting with a duplex appendix. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Guanà R, Pagliara C, Zambaiti E, Scottoni F, Pane A, Garofalo S, Pizzol A, Giuliani F, Carpino A, Gennari F. Incidental Ultrasound Diagnosis of Neonatal Intussusception Secondary to Meckel's Diverticulum in a Neurologically Impaired Child. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932280. [PMID: 34482359 PMCID: PMC8428622 DOI: 10.12659/ajcr.932280] [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] [Indexed: 12/02/2022]
Abstract
Patient: Female, 1-month-old
Final Diagnosis: Intussusception
Symptoms: Rectal bleeding
Medication: —
Clinical Procedure: Ultrasonography
Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Riccardo Guanà
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Camilla Pagliara
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Elisa Zambaiti
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Federico Scottoni
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Alessandro Pane
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Salvatore Garofalo
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonio Pizzol
- Department of Pediatric Gastroenterology, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesca Giuliani
- Department of Pediatrics and Neonatology, Regina Margherita Children's Hospital, Turin, Italy
| | - Andrea Carpino
- Department of Pediatrics and Health Sciences, Turin University, Turin, Italy
| | - Fabrizio Gennari
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
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Gawrieh B, Shater W, Deeb MA, Ghuzlan A, Kassab H, Salhab N. Litrre's hernia: partially reduced inguinal hernia in a 3-year-old boy. J Surg Case Rep 2021; 2021:rjab421. [PMID: 34611490 PMCID: PMC8485683 DOI: 10.1093/jscr/rjab421] [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: 08/12/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
This report examines the case of a 3-year-old child presenting with a 1-month history of swelling in the right groin. The boy had no associated nausea or vomiting, was afebrile and had had normal bowel movements. Attempts to reduce the swelling were only partially successful. Ultrasonography indicated the presence of turbid hydrocele and a hernia sac containing an intestinal loop. Accordingly, the patient underwent an urgent herniotomy. Exposing the hernia sac revealed 5 cm Meckel's diverticulum, and the base of the diverticulum was resected from the inside of the hernia sac. The boy was discharged 4 days after the operation in good clinical condition. The presented case highlights the need to consider Littre's hernia when dealing with partially reduced inguinal hernias in children with no general signs or evidence of intestinal obstruction.
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Affiliation(s)
- Bardisan Gawrieh
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Waseem Shater
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Mohammad Ali Deeb
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Alaa Ghuzlan
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Hanna Kassab
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Nabila Salhab
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
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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
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Gunadi, Damayanti W, Saputra RP, Ramadhita, Ibrohim IS, Lestiono A, Melati D, Permatahati WI, Widowati T, Makhmudi A. Case Report: Complicated Meckel Diverticulum Spectrum in Children. Front Surg 2021; 8:674382. [PMID: 34113646 PMCID: PMC8185063 DOI: 10.3389/fsurg.2021.674382] [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] [Received: 03/01/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Meckel diverticulum (MD) is the most common congenital anomaly of the intestines, with an incidence of 2% of the general population. It can present as various clinical features with complications and be life threatening if diagnosis is delayed and treatment late. Case Presentation: We report three pediatric cases with complicated MD: one female presented with small-bowel obstruction, one male with peritonitis, and one female with severe iron-deficiency anemia, without gross gastrointestinal bleeding nor any ectopic gastric mucosa. All patients underwent exploratory laparotomy, segmental small-bowel resection, and primary anastomosis. They successfully recovered and were uneventfully discharged on the fourth, seventh, and 10th postoperative days, respectively. Conclusions: MD can present with various complication spectrums, including small-bowel obstruction, peritonitis, and severe iron-deficiency anemia, which may cause difficulty in definitive diagnosis, particularly in children. Segmental small-bowel resection and primary anastomosis are effective surgical approaches and show good outcomes for MD patients.
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Affiliation(s)
- Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Wahyu Damayanti
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Robin Perdana Saputra
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ramadhita
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ibnu Sina Ibrohim
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Andi Lestiono
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Devy Melati
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Winda Intan Permatahati
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Titis Widowati
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Akhmad Makhmudi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Rosado M, Serena T, Pui J, Parmely J. A case report of a ruptured Meckel's diverticulum with ectopic gastric and pancreatic tissue with negative computed tomography. Int J Surg Case Rep 2021; 83:105994. [PMID: 34098189 PMCID: PMC8187837 DOI: 10.1016/j.ijscr.2021.105994] [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: 03/08/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction A Meckel's diverticulum is a rare but known cause of an acute abdomen and can often be confused for acute appendicitis on physical examination. It is caused by an incomplete closure of the omphalomesenteric duct. It is present in 2% of the population and only 2% of those patients are symptomatic. Case presentation This is the case of a sixty-four-year-old male presented to the surgical clinic at request of his primary care physician with concern for acute appendicitis. The patient had a CT A/P with IV contrast performed two days prior to his office visit for the same pain which was non-diagnostic. The patient was taken to the operating room and found to have Meckel's Diverticulitis which was managed by laparoscopic hand-assisted small bowel resection and anastomosis. The patient had an uncomplicated postoperative course. Pathology demonstrated ulcerated gastric mucosa and pancreatic tissue. Discussion Symptomatic Meckel's diverticulum is managed with small bowel resection versus diverticulectomy based on characteristics of the diverticulum. The most common type of ectopic tissue is gastric followed by pancreatic. It is rare to find both types of tissue together. Conclusion This case describes an unusual case of a rare acute surgical pathology with non-diagnostic imaging and labs. This case also describes an exceedingly rare histopathology of a Meckel's Diverticulum with the presence of both ectopic gastric and pancreatic tissues. Meckel's Diverticulum in adults commonly presents with inflammation, small bowel obstruction and perforation. The recommendation for treatment of a symptomatic Meckel's diverticulum is surgical resection. Meckel's Diverticulum contain ectopic tissue, most commonly gastric and pancreatic tissue but rarely together.
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Affiliation(s)
- Marcos Rosado
- Department of General Surgery, Beaumont, Health Farmington Hills, MI, USA
| | - Thomas Serena
- Department of General Surgery, Beaumont, Health Farmington Hills, MI, USA
| | - John Pui
- Department of Pathology, Beaumont, Health Farmington Hills, MI, USA
| | - John Parmely
- Department of General Surgery, Beaumont, Health Farmington Hills, MI, USA
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Li F, Jia G. Gastrointestinal stromal tumor in ruptured Meckel's diverticulum located in jejunum caused myelosuppression for a short time: A case report. Int J Surg Case Rep 2021; 84:105968. [PMID: 34225064 PMCID: PMC8259299 DOI: 10.1016/j.ijscr.2021.105968] [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: 03/25/2021] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastrointestinal stromal tumor (GIST) in Meckel's diverticulum (MD) is rare but it seems to be a common phenomenon that GIST triggers MD perforation or rupture; the exact mechanism is unclear. In addition, the location of GIST in perforated or ruptrued MD is most common in ileum, rarely in jejunum. We herein report a GIST in ruptured MD Located in jejunum and severe peritoneal cavity infection leads to myelosuppression. CASE PRESENTATION A female patient was admitted to our hospital with "abdominal pain". Physical examination and laboratory tests revealed that the patient was in shock and myelosuppression. Abdominal X-ray photograph and computed tomography indicated perforation of digestive tract. Laparotomy revealed rupture of MD located 90 cm from the Treitz ligament and a tumor was also found in the MD. As the condition is critical, the MD was excisioned from its root and the small bowel gap was closed and repaired. Laboratory indicators showed that myelosuppression was removed 24 h after operation. The pathological findings established a GIST in the MD. The patient was discharged on postoperative day 5 without significant complications. CLINICAL DISCUSSION A GIST in ruptured MD Located in jejunum caused the severe peritoneal cavity infection and myelosuppression In a short time, as seen in this case. Failure to recognize the severity of the disease and delay in treatment will endanger the life of the patient. CONCLUSION GIST in MD Located in jejunum is very rare, and the rupture of the MD can be life-threatening at any time.
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Affiliation(s)
- Fengjuan Li
- Department of Neurology, Baotou Eighth Hospital, Baotou, Inner Mongolia, China
| | - Guoqun Jia
- Department of General Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, Inner Mongolia, China.
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27
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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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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.
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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
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Gastric heterotopic pancreas in children: A prospective endoscopic study. J Pediatr Surg 2020; 55:2154-2158. [PMID: 31757509 DOI: 10.1016/j.jpedsurg.2019.10.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To document the prevalence and variable appearance of gastric heterotopic pancreas (HP) in children undergoing upper gastrointestinal (GI) endoscopy. METHODS A prospective 4-year study of children undergoing flexible upper GI endoscopy in a single institution. RESULTS A total of 607 upper GI endoscopies were performed in 478 pediatric patients during the 4-year period. Eleven children (6 girls, 5 boys) aged 2.9 to 16.9 years had endoscopic features typical of gastric HP. All but one lesion was located in the gastric antrum and most appeared as an umbilicated submucosal nodule measuring 1-2 cm in diameter. Five of 13 children with repaired esophageal atresia (EA) and two of nine children with trisomy 21 had gastric HP. The prevalence of endoscopically visualized gastric HP in children without a history of EA or trisomy 21 was 1.1%. CONCLUSIONS Gastric HP is present in about 1% of pediatric upper GI endoscopies. It is significantly more common in patients with EA and may also be associated with trisomy 21. Gastric HP typically appears as a single 1-2 cm antral submucosal nodule, usually with a central pit. Recognition of this lesion is important to avoid misdiagnosis and inappropriate treatment. LEVEL OF EVIDENCE Level II (diagnostic).
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30
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Kloth C, Roßkopf J, Schmidt SA, Wowra T, Gems R, Beck A, Vogele D. [Abdominal pain and anaemia in a young patient]. Radiologe 2020; 60:1169-1171. [PMID: 32886160 DOI: 10.1007/s00117-020-00740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - J Roßkopf
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - S A Schmidt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T Wowra
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - R Gems
- Klinik für Allgemein- und Viszeralchirurgie, Sektion Kinderchirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - A Beck
- Klinik für Pathologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - D Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
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31
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Meckel's mesodiverticular band causing an internal hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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32
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Nessel TA, Kerndt CC, Shareef ZJ, Doig C. Myocardial Ischemia, a Rare Presentation of Meckel's Diverticulum. Spartan Med Res J 2020; 5:12844. [PMID: 33655180 PMCID: PMC7746025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/15/2020] [Indexed: 10/08/2023] Open
Abstract
CONTEXT Meckel's diverticulum is a rare congenital anomaly of the gastrointestinal tract. It is typically asymptomatic and found incidentally in the work-up of another medical complaint. However, it has been known to cause complications in a minority of cases. METHODS This case involves an elderly male in his early 80's who presented to the emergency department with a 2-day history of emesis and hematochezia, in addition to sudden onset syncope and angina-like symptoms. Serial electrocardiograms demonstrated diffuse ST-segment depressions, consistent with myocardial ischemia. The patient underwent laboratory testing, imaging, endoscopy, and a subsequent exploratory laparotomy. RESULTS Laboratory results revealed lactic acidosis, anemia, and leukocytosis. Upper endoscopy resulted in negative findings. Imaging, including CT-scan and Technetium-99 RBC scan, visualized a gastrointestinal bleed. However, the arterial embolization procedure was unable to stop the bleeding diverticulum. Exploratory laparotomy revealed an infarcted Meckel's diverticulum. CONCLUSIONS This case demonstrates the importance of clinicians generating a wide differential when evaluating a gastrointestinal bleed, and considering Meckel's diverticulum as a potential cause of a bleed with an unknown source. The primary test to diagnose a Meckel's diverticulum is a Technetium-99 RBC scan. However, visualization via exploratory laparotomy is the best test for definitive diagnosis. The decision to intervene surgically earlier can limit mortality with symptomatic Meckel's diverticula.
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Affiliation(s)
| | - Connor C Kerndt
- Spectrum Health/Michigan State University College of Human Medicine
| | - Zaid J Shareef
- Michigan State University College of Osteopathic Medicine
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Wu J, Huang Z, Wu H, Ji M, Wang Y, Tang Z, Huang Y. The diagnostic value of video capsule endoscopy for Meckel's diverticulum in children. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:429-433. [PMID: 32450705 DOI: 10.17235/reed.2020.6708/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is also an important cause of bloody stool and anemia in children. However, there are few data about video capsule endoscopy (VCE) for MD in children. This study aimed to evaluate the diagnostic value of VCE for MD in children. MATERIALS AND METHODS children who underwent VCE for obscure gastrointestinal bleeding from October 1st 2015 to August 31st 2019 at the Children's Hospital of Fudan University were included in this retrospective study. Medical data, VCE data and Meckel's scans, etc. were collected for each patient. RESULTS sixteen patients were diagnosed with MD by VCE, including 13 males and 3 females. The age of the patients ranged from 4 years to 13 years, with an average of 7.8 ± 2.7 years. Lower gastrointestinal tract bleeding was the main symptom for patients with MD, including hematochezia (75 %) and melena (25 %). Of the VCE findings, 14 patients had double lumen signs and 2 showed protruding lesions. Among the 16 patients diagnosed with MD by VCE, 14 patients were diagnosed with MD by Meckel's scan, 3 with MD by abdominal enhanced CT and 14 patients were diagnosed with MD by surgery. During the follow-up, bleeding occurred sporadically in patient 12 and the reason is still unknown. CONCLUSIONS VCE is useful for the diagnosis of MD and should be used as a valuable and less invasive examination to confirm or establish a diagnosis.
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Affiliation(s)
- Jie Wu
- Gastroenterology, Children's Hospital of Fudan University
| | - Zhiheng Huang
- Gastroenterology, Children's Hospital of Fudan University,
| | - Ha Wu
- Nuclear Medicine, Children's Hospital of Fudan University
| | - Min Ji
- Radiology, Children's Hospital of Fudan University
| | - Yuhuan Wang
- Gastroenterology, Children's Hospital of Fudan University
| | - Zifei Tang
- Gastroenterology, Children's Hospital of Fudan University
| | - Ying Huang
- Gastroenterology, Children's Hospital of Fudan University
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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.
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Varga I, Nosál M, Babál P. Ectopic lamellar Pacinian corpuscle within the thymus. Atypical or abnormal location? ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:273-276. [PMID: 32747922 PMCID: PMC7728121 DOI: 10.47162/rjme.61.1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 05/20/2020] [Indexed: 12/19/2022]
Abstract
Lamellar (Pacinian) corpuscle is a cutaneous encapsulated sensory corpuscle, mainly functioning as a rapidly adapting low-threshold mechanoreceptor with characteristic "onion skin"-like appearance. Even though the Pacinian corpuscle is typically located in the skin, histomorphologically and confirmed by using immunohistochemical methods, we have identified it within the interstitium of the thymus of a newborn with congenital heart defect. To the best of our knowledge, this is the first such account ever to be published. The structure of the thymic Pacinian corpuscle was the same as the Pacinian corpuscle in the skin. The ectopic thymic Pacinian corpuscle can be hypothetically explained as the consequence of impaired migration of neural crest cells, since neural crest-derived cells play an important role in the development of the Pacinian corpuscle, as well as the thymus and heart. In general, the occurrence of ectopic Pacinian corpuscle in different organs is rare. In the scientific literature, there are reports of its sporadic presence in the pancreas, in the lymph nodes, inside the prostate and the urinary bladder wall. Our report presents the first described case of the Pacinian corpuscle in a heterotopic location in the thymus. Similar to other incidental findings of this anatomic structure, explanation of its ectopic development, as well as its local function remains only speculative.
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Affiliation(s)
- Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic;
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