Meckel's Diverticulum in Adults: Surgical Concerns

Intestinal obstruction secondary to perforation of Meckel's diverticulum caused by dentures: a case report and review of literature

BACKGROUND

Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. However, MD is rare in clinical practice, and perforation of a MD by a foreign body is even rarer. Preoperative diagnosis is difficult because there is often insufficient information; therefore it is usually diagnosed intraoperatively. Although rare, it should be considered as a differential diagnosis in patients who have ingested foreign bodies.

CASE PRESENTATION

The following is the case of a 52-year-old female patient who was admitted because of generalized abdominal pain for 5 days, related to nausea and vomiting. She also stopped passing gas. Inflammatory indicators were elevated, and computed tomography (CT) revealed gas-liquid levels in the small intestine and high-density objects in the ileum. Based on the patient's condition, laparotomy was performed instead because the laparoscopic procedure was difficult to perform. Intraoperatively, a foreign body perforated the diverticulum of the terminal ileum, resulting in the development of an abdominal abscess. Finally, we performed resection of the ileal diverticula and partial resection of the ileum. After the surgery, it was confirmed that the foreign bodies were two dentures accidentally eaten by the patient.

CONCLUSION

A thorough understanding of the clinical presentation, imaging features, and treatment of MD and its complications will assist clinicians in making prompt and accurate diagnoses and providing symptomatic treatment.

Acute intestinal obstruction due to meckel's diverticulum: A case report and literature review

Introduction

and Importance: Meckel's diverticulum is a rare congenital condition often detected incidentally. Meckel's diverticulum, a rare disease, may result in acute intestinal obstruction and is frequently misdiagnosed. This study aims to report a case of acute intestinal obstruction due to Meckel's diverticulum.

Case presentation

A 61-year-old Javanese man was admitted to the emergency room with a history of constipation, nausea, vomiting, and abdominal pain. Physical examination showed abdomen distention, tenderness in the lower quadrant, and hyperactive bowel sound. Rectal examination found that the rectal ampulla was collapsed. A plain abdominal Radiograph showed small bowel dilatation and air-fluid levels. The patient was diagnosed with small bowel obstruction due to suspected left-sided colon cancer and taken up for exploratory laparotomy.

Clinical discussion

On exploration, Meckel's diverticulum measuring 3.5 cm in length and with a 2 cm base was found about 70 cm proximal to the Bauhin valve; the thin part formed a band that entangled the small bowel. Ileo-ileal resection anastomosis was performed.

Clinical discussion

Meckel's diverticulum is an intestinal pouch caused by incomplete obliteration of the vitelline duct during gestation. This condition affects 2 % of the population and is within 2 feet of the Bauhin valve. The mesodiverticular band was found to be the source of the bowel obstruction. Surgical resection is required for complicated diverticulum.

Conclusion

Meckel's diverticulum can be difficult to diagnose and require a higher level of suspicion. Although Meckel's diverticulum is uncommon in adults, it should be considered a cause of small bowel obstruction.

Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review

Background

Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, poses a dilemma when incidentally encountered during surgery. Despite historical descriptions and known complications of symptomatic MD, the decision to resect an incidental MD (IMD) lacks clear guidelines. This study aims to assess whether resecting IMDs is justified by synthesizing evidence from studies published between 2000 and 2023. Factors influencing this decision, such as demographic risks, surgical advancements and complications, are systematically examined.

Methods and Material

Following the PRISMA 2020 guidelines, this review incorporates 42 eligible studies with data on outcomes of asymptomatic MD management. Studies, both favoring and opposing resection, were analyzed.

Results

Considering complications, malignancy potential, and operative safety, the risk-benefit analysis presents a nuanced picture. Some authors propose conditional resection based on specific criteria, emphasizing patient-specific factors. Of 2934 cases analyzed for short- and long-term complications, the morbidity rate was 5.69%. Of 571 cases where mortality data were available, all 5 fatalities were attributed to the primary disease rather than IMD resection.

Conclusion

The sporadic, unpredictable presentation of IMD and the variability of both the primary disease and the patient make formulation of definitive guidelines challenging. The non-uniformity of complications reporting underscores the need for standardized categorization. While the balance of evidence leans towards resection of IMDs, this study acknowledges the individualized nature of this decision. Increased safety in surgery and anesthesia, along with better understanding and management of complications favor a judicious preference for resection, while taking into account patient characteristics and the primary disease.

Torsion of Meckel's diverticulum-a case report and literature review

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Torsion is a rare complication of MD with only 48 cases described in the English literature to date. We describe a case of a 22-year-old male who presented to the emergency department with lower abdominal pain. Pre-operative computed tomography scan suggested a torted MD. This was confirmed on diagnostic laparoscopy and managed with segmental resection of the MD and a concurrent appendicectomy. Histopathology confirmed torsion of MD and a normal appendix. The patient recovered well without any complications. Torsion occurs invariably with giant MD defined as a length of >5 cm. Surgical options for MD include diverticulectomy, wedge resection and segmental resection via laparoscopic or open approach. The rate of pre-operative diagnosis remains low but with advances in imaging and awareness of this condition, this is likely to increase with time.

Meckel's diverticulum: analysis of 27 cases in an adult population

Background

Meckel's diverticulum is a rare congenital pathology among newborns. Nevertheless, it is an uncommon abdominal pathology in the adult population. Therefore, we aim to provide a detailed account of our surgical approach in treating 27 cases of Meckel's diverticulum.

Methods

This study is a cross-sectional analysis that utilized a database with prospectively collected data from 2004 to 2022. All patients under the age of 18 were excluded from the population. We described the population's demographic characteristics, symptoms, anatomopathological study, surgical technique, complications, morbidity, and mortality. A subgroup analysis was performed between the symptomatic and asymptomatic patients.

Results

A total of 27 patients who underwent surgical resection for a posteriorly diagnosed Meckel's diverticulum were included. The male population accounted for 81.4% (n = 22) of the sample size. The symptomatic group consisted of 18 male and four female patients. Abdominal pain was the predominant symptom in 85% of the patients. Out of the 22 symptomatic patients, only 9% had a positive perioperative diagnosis of Meckel's diverticulum. All 27 patients with diverticulum diagnosis received the resection through diverticulectomy (n = 6), small bowel resection with end-to-end anastomosis (n = 6), and small bowel resection with lateral to lateral anastomosis (n = 15). The mean distance between the diverticulum and the ileocecal valve was 63.4 cm. The symptomatic group had an average diverticulum length of 3.54 cm, with an average base width of 2.47 cm. In the other group, the values were 2.75 and 1.61 cm. The average length of hospital stay in the symptomatic group was 7.3 days.

Conclusions

Meckel's diverticulum is a rare pathology in the adult population. Its presentation varies from asymptomatic to symptomatic patients, and surgery is the cornerstone treatment for this pathology.

Meckel's diverticulum: Unusual cause of significant bleeding in an adult male

Meckel's diverticulum is a common congenital gastrointestinal malformation affecting 2% of the general population. Most affected patients are asymptomatic, and excessive bleeding causing a significant drop in hemoglobin count is an uncommon complication of Meckel's diverticulum, especially in adult patients. Herein, we present an adult case of Meckel's diverticulum that nearly led to hemodynamic instability. Laparotomy and segmental small bowel resection were critical in treating the patient.

Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.

A gigantic Meckel's diverticulum: A case report of an exceptional cause of small bowel obstruction

INTRODUCTION

Meckel's diverticulum (MD) is the most common congenital malformation of the digestive tract, but the odds of stumbling on MD exceeding 10 cm are rare. Although obstruction is described in the literature, its occurrence due to an internal hernia caused by a fibrous band generated from a gigantic diverticulum is exceptional. This presentation aims to illustrate an exceptionally rare case of a gigantic MD responsible for a bowel obstruction due to the constriction caused by a fibrous band.

CASE PRESENTATION

A 45-year-old patient was admitted with symptoms of small bowel obstruction. On Examination, the abdomen was distended with rebound tenderness in the right iliac fossa. A CT scan showed a small bowel volvulus without signs of appendicitis. During emergency laparotomy, we found a 25 cm-long MD. The tip of the diverticulum was linked to the adjoining mesentery through a fibrous band, forming a narrow internal ring responsible for the strangulation of a part of the ileum, leading to gangrene.

DISCUSSION

Small bowel obstruction caused by a gigantic MD is rare. Diagnosis can be challenging due to its unspecific features. Management of complicated MD is surgical. Nevertheless, the management of asymptomatic MD continues to be a topic of significant disparity among authors, as there are no definitive guidelines that unequivocally dictate whether resection is warranted or not.

CONCLUSION

A gigantic MD causing small bowel obstruction is rare. Emergency doctors and surgeons should maintain a high index of suspicion for complicated MD in the preoperative phase to reduce morbidity and mortality.

Double trouble: concomitant Meckel's diverticulitis and acute appendicitis

Although Meckel's diverticulum is the most common congenital anomaly of the small bowel (2% prevalence worldwide), it rarely causes symptoms, with only 4% of those with the anomaly developing any complications, including Meckel's diverticulitis. In contrast to this, appendicitis is the most common general surgical emergency, with a lifetime incidence of 6.7-8.6%. Therefore, the case of a man presenting with right-sided abdominal pain to an Emergency Department with both Meckel's diverticulitis and appendicitis is rare. This case study illustrates the importance of careful assessment of the entire abdomen when operating on patients with right-sided abdominal pain, so as not to miss Meckel's diverticulitis even when appendicitis has already been found.

Clinical characteristics and treatment outcomes of symptomatic Meckel diverticulum: a comparative study among children, adolescent, and adult patients

Purpose

We investigated the clinical characteristics and treatment outcomes of symptomatic Meckel diverticulum (MD) in adolescents by comparison with children and adults.

Methods

We retrospectively reviewed the medical records of patients who underwent symptomatic MD surgery from January 2002 to December 2019. Demographic information, clinical presentations, preoperative evaluations, operative variables, postoperative outcomes, and pathologic findings were collected. We performed analyses by dividing all patients into three groups according to age at surgery: child group (<10 years), adolescent group (10-19 years), and adult group (≥20 years).

Results

Forty-three patients underwent symptomatic MD surgery (the child group, 14; the adolescent group, 17; and the adult group, 12). Vomiting and intestinal obstruction decreased significantly with age (P = 0.042 and 0.001), whereas hematochezia and gastrointestinal bleeding showed an increasing trend with age, although not statistically significant (P = 0.064 and 0.064). Ultrasound performance decreased significantly with age (P = 0.002), whereas CT performance showed an increasing trend with age, although not statistically significant (P = 0.193). Preoperative diagnosis rate increased significantly with age (P = 0.029). Laparoscopic surgery was performed significantly more in the adult group than in other groups (P = 0.001). The sizes of MD were significantly greater in the adolescent group than in other groups (P = 0.006 and 0.002).

Conclusion

The clinical characteristics and treatment outcomes of symptomatic MD in adolescents exhibit a transitional pattern between children and adults. Therefore, it is important for clinicians to recognize that adolescent patients with symptomatic MD have the characteristics of both children and adult patients to ensure optimal care.

INTESTINAL OBSTRUCTION FROM MECKEL'S DIVERTICULUM IN AN ADULT; UNSUSPECTED BUT FOUND- A CASE REPORT

Introduction

Most cases of Meckel's Diverticulum (MD) are asymptomatic and when symptomatic, preoperative diagnosis of MD maybe a dilemma. Intestinal obstruction is a major complication in the adult population.

Case presentation

We report a case of a 24-year-old female presenting with intestinal obstruction from Meckels Diverticulum.

Conclusion

MD is largely asymptomatic in adults, however may be present and should be included in our array of differential diagnoses.

Management of Littre Hernia-Case Report and Systematic Review of Case Reports

Littre hernia is a rare type of hernia in which a Meckel diverticulum is found in the hernia sac. Given the rare nature of this disease, little data on demographics and surgical management exists. In this article, we provide a case report of a strangulated inguinal Littre hernia and perform a systematic review of the literature. The PubMed database was searched on 5 March 2022, and all cases of Littre hernia in adults that had English abstracts or full-text were analyzed. Our primary objective was to evaluate the surgical management and outcomes of this particular type of hernia, and our secondary objectives were to assess demographic characteristics, presentation particularities, and recurrence rates. We identified 89 articles with 98 cases, including our own. Results show a high prevalence of complications described intraoperatively, with strangulation being present in up to 38.46% of patients. The laparoscopic approach was utilized in patients with femoral, inguinal, and umbilical hernias. The most commonly performed type of resection was MD resection, followed by bowel resection, while a minority of cases (5.48%) remained unresected. Mesh repair was more frequently performed in patients with MD resection. A mortality rate of 8.7% in patients who underwent bowel resection was found. A relatively high number of reports of ectopic tissue (21.21%), ulceration (12.12%), and tumors (9.09%) were found. The average follow-up was 19.5 ± 10.29 months, with no hernia recurrence. In conclusion, most cases are admitted in an emergency setting, and intestinal obstruction is frequently associated. A minimally invasive approach can be an option even for complicated hernias. MD resection or bowel resection is usually employed, depending on the extent of ischemic lesions. Patients undergoing bowel resection may be prone to worse outcomes.

Meckel's Diverticulum Charading as Crohn's Disease: A Single-Institution Case Series

Meckel's diverticulum is the most common gastrointestinal congenital anomaly and may present with lower gastrointestinal bleeding, abdominal pain, and nausea. Imaging and endoscopic findings can be similar to those of Crohn's disease, including transmural inflammation, stricturing, and superficial ulceration frequently in the distal ileum. Here, we present a case series of three patients who were initially diagnosed with Crohn's disease and ultimately found to have Meckel's diverticulum alone on final pathology. This single-institution case series, the largest in the literature, highlights the importance of maintaining a high index of suspicion for Meckel's diverticulum, especially in the absence of microscopic evidence of inflammatory bowel disease.

Meckel's diverticulectomy: a multi-centre 19-year retrospective study

BACKGROUND

Meckels diverticulum (MD) causes a number of acute surgical pathologies and can contain ectopic tissue with the surgical aim to resect all ectopic mucosa. This has traditionally implied a small bowel resection (BR); though contemporary literature has demonstrated Meckel's diverticulectomy to be safe. The aim of this study was to determine optimal resection strategy, and assess MD histopathological features and their relationship to outcomes.

METHODS

A 19-year retrospective review of patient medical records across seven hospitals was conducted with demographic, clinical and pathological data collected. Analysis was conducted using a student's t-test for continuous variables and chi-squared test for categorical variables. Univariate regression was performed to identify risk factors. P < 0.05 was considered statistically significant.

RESULTS

One hundred and sixty patients underwent resection of MD, 70 (44%) had Meckel's diverticulectomy and 90 (56%) had BR. No significant difference in length (P = 0.486), width (P = 0.238), or ratio (P = 0.188) of diverticulectomy compared to BR, with fewer complications in diverticulectomy. In all, 24 (15.3%) MD were perforated, of whom 5 had gastric mucosa, 2 had mixed ectopic mucosa and 1 carcinoid tissue. There were no cases of ectopic mucosa in the resection margin requiring re-operation, or causing base perforation. MD specimen with greater length: width ratio was a risk factor for perforation OR 1.437 P = 0.042 but not for malignancy P = 0.813 or ectopic tissue P = 0.185.

CONCLUSION

Meckel's diverticulectomy is safe via laparoscopic or open approach compared with BR. Despite higher perforation rates in MD with greater length: width ratio, no malignancy or ectopic risk was identified, supporting diverticulectomy as a safe operative approach.

Acute abdomen following axial torsion of a Giant Meckel's diverticulum in a young male: A case report

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.

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Giant Meckel's diverticulum (MD) is a rare entity.

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Complications such as torsion and diverticulitis are common complications of Giant MDs.

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Basic radiological studies lack sensitivity and specificity in detecting MDs.

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High degree of clinical suspicion is warranted whenever symptomatic MD is a probable diagnosis.

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Early surgical intervention with laparotomy or laparoscopy leads to favourable outcomes.

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Comprehensive data on Giant MDs are a necessity.

Obstructive acute abdomen due to Meckel's diverticulum in adult: Case report

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.

Treatment of an unusual case of Meckel's diverticulum with a new robotic platform

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.

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Meckel's diverticulum can persist in the elderly, thus ruling out the disease based on age is not reasonable.

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Many diagnostic techniques can be used to investigate Meckel's diverticulum, however the most reliable is the Meckel's scan.

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Once Meckel's is diagnosed surgical treatment is usually curative.

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Small bowel resection can be done with this new robotic platform.

Emergency Presentations of Meckel’s Diverticulum in Adults

Introduction

Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract in humans that is commonly encountered during surgical practice as the cause of the patient's presentation or as an incidental finding during other unrelated procedures. Most clinical symptoms are caused due to its complications.

Results

The mean age of the involved patients was 24.79 years with slight male predominance, 62.9% males compared to 37.1% females. The mean length of the diverticulum was 55.21 cm. The most common emergency presentation was right lower quadrant abdominal pain in 31% of the patients, intestinal obstruction in 28.6%, acute lower abdominal pain and guarding and acute abdomen in 18.6% and 15.7% of patients, respectively, bleeding per rectum in 2.9%, acute right upper quadrant abdominal pain in 1.4%, and obstructed paraumbilical hernia containing the diverticulum in one patient. Perforation of the Meckel's diverticulum was reported in 18.6%. Histopathological examination showed acute inflammation in the wall of the diverticulum in 37.1%, lymphoid hyperplasia in 24.3%, hemorrhagic necrosis in 22.9%, and chronic inflammation in 8.6%. Ectopic mucosa was detected in 50% of the cases, gastric mucosa was detected in 42.86%, ectopic pancreatic mucosa was detected in 5.71%, and both gastric and pancreatic types in 1.43%.

Conclusion

Long diverticula are more liable to develop complications. At surgery, inspection and palpation of the wall of the diverticulum must be done for any evidence of inflammation, necrosis, perforation, or abnormal thickening of the walls of the diverticulum. Resection of the segment of the bowel that contains the diverticulum with primary anastomosis is preferable to other procedures due to the risk of leaving behind an abnormal heterotopic mucosa.

Meckel's diverticulum causing acute intestinal obstruction: A case report and comprehensive review of the literature

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.

Epidemiology of Meckel's diverticulum: A nationwide population-based study in Taiwan: Characteristics of the cases from surgery between 1996 and 2013

The diverse presentation of Meckel's diverticulum (MD) is a diagnostic challenge for clinicians and most previous studies consist of single institutional case series. The aim of this study was to review the related diagnoses of MD and to investigate the epidemiological characteristics using Taiwan's National Health Insurance Research Database.We conducted an observational study using a population-based database. Patients diagnosed with MD who concurrently received intestinal surgery were identified. We analyzed the patients' demographic characteristics and relevant diagnoses using χ2 test and 2-sample t test.We identified 2453 newly diagnosed MD patients from 1996 to 2013 and 1227 patients (50%) with intestinal obstruction, gastrointestinal bleeding, and acute appendicitis (acute abdominal pain) were defined as symptomatic. The male to female ratio was 2.4:1 with half of the patients experiencing symptomatic MD before the age of 20 years' old. The age-specific and annual incidence were calculated for all MD and symptomatic MD. Among the symptomatic MD patients, intestinal obstruction was present in 583 (48%), acute appendicitis was present in 464 (38%), and gastrointestinal bleeding was present in 283 (23%) patients. Intestinal obstruction was the most common preoperative diagnosis in the 0 to 10 years and >20 years' age groups, and acute appendicitis (acute abdominal pain) was the most common diagnosis in the 11 to 20 years' age group.This population-based 18 years' epidemiologic study described the distributions of MD symptoms among different age groups, which may help clinicians gain a better understanding of this diagnostically challenging gastrointestinal anomaly.

Axially torsional Meckel's diverticulum accompanied by small bowel volvulus: a case report

Small bowel volvulus secondary to Meckel’s diverticulum is rare, and a delayed diagnosis results in disastrous outcomes. Computed tomography is conducive to early differential diagnosis. In particular, a blind-ending pouch structure on CT always indicates Meckel’s diverticulum. Diverticulectomy with or without adjacent partial small intestinal resection is the standard treatment for symptomatic Meckel’s diverticulum. However, the therapy for asymptomatic Meckel’s diverticulum is controversial. Here, we report the case of a 20-year-old man who suffered intestinal obstruction secondary to small bowel volvulus caused by an axially torsional, gangrenous, and giant Meckel’s diverticulum. Diverticulectomy with partial intestinal resection was performed.

Meckel's Enterolith Causing Small Bowel Obstruction: A Useful Solution to a Unique Problem

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its course is usually benign but may also result in complications requiring surgical intervention. A diverticulum may also permit the removal of intraluminal objects without bowel resection and anastomosis.

A woman in her 50s was found to have a mechanical small bowel obstruction secondary to an intraluminal mass within the terminal ileum. On exploration, an MD was encountered proximal to the mass. A diverticulectomy was performed after maneuvering the enterolith into the diverticulum.

Meckel’s diverticulum with an associated enterolith is a rare cause of small bowel obstruction. Historic imaging may show long-standing stones in the bowel lumen and provide a diagnostic clue. Diverticulectomy may be performed to reduce the risks of small bowel resection and anastomosis. This technique can be used for other intraluminal objects requiring removal in the presence of an MD.

A case report of a ruptured Meckel's diverticulum with ectopic gastric and pancreatic tissue with negative computed tomography

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.

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Meckel's Diverticulum in adults commonly presents with inflammation, small bowel obstruction and perforation.

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The recommendation for treatment of a symptomatic Meckel's diverticulum is surgical resection.

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Meckel's Diverticulum contain ectopic tissue, most commonly gastric and pancreatic tissue but rarely together.

An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

Internal Hernia and Volvulus in an Adult Male Caused by Meckel's Diverticulum: A Case Report

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.

Intestinal obstruction and ischemia by necrotic annular Meckel's diverticulum: Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Meckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Diagnosis of MD is a challenge because of its rarity and frequent asymptomaticity. Radiological exams generally aren't useful for its diagnosis. Intestinal obstruction represents the most common complication of MD in adults. Surgery is the appropriate treatment of complicated MD.

CASE PRESENTATION

A 70-year-old Caucasian male was admitted to the Emergency Department with a two-day history of abdominal pain associated with inability to pass gas or stool, nausea and vomiting. Physical examination revealed abdominal distention and abdominal pain without Blumberg's sign. Abdominal contrast-enhanced computed tomography (CECT) showed small bowel obstruction caused by suspected MD. Laboratory tests reported high serum levels of glycemia, LDH, C-reactive protein and leukocytosis. After diagnosis of intestinal obstruction, the patient underwent exploratory laparotomy: a segmental resection of ischemic distal ileum bearing a necrotic MD was performed. The postoperative course of patient was uneventful.

CLINICAL DISCUSSION

MD is found in 2%-4% of the population in large autopsy and surgical series. MD is mostly asymptomatic and incidentally discovered if not complicated; a debate exist about management of asymptomatic MD. Surgery represents the definitive treatment of complicated MD.

CONCLUSION

MD is a true diverticulum rarely discovered in adults. Diagnosis of MD is difficult even with the help of radiological exams. Although surgical resection represents the correct treatment of symptomatic MD, nowadays there is no consensus on the optimal treatment of asymptomatic and incidentally discovered MD.

Perforated Meckel's Diverticulitis in a Patient with Unknown Intestinal Malrotation: Clinical Pitfall

Symptomatic Meckel's diverticulum is rare in adults. The most frequent complications are intestinal obstruction and diverticulitis. Diagnosis of Meckel's diverticulitis can be challenging due to nonspecific clinical manifestation of pain in the right lower abdominal quadrant, mimicking acute appendicitis. If associated with congenital malformation, such as intestinal malrotation, the anomalous anatomy makes the diagnosis even more challenging. In such cases, radiological imaging is essential to guide further management. We present a case of Meckel's diverticulitis in which physicians were initially misguided because of the atypical clinical presentation. Yet, anamnestic details directed to a potential underlying malformation, leading to supplementary radiological examination and the final diagnosis.

Meckel's Diverticulum: A National Surgical Quality Improvement Program Survey in Adults Comparing Diverticulectomy and Small Bowel Resection

BACKGROUND

Meckel's diverticulum is a congenital abnormality often associated with the pediatric population. When seen in the adult population, management is controversial. This study sought to determine demographic and outcome differences between diverticulectomy and small bowel resection in adults diagnosed with Meckel's diverticulum.

METHODS

An analysis of the American College of Surgeons National Surgical Quality Improvement database (2015-2018) was performed, capturing patients with a postoperative diagnosis of Meckel's diverticulum. Inclusion criteria included diverticulectomy or small bowel resection, and exclusion criteria included other major procedures such as colectomy or concomitant diverticulectomy and a small bowel resection. Demographics and outcomes were analyzed between those receiving diverticulectomy or resection.

RESULTS

506 patients undergoing surgical treatment of Meckel's diverticulum were captured. The majority of these patients were white (79.05%), male (68.77%), and averaged 46 years old. The 2 populations were homogenous, with no significant differences in demographics or comorbidities between populations. Mean operative time was shorter in the diverticulectomy group than the resection group (68.92 ± 35.89 vs. 89.33 ± 40.16 minutes, P < .0001). There were no deaths at 30 days. Length of stay, readmission rate, wound infection, and discharge destination were similar among both groups.

DISCUSSION

Our analysis of a national database reveals no difference in outcomes between patients receiving a diverticulectomy or resection for Meckel's diverticulum. Operating time may be slightly increased for resection. However, decision to excise the diverticulum vs. the segment of small bowel should be individualized to each patient, their pathology, and clinical picture.

An atypical presentation of a mesenteric Meckel's diverticulum in a 7-year-old warmblood mare: case report

Background

Meckel’s diverticula are a rare cause of small intestinal strangulation, diagnosed at laparotomy or necropsy. This congenital anomaly of the gastrointestinal tract originates from a remnant of the vitelline duct. In reported equine cases, they present as a full-thickness diverticulum on the antimesenteric border of the distal jejunum or proximal ileum.

Case presentation

On laparotomy a Meckel’s diverticulum positioned at the mesenteric side was found to be the cause of small intestinal strangulation. This position is very uncommon and to the best knowledge of the authors there is no unambiguous description of another case.

Conclusions

Meckel’s diverticula should be on the list of differential diagnoses in cases of small intestinal strangulation. As in humans, equine Meckel’s diverticula can have the standard antimesenteric as well as a more exceptional mesenteric location. This case adds to the series of anecdotal reports of anomalies with regard to Meckel’s diverticula in the horse.

Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review

Recent reports have recommended laparoscopic diverticulectomy for symptomatic Meckel diverticulum (MD) rather than laparoscopic-assisted extracorporeal resection. This technique may risk leaving residual ectopic mucosa leading to complications. This systematic review attempts to quantify the relative risks of both approaches. A systematic review was conducted according to PRISMA guidelines. Articles were eligible for inclusion if they reported data on the laparoscopic management of symptomatic MD in children. Eleven reports were identified, all of which were institutional retrospective studies. Pooled outcome data on 248 children showed no statistically significant difference in complications between laparoscopic diverticulectomy (n = 133) and laparoscopic-assisted segmental resection (n = 115) (3% vs. 6.1%, p = 0.39). One patient from the diverticulectomy group re-presented with recurrent bleeding necessitating segmental small bowel resection. Conclusions are limited by the number of patients and variable follow up. Short, wide MD with a height:base ratio of < 2; diverticula with thickening or ischemia at the base and those complicated by volvulus or small bowel obstruction are probably best treated by laparoscopic-assisted extracorporeal resection. For other symptomatic diverticula laparoscopic diverticulectomy is a reasonable approach with a less than 1% risk of leaving residual ectopic gastric mucosa.

A case of perforation of Meckel's diverticulum with enterolith

Background

Perforation of Meckel’s diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel’s diverticulum with one enterolith, which could not be accurately diagnosed by preoperative computed tomography.

Case presentation

A 16-year-old male patient with acute onset of severe abdominal pain and a localized muscle guarding in the right hypochondrium had a solitary stone detected in the right abdomen by radiography. Abdominal computed tomography revealed a saclike outpouching of the small intestine, which contained fluid levels and an enterolith, with a mesenteric inflammatory change in the right paraumbilical area. He was diagnosed with peritonitis due to appendicitis or Meckel’s diverticulitis with enterolith, and emergency operation was indicated. The perforated Meckel’s diverticulum was identified approximately 30 cm proximal to the ileocecal valve. The diverticulum was transected at the base and removed. The patient’s postoperative course was uneventful.

Conclusions

It is crucial for clinicians to thoroughly examine patients and appropriately request investigations that consider perforation of Meckel’s diverticulum as a possible diagnosis to facilitate prompt treatment.

The Many Faces of Meckel's Diverticulum: Update on Management in Incidental and Symptomatic Patients

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.

A Rare Case of Acquired Transthoracic Littre's Hernia

Introduction  The Littre hernia is a rare complication of Meckel's diverticulum. Meckel's diverticulum is vestigial remnant of the omphalomesenteric duct occurring in approximately 2% of the general population with an estimated 4 to 16% risk of complications. Usual sites of the Littre hernia include inguinal (50%), umbilical (20%), and femoral (20%). We report a case of an acquired transthoracic Littre's hernia occurring through the left part of the diaphragm triggered by a history of traumatic rib fractures associated with alcohol abuse. Case Report  A 71-year-old man presented with 4-day history of worsening shortness of breath, colicky lower abdominal pain, and inability to open bowels despite passing flatus, without nausea or vomiting. His past medical history was remarkable for multiple traumatic rib fractures caused by falls which were associated with excessive alcohol consumption. A noncontrast computed tomography (CT) scan of the abdomen and pelvis showed distended jejunal loops containing air/fluid levels likely resulting from herniated jejunum between the left chest wall and left diaphragm. An urgent laparotomy was performed which revealed small bowel and omentum herniating through a small defect in the left posterior hemidiaphragm. The contents of the sac were reduced and a Meckel's diverticulum was found inside the sac, characteristic of Littre's hernia. The diaphragmatic defect was closed and the Meckel diverticulum stapled and excised. Discussion  Herniation of Meckel's diverticulum through the diaphragm most commonly occurs in the pediatric population. Acquired transthoracic Littre's hernia is rare and may arise following thoracobdominal trauma caused by surgery, motor vehicle accidents, and falls from height. Left-diaphragmatic tears are characteristically more clinically apparent and symptomatic than the right since the liver often has a protective effect on the right part of the diaphragm. Herniation of abdominal contents in the chest cavity causes respiratory distress and requires urgent surgical correction. Diagnosis is often delayed since diaphragmatic hernia tends to present very late after the initial trauma, subjecting the patient to possible life-threatening complications. While it is easier to reduce the herniated contents and repair the diaphragm via a thoracic approach, laparotomy is often preferred in cases of acute trauma associated with intra-abdominal injuries. Repair of Littre's hernia then consists of resection of the diverticulum and herniorraphy. Conclusion  Internal Littre's hernia is usually of congenital origin. This is the first case of a transthoracic Littre's hernia caused by traumatic rib fractures. Hence, it is of utter importance that a clinician is aware of such uncommon pathology.

Single incision laparoscopic surgery (SILS) for Meckel's diverticulum

A 65-year-old male patient presented with a chief complaint of abdominal pain. Abdominal computed tomography (CT) showed slight intestinal dilation and obstruction of the upper right quadrant of the small intestine, while ectopic gastric mucosal scintigraphy revealed abnormal accumulation in agreement with the CT-identified structure. The cause of bowel obstruction was diagnosed as Meckel's diverticulum; the patient was referred for surgery. A small laparotomy was performed with a 35-mm skin incision to the center of the navel. Once a lap disk was attached, a laparoscope was inserted to visualize the abdominal cavity. The small intestine that includes the structure was pulled out from the umbilicus to the outside of the peritoneal cavity and partially resected. On the pathological tissue findings, the patient was diagnosed with Meckel's diverticulum. We report our experience with single-lap laparoscopic surgery for a case of intestinal obstruction caused by Meckel's diverticulum and review pertinent literature.

Predictive model of heterotopy in Meckel's diverticulum in children

BACKGROUND

The presence of heterotopic tissue in Meckel's diverticulum (MD) increases the incidence of future complications. Based on this concept, this study aimed to detect clinical and morphological parameters able to predict the probability of heterotopy in incidentally discovered uncomplicated MD and to develop a risk-based classification tool.

METHODS

The clinical records of 146 patients who underwent MD resection were reviewed. MD complications (bleeding, inflammation, perforation or involvement in pathological processes such as intussusception) and MD dimensions (width, length and the product width × length) were evaluated in association with heterotopy. Regression analysis was used to explore the discrete effect of clinically relevant parameters, which were subsequently combined in a Classification and Regression Tree.

RESULTS

The probability of heterotopy was higher in complicated MDs. The width of the base of the MD and the product width × length were also significant predictors of heterotopy. A stepwise combination (Classification and Regression Tree model) of (i) uncomplicated macroscopic presentation, (ii) width <2.5 cm, (iii) age <10 years and (iv) product width × length <4 cm² resulted in a null probability of heterotopy in our study group.

CONCLUSION

The combination of MD-related clinical and morphological parameters using advanced statistical tools may assist in estimating the probability of heterotopy. This may be applied in incidentally discovered uncomplicated MDs during abdominal surgery for other morbidities. Prospective studies are required to confirm our findings and test the practical usefulness of the classification tool developed here.