A case of intussuscepted Meckel’s diverticulum

Intestinal obstruction due to ligament arising from the distal end of Meckel's diverticulum: A case report

Intestinal obstruction due to ligament (fibrous band) arising from the top of Meckel's diverticulum is a rare cause. To date, in the world, only a few cases have been reported and there are not enough statistics on the incidence of this disease. This case presentation will help doctors working in the field of pediatric surgery or of pediatric imaging diagnosis have more experiences on diagnosis and treatment, and enrich the medical literature on this rare disease. We report a case of an 8-year-old boy with intestinal obstruction due to ligament arising from Meckel's diverticulum with complete data set such as clinical manifestations, imaging diagnosis (ultrasound, unprepared abdominal x-ray, computerized tomography scanner with contrast injection), surgical information, and histopathological findings. Intestinal obstruction due to the ligament arising from the apex of Meckel's diverticulum is an extremely rare disease and has asymptomatic imaging features so the preoperative diagnosis is only based on the indirect findings of computerized tomography scanner. The early diagnosis of an intestinal obstruction due to fibrous band can be made by using imaging methods such as ultrasound, unprepared abdominal x-ray, computerized tomography scanner with contrast injection, contributing to the prompt diagnosis in order to avoid serious complications including bowel necrosis, intestinal perforation, and perforated diverticulum.

Intussusception as a rare clinical presentation of a child with type 1 diabetes and diabetic ketoacidosis

Intussusception in children is mainly idiopathic or due to a viral aetiology. Occasionally, pathological lead points like Meckel diverticulum or rarely metabolic causes like hyperglycaemia can result in formation of an intussusception. We describe the case of a boy with diabetic ketoacidosis presenting with abdominal pain. Despite correction of acidosis, the gastrointestinal symptoms persisted for which an ultrasonography of the abdomen was performed. It revealed an ileo-ileal intussusception, which was confirmed by a CT scan. He underwent an exploratory laparotomy. After reduction of the intussusception, a Meckel diverticulum was found as the lead point that was then resected. We present a case of a child with type 1 diabetes having an intussusception due to Meckel diverticulum, which was probably made worse by the decreased intestinal motility due to hyperglycaemia. Intussusception should thus be suspected in patients with diabetic ketoacidosis if the pain is persistent despite correction of acidosis.

Clinics in diagnostic imaging (162). Meckel's diverticulum

A 28-year-old Chinese man presented with acute bleeding per rectum. Computed tomography showed a posterior outpouching arising from the distal ileum. The outpouching had hyperaemic walls, but no active contrast extravasation was detected. Technetium-99m pertechnetate scintigraphy showed focal areas of abnormal uptake in the right side of the pelvis, superior and posterior to the urinary bladder. These areas of uptake appeared simultaneously with the gastric uptake and demonstrated gradual increase in intensity on subsequent images. The diagnosis of Meckel's diverticulum was confirmed on surgery and the lesion was resected. The clinical and imaging features of Meckel's diverticulum are discussed.

Intussusception of the Meckel's diverticulum within its own lumen: Unknown complication

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It is important to differentiate this rare pathological feature of MD from other entities as the treatment is surgical rather than medical.

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No pathognomonic clinical symptoms indicating MD has been reported.

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Diagnosis usually is by a technetium Tc 99m-pertechnetate scanning.

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The treatment of symptomatic MD is surgical resection (wedge resection of the MD or resection of ileum).

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The heterotopic tissue is: gastric, pancreatic, jejuna, duodenal, colonic or hepatobiliary tissue.

Introduction

Intussusception with the Meckel’s diverticulum (MD) is a rare cause of chonic abdominal pain in the adults. We wish to present this first case of intussusception of MD within its own lumen without small bowel obstruction.

Presentation of case

We report the case of a 27-year-old man who was admitted to the emergency room due to a diffuse abdominal pain. Abdominal CT scan showed invagination of MD. The exploratory laparoscopy revealed the presence of intussusception of MD within its own lumen. Segmental resection of the small intestine was performed. The patient was discharged on the third post-operative day.

Discussion

The prevalence of MD is 1 to 4%. Diagnosis is often difficult and delayed because clinical symptoms are not specific and the diagnosis is performed mainly by imaging studies. Factors pre-disposing these patients to intussusception of MD within its own lumen include a narrow diverticulum, large diverticululm, and associated inflammation of the diverticulum. Intestinal obstruction is a more common complication in adults, whereas in children, bleeding is the more common complication. In our case, the patient had a diffuse abdominal pain without small bowel obstruction because the intussusception of MD was within its own lumen. Laparoscopy may be useful for confirming the presence of intussusception, and demonstrating the underlying organic lesion serving as the lead point.

Conclusion

It is important to differentiate this rare pathological feature of MD from other entities as the treatment is surgical rather than medical. Abdominal surgeons should bear in mind this rare entity.

Intussusception secondary to a meckel diverticulum in an adolescent

Adult intussusception caused by an inverted Meckel diverticulum is rare. We report a 39-year-old Turkish man with intussusception due to Meckel diverticulitis. Ileoileal intussusception was suggested by computed tomography. Exploration revealed ileoileal intussusception with Meckel diverticulum. A diverticulectomy with small bowel resection was performed.

Intussusception Secondary to a Meckel's Diverticulum in an Adolescent

A 13-year-old girl presented to the Emergency Department with vomiting and abdominal pain. On examination, she had only mild abdominal tenderness, but a mass was palpable in her right lower quadrant. Intussusception was diagnosed on ultrasound and confirmed on computed tomography (CT) scan, and operative findings revealed a jejunojejunal intussusception secondary to Meckel's diverticulum. Intussusception is a surgical abdominal emergency, which can present in all ages but is the most common reason for small bowel obstruction in childhood. It is a well-known cause of abdominal pain, vomiting, and bloody diarrhea in infancy but often not considered when evaluating the older child with similar symptoms. However, consideration of this diagnosis is important, as more than 1/3 of cases present beyond the age of 7. In older children, intussusception is more likely to be related to underlying pathology, such as Meckel's diverticulum, malignancy, or polyp. Intussusception should be on the differential in any patient with isolated abdominal complaints, and when it is diagnosed in an older child, it should be recognized that it is likely secondary to underlying pathology.

Adult intussusception caused by an inverted meckel diverticulum

Adult intussusception caused by an inverted Meckel diverticulum is rare. We report a 55-year-old Japanese man with intussusception. He was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness and muscle guarding. Computed tomography scanning demonstrated a typical inhomogeneous target-shaped mass in the right abdomen. We diagnosed intussusception and performed emergency surgery. At laparotomy, ileocolic intussusception was observed and the ileocecal segment was resected. The surgical specimen comprised an 84 cm segment of resected ileocecum with an elongated polypoid lesion measuring 11 × 2 cm within the ileal lumen. Histopathological examination demonstrated that the polypoid lesion was an inverted Meckel diverticulum. Postoperatively, the patient made an uneventful recovery.

Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report

Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.