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Nejatollahi SMR, Mostafavi K, Ghorbani F. Abdominal pain in a young lady with inverted Meckel's diverticulum: a case report. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2024; 17:100-103. [PMID: 38737928 PMCID: PMC11080686 DOI: 10.22037/ghfbb.v17i1.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/10/2023] [Indexed: 05/14/2024]
Abstract
Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract which is located in small bowel within 2 feet of the ileocecal valve. Nevertheless, an inverted Meckel's diverticulum is an uncommon condition believed to result from aberrant peristalsis in that specific area. This article showed signs, symptoms, and possible clinical presentations using CARE guidelines in a case of inverted Meckel's diverticulum and reviews other possible features lastly, definitive treatment, results, and case follow-up were shown to refresh, and raise surgeons' awareness of this rare disorder.
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Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keihan Mostafavi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Yang J, Chen Z, Fan Y, Zhou L, Tian Q, Yin X, Jin X, Zhang H, Ning S. Endoscopic characteristics of Meckel's diverticulum in adults: a retrospective case-series from two tertiary general hospitals in China. Scand J Gastroenterol 2023:1-8. [PMID: 36651020 DOI: 10.1080/00365521.2022.2164211] [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: 01/19/2023]
Abstract
BACKGROUND To analyze the diversity in endoscopic manifestations of Meckel's diverticulum (MD) in adults by using balloon-assisted enteroscopy (BAE) and supply more information on the application of BAE. METHODS A retrospective study was carried out on adult patients diagnosed with MD by BAE in two tertiary general hospitals in China, from May 2007 to September 2021. The patients were divided into a small bowel bleeding (SBB) group and a control group according to their main symptoms. Clinical charts and endoscopic images were reviewed, analyzed, and summarized. RESULTS Single diverticulum in the ileum and double-lumen sign were observed in all patients. The SBB group consisted of 51 patients, among which 35 cases of ulcerative lesions, 9 cases of erosive lesions, 9 cases of active bleeding/blood clots, and 4 cases of lumps inside the diverticulum were observed respectively. Majority of ulcerative lesions were inside the diverticulum (23/35). A circumferential stricture inside the diverticulum was discovered in 11 cases, and ulcerative lesions tended to occur at this structure (10/11). In the control group consisting of 15 patients, 1 case of erosive lesions at the orifice edge was observed. The percentage of patients with MD-associated ulcerative lesions was significantly higher in the SBB group than that in the control group (p < 0.001). CONCLUSIONS The endoscopic manifestations of MD in adults are extraordinarily complex and connected with the patients' primary symptoms. The internal features of MD should be regarded as crucial observational objectives in adult patients.
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Affiliation(s)
- Jing Yang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhitao Chen
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Fan
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhou
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Tian
- Department of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Yin
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
| | - Xiaowei Jin
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shoubin Ning
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
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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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Gao PT, He MJ, Li QL, Zhou PH, Ma LL. Novel technique for treating intussuscepted intestinal Meckel's diverticulum: enteroscopic intestinal diverticulum dissection (EIDD). Endoscopy 2022; 54:E578-E580. [PMID: 34933362 DOI: 10.1055/a-1704-6783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Ping-Ting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Meng-Jiang He
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Li Ma
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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Inverted Meckel's Diverticulum Masquerading as a Subepithelial Tumor of the Ileum. ACG Case Rep J 2022; 9:e00773. [PMID: 35558640 PMCID: PMC9088228 DOI: 10.14309/crj.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
We describe a case of an inverted Meckel's diverticulum presenting as an intraluminal subepithelial lesion on intraoperative enteroscopy. A 53-year-old woman presented with chronic iron deficiency anemia unresponsive to escalating iron supplementation. After equivocal upper and lower endoscopy and negative cross-sectional imaging, capsule endoscopy suggested a submucosal mass lesion in the proximal ileum. Antegrade double-balloon enteroscopy was unsuccessful in reaching the lesion. A large pedunculated, submucosal-appearing lesion was finally identified on intraoperative enteroscopy. The mass was surgically resected, and final pathology confirmed an inverted Meckel's diverticulum.
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Tapaskar N, Genere JR, Prachand VN, Semrad CE. Superior outcomes with double-balloon enteroscopy for small bowel lesion marking followed by intracorporeal as opposed to extracorporeal resection and reconstruction. Surg Endosc 2022; 36:3227-3233. [PMID: 34287705 DOI: 10.1007/s00464-021-08632-6] [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] [Received: 10/06/2020] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Double-balloon enteroscopy (DBE) is used for the diagnosis and therapy of small bowel disease. Endoscopic sampling and marking small bowel lesions destined for surgery permit intracorporeal resection and reconstruction (IRR), thereby facilitating a complete minimally invasive technique. There are limited data that compare outcomes of IRR to conventional extracorporeal resection and reconstruction (ERR). The purpose of this study was to evaluate the surgical outcomes of patients undergoing pre-operative DBE for lesion marking followed by laparoscopic IRR compared to those undergoing ERR. METHODS A retrospective chart review was performed on patients who underwent DBE followed by small bowel resection from 2006 to 2017 at a single tertiary care medical center. IRR was defined as laparoscopic inspection to identify the lesion (previously marked by DBE or by laparoscopic-assisted DBE) followed by intra-abdominal bowel resection and anastomosis with specimen extraction via minimal extension of a laparoscopic port site. ERR was defined as extracorporeal resection and/or reconstruction performed via a conventional or mini-laparotomy abdominal incision. RESULTS A total of 82 patients met inclusion criteria and were reviewed. Thirty-two patients (39%) had ERR and 50 patients (61%) had IRR. The most common indications for DBE were small bowel bleeding (76%) and small bowel mass or thickening on prior imaging studies (16%). Successful DBE was higher in the IRR group when compared to the ERR group, but not significantly different (90% vs 75%, p-value 0.07). Patients who underwent IRR had faster bowel function recovery (2 vs 4 days, p < 0.01), shorter time to discharge (3 vs 7 days, p < 0.01), and fewer post-operative complications (10 vs 18; p < 0.01), when compared to the ERR group. CONCLUSION DBE successfully facilitated laparoscopic small bowel IRR and this approach was associated with faster return of bowel function, shorter recovery time, and decreased morbidity when compared to ERR.
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Affiliation(s)
- Natalie Tapaskar
- Department of Medicine, The University of Chicago, Chicago, USA.
- University of Chicago Medical Center, 5841 S Maryland Avenue, MC 4076, Chicago, IL, 60637, USA.
| | - Juan Reyes Genere
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | | | - Carol E Semrad
- Department of Medicine, The University of Chicago, Chicago, USA
- Section of Gastroenterology Hepatology and Nutrition, The University of Chicago, Chicago, USA
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El Hajra Martínez I, Calvo M, Martínez-Porras JL, Gomez-Pimpollo Garcia L, Rodriguez JL, Leon C, Calleja Panero JL. Inverted Meckel’s diverticulum diagnosed using capsule endoscopy: A case report. World J Gastroenterol 2021; 27:6154-6160. [PMID: 34629826 PMCID: PMC8476338 DOI: 10.3748/wjg.v27.i36.6154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/13/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Meckel’s diverticulum is a common asymptomatic congenital gastrointestinal anomaly. However, its presentation as an inverted Meckel's diverticulum is a rare complication, of which few cases have been reported in the literature.
CASE SUMMARY Here, we report the case of a 33-year-old man with iron deficiency anemia without manifestation of gastrointestinal bleeding. An upper gastrointestinal endoscopy and total colonoscopy were performed, but no abnormalities were found within the observed area. Finally, a capsule endoscopy was performed and offered us a clue to subsequently confirm the diagnosis of inverted Meckel's diverticulum via computed tomography scan. Laparoscopic intestinal resection surgery was performed. The final pathology report described a Meckel’s diverticulum.
CONCLUSION Since inverted Meckel's diverticulum is an uncommon disease and its clinical presentation is not specific, it may go undetected by capsule endoscopy. Successful diagnosis and treatment of this disease requires a high index of clinical suspicion.
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Affiliation(s)
| | - Marta Calvo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Madrid 28222, Spain
| | | | | | - Jose L Rodriguez
- Department of Diagnostic Pathology, Hospital Universitario Puerta de Hierro, Madrid 28222, Spain
| | - Carmen Leon
- Department of Surgery, Hospital Universitario Puerta de Hierro, Madrid 28222, Spain
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Bains L, Bhatia R, Kaushik R, Lal P, Rajpaul G, Veerpal. Inverted Meckel's diverticulum: a case report. J Med Case Rep 2021; 15:264. [PMID: 34020701 PMCID: PMC8140418 DOI: 10.1186/s13256-021-02736-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 02/14/2021] [Indexed: 12/28/2022] Open
Abstract
Background Inverted Meckel’s diverticulum refers to the condition in which the diverticulum inverts on itself. The reasons for such an inversion are poorly understood due to the rarity of the condition. We present a case of inverted Meckel’s diverticulum, an uncommon finding, as a cause of recurrent intussusception. Case presentation A 30-year old Indian woman presented with complaints of pain in the central abdomen for 3 days, accompanied with vomiting and loose stools. Computed tomography images were suggestive of intussusception with intestinal obstruction. Intra-operative findings were suggestive of an intussuscepted segment of ileum measuring 10 cm in length, proximal to ileocecal junction. Ileo–ileal anastomosis was performed after appropriate resection. Upon opening the specimen, we were surprised to find an inverted Meckel diverticulum with lipoma at one end causing the intussusception. The patient made an uneventful recovery and was discharged after 5 days. Conclusion The reasons for inversion include abnormal peristalsis around the diverticulum and non-fixity of the diverticulum itself. The inverted diverticulum itself can cause luminal compromise and acts as a lead point for intussusception leading to obstruction. Computed tomography remains the diagnostic tool of choice for identifying intestinal obstruction and intussusception. Although pathological signs, such as lipoma, can be identified, the identification of any inversion will require a proficient radiologist. Inverted Meckel’s diverticulum is a rare condition which is difficult to diagnose preoperatively. Treatment is surgical, whether diagnosed pre-operatively or intra-operatively, and includes segmental resection and anastomosis. This uncommon condition should be noted as one-off differential diagnosis for intussusception and intestinal obstruction.
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Affiliation(s)
- Lovenish Bains
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Rahul Bhatia
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Rohit Kaushik
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Pawan Lal
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Gayatri Rajpaul
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Veerpal
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
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Qiao WG, Zhang LZ, Zhi FC. Tumor-like heterotopic gastric mucosa discovered by wireless capsule endoscopy. J Dig Dis 2017; 18:543-544. [PMID: 28296263 DOI: 10.1111/1751-2980.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/27/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Wei Guang Qiao
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Lan Zhi Zhang
- Department of Pathology, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Fa Chao Zhi
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Abstract
RATIONALE Heterotopic gastric mucosa has been described at various locations of the body; however, the polyp composed of heterotopic gastric mucosa in the small intestine is rare. PATIENT CONCERNS A 15-year-old boy visited us for investigation of recurrent episodes of melena. Capsule endoscopy (CE) revealed a polypoid tumor in the ileum, with an active nearby hemorrhage. Contrast-enhanced computed tomography (CECT) showed a tumor in the right quadrant of the abdomen, with a diameter of about 18 × 14 mm. DIAGNOSES The patient was diagnosed with polypoid gastric heterotopia. INTERVENTIONS We performed an operation to resect the lesion. OUTCOMES The patient recovered smoothly after surgery and was discharged on postoperative day 7 and followed up for 3 months. He has not experienced gastrointestinal intestinal (GI) symptoms up to now. LESSONS Giant polypoid gastric heterotopia in the small intestine is extremely rare, which can express as an occasional finding with or without symptoms. Surgical resection is the preferred therapy when symptoms appear.
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