Bleeding Meckel's Diverticulum Research Articles

Futility of barium sulfate in diagnosis of bleeding Meckel's diverticulum : M. M. Meguid, R. H. Wilkinson, T. Canty, A. J. Eraklis and S. Treves. Arch. Surg. 108:361–362 (March), 1974

Futility of barium sulfate in diagnosis of bleeding Meckel's diverticulum : M. M. Meguid, R. H. Wilkinson, T. Canty, A. J. Eraklis and S. Treves. Arch. Surg. 108:361–362 (March), 1974

Preoperative diagnosis of Meckel diverticulum. Agiographic and radionuclide studies in an adult

In a 26-year-old man with bleeding Meckel diverticulum, the combined use of mesenteric angiography and scintillation imaging established the diagnosis preoperatively. There was excellent correlation between the results of these studies and the histologic findings in the resected diverticulum. (<i>JAMA</i>229:1900-1902, 1974)

Preoperative Diagnosis of Meckel Diverticulum

In a 26-year-old man with bleeding Meckel diverticulum, the combined use of mesenteric angiography and scintillation imaging established the diagnosis preoperatively. There was excellent correlation between the results of these studies and the histologic findings in the resected diverticulum. (JAMA229:1900-1902, 1974)

Barium Studies in Meckel Diverticulum-Reply

Reply To the Editor .—Our report on the efficacy of barium in the diagnosis of bleeding Meckel diverticulum ( Arch Surg 108:361, 1974) was based on retrospective examination of records and radiographs of patients of many physicians. One can always find inadequacies when no prearranged protocol has been utilized. The critical comments made cannot be entirely refuted; we are merely reporting our experience in an active children's hospital. At barium enema, the distal part of the ileum is filled with barium as often as possible (probably 60% to 70% of the time) if there is no contraindication. Only four of 32 patients had small bowel examinations, frequently because early surgical intervention precluded a complete examination once gastrointestinal tract disease was excluded. But it does not seem unreasonable to expect a low yield on these exams performed here in the general run of children in whom—statistically 1% to 2% should have a

Barium Studies in Meckel Diverticulum

To the Editor .—It has long been accepted by radiologists that the demonstration of a Meckel diverticulum by means of barium examination is difficult. However, nothing in the article entitled Futility of Barium Sulfate in Diagnosis of Bleeding Meckel Diverticulum ( Arch Surg 108:361, 1974) warrants the authors' conclusions. Of 32 infants studied, only four had a small bowel study! In the 29 who had a barium enema, was any attempt made to reflux barium into the small bowel? In other words, their conclusion that barium examination is useless amounts to a non sequitur. Even their recommendation of a sodium pertechnetate Tc 99m scan lacks documentation. How many of the infants had such a scan? In how many was the correct diagnosis afforded by this study? How many false-positives were encountered? In short, in my opinion their report hardly merits publication in a scientific journal.

Futility of barium sulfate in diagnosis of bleeding meckel diverticulum.

Thirty-two infants underwent surgery, during a 21-year period, for painless rectal bleeding due to Meckel diverticulum. Radiological examinations do not help in the diagnosis of this lesion. Three infants had no radiological investigation before surgery. Twenty-nine infants had a barium sulfate enema, fourteen an upper gastrointestinal examination, and four had a small bowel examination. The cause of bleeding was not determined. It is questioned whether radiological examination of the gastrointestinal tract should constitute a part of the routine investigation in a previously healthy infant who has painless rectal bleeding. The yield in making a correct diagnosis is greater from a careful history, the finding of a benign abdomen, and normal findings from sigmoidoscopic examination. Abdominal scanning with sodium pertechnetate Tc 99m, which is selectively taken up by normal and aberrant gastric mucosa, is a helpful diagnostic tool.

Angiographic demonstration of a bleeding Meckel's diverticulum.

The diagnosis of a bleeding Meckel's diverticulum was made by angiography in a 22-year-old man who presented with lower gastrointestinal bleeding. The diagnosis was confirmed by barium examination. Angiographic findings included abnormal-appearing embryonic branches of the superior mesenteric artery, hypervascular areas thought to represent ectopic gastric mucosa, and contrast medium accumulation within the wall of the Meckel's diverticulum itself.

GASTROINTESTINAL BLEEDING OF "UNKNOWN ORIGIN". A STUDY OF CASES IN INFANCY AND CHILDHOOD.

Some years ago we studied and reported a series of 428 cases of gastrointestinal bleeding in infancy and childhood from the Childrens Hospital of Los Angeles. 3 Of special interest in that series was the diagnosis and management of the bleeder—that is, the patient in whom the gastrointestinal hemorrhage was continuously- the primary and leading complaint, in contradistinction to those patients in whom the bleeding occurred as an incidental feature of some other well-delineated disease or syndrome. These cases of primary gastrointestinal hemorrhage numbered 171 (40% of the series) and were found to be due to a variety of causes, the most important of which were oesophageal varices (17), peptic ulcer (11), polyps of colon (40), Meckel's diverticulum (27), enterocolitis and ulcerative colitis (24), and unknown (25). Since the clinical diagnosis of bleeding Meckel's diverticulum cannot usually be made by roentgenographic or laboratory methods currently available, it has become

Case analysis clinic: Bleeding Meckel's diverticulum in an adult

The management of the patient with massive gastrointestinal hemorrhage due to a Meckel's diverticulum is discussed. The fluorescein string test is helpful in localizing the source of hemorrhage to the region of the distal ileum.

Meckel's diverticulum as a source of hemorrhage

On the general basis of the question concerning the bleeding Meckel diverticulum, two cases of such a hemorrhage are described. The first patient was a three year old boy who had two periods of hemorrhage. The first hemorrhage occurred during a seige of chicken pox and the other several weeks later. In this case gastric mucosa was found in the Meckel diverticulum and the picture suggested an acute ulceration. The other case, that of a seventy-three year old woman, is a rarity. This patient had previously had two periods of hemorrhage several years before, and was hospitalized because of the third one. The mucosa of the Meckel diverticulum was ileal and there were areas of hemorrhage without ulceration.

Hemorrhage from a Meckel's diverticulum as a cause of melena in infancy; report of a case in which the diverticulum was demonstrated roentgenographically.

In the differential diagnosis of melena in infancy one of the conditions to be considered is hemorrhage from a Meckel's diverticulum. In the case to be reported here, a Meckel's diverticulum was demonstrated by a preoperative roentgenogram. The diagnosis was made clinically by the pediatrician and the consulting surgeon, but roentgenograms afforded positive evidence. Surgical removal of the diverticulum resulted in a cessation of the melena. Case Report T. G., white male, age thirteen months, was admitted to the hospital Nov. 25, 1948, because of bloody bowel movements and intense pallor. He had been passing large amounts of fresh and clotted blood in the stools for about twelve hours prior to admission. The pertinent previous history was as follows: The parents had first noticed blood in the stools in June 1948. Bleeding occurred on one day, followed by normal stools the next day and a recurrence of bleeding on the third day. A physician was consulted. A stool specimen at that time showed no blood. The child was not acutely ill, and because no abnormal condition was found on clinical examination, he was allowed to return home without hospitalization. In September 1948, there was a recurrence of bleeding for one day. At that time the parents noticed an increasing pallor. On admission of the infant to the hospital, Nov. 25, 1948, the examining pediatrician (C. F. F.) noted gross blood in the stools. The child appeared acutely ill and was very pale. Examinations of the eyes, ears, nose and throat, the thorax, the genitals, and the back and extremities were normal. Abdominal examination revealed no palpable masses or areas of rigidity. Rectal examination disclosed no abnormalities, but there was blood on the examining finger. Urinary findings were negative. The blood count showed a marked secondary anemia (6.6 gm. hemoglobin, 2,760,000 erythrocytes). Repeated studies on the same day and the following morning showed elevation of the white count, ranging between 12,000 and 17,000, but the differential count was normal. The blood was type 2, and was Rh positive. The child continued to pass bright red and dark blood in the stools, and the pediatrician considered a diagnosis of a bleeding Meckel's diverticulum most likely. Surgical consultation was obtained (W. R. L. II). It was the opinion of the surgeon, also, that a bleeding Meckel's diverticulum was the most likely diagnosis, but it was deemed advisable to examine the colon by x-ray prior to undertaking exploratory operation. Roentgen Examination: Before beginning the roentgen examination, the radiologist was aware of the clinical diagnosis of probable bleeding Meckel's diverticulum. The examination was undertaken primarily to rule out two other lesions: (1) a solitary polyp or polyposis of the colon (rectal examination had failed to reveal any polyps); (2) an intussusception (clinical examination had failed to reveal any definite evidence of this lesion).

Meckel's diverticulum: Report of two cases

1. 1. A brief review is given of the history, embryology and incidence of Meckel's diverticulum. 2. 2. The complications which may result from the presence of such a diverticulum are noted. 3. 3. A case of bowel obstruction associated with torsion and gangrene of a Meckel's diverticulum is presented. 4. 4. A case of bleeding Meckel's diverticulum in an eleven months old infant is presented.

MECKEL'S DIVERTICULUM

The case reported in this paper is of interest not only because it appears to be unique but also because it emphasizes two aspects of Meckel's diverticulum which have received some attention but are not yet sufficiently appreciated or emphasized. These considerations are, first, that Meckel's diverticulum rather frequently contains heterotopic alimentary tissue, and second, that the diverticulum may manifest itself clinically by bleeding, especially if it contains heterotopic gastric tissue, although this is not the only cause of bleeding. An analysis of the reported cases of bleeding Meckel's diverticulum with a discussion of the more probable causes of the hemorrhage will be given subsequently. REPORT OF CASE1 History. —A boy, aged 16, American born, a high school student, had been in good health up to the onset of the illness to be described, with the exception of mild but persistent constipation associated with occasional vague, transitory pain in