Congenital Gastrointestinal Anomalies Research Articles

Evolution of Resting Energy Expenditure, Respiratory Quotient, and Adiposity in Infants Recovering from Corrective Surgery of Major Congenital Gastrointestinal Tract Anomalies: A Cohort Study.

This cohort study describes the evolution of resting energy expenditure (REE), respiratory quotient (RQ), and adiposity in infants recovering from corrective surgery of major congenital gastrointestinal tract anomalies. Energy and macronutrient intakes were assessed. The REE and RQ were assessed by indirect calorimetry, and fat mass index (FMI) was assessed by air displacement plethysmography. Longitudinal variations over time are described. Explanatory models for REE, RQ, and adiposity were obtained by multiple linear regression analysis. Twenty-nine infants were included, 15 born preterm and 14 at term, with median gestational age of 35.3 and 38.1 weeks and birth weight of 2304 g and 2935 g, respectively. In preterm infants, median REE varied between 55.7 and 67.4 Kcal/kg/d and median RQ increased from 0.70 to 0.86–0.92. In term infants, median REE varied between 57.3 and 67.9 Kcal/kg/d and median RQ increased from 0.63 to 0.84–0.88. Weight gain velocity was slower in term than preterm infants. FMI, assessed in a subset of 15 infants, varied between a median of 1.7 and 1.8 kg/m2 at term age. This low adiposity may be related to poor energy balance, low fat intakes, and low RQ¸ that were frequently recorded in several follow-up periods.

Extrarenal Wilms tumor in children: A retrospective observational case series

Pediatric extrarenal Wilms tumor (ERWT) is rare. The diversity of clinical characteristics makes diagnosis, treatment and judging the prognosis difficult. Long-term follow-up outcomes and the possible prognostic factors of ERWT are still insufficient. To identify the characteristics, therapeutic strategies and long-term results of pediatric ERWT. All children with ERWT in our institution were retrospectively reviewed. The National Wilms Tumor Study (NWTS) system was used to evaluate tumor grade. Among the 876 patients with Wilms tumor in our institution between January 1986 and July 2018, 5 (0.57%) patients had ERWT. Of the 5 children with ERWT, the locations were the retroperitoneum in 3 patients (including 1 presacral) and the gubernaculum testis of an undescended testis and a duplicate sigmoid colon in 1 patient each. Two patients were stage II, and 3 patients were stage III. The three patients with larger tumor sizes had preoperative tumor rupture. In the long-term follow-up, ranging from 1.0 to 10.8 years, 3 patients had disease-free survival, and 2 patients with older age, a larger tumor size and preoperative tumor rupture had recurrence with metastasis, including 1 death. Wilms tumor extremely rarely originates outside the kidney. The current case series represents the first report of ERWT accompanied by a duplicate sigmoid colon. ERWT can coassociate with congenital gastrointestinal and genitourinary system anomalies, such as undescended testis and duplicate sigmoid colon, which provide clues to the preoperative diagnosis of ERWT. Deep and not easily palpated locations for the ERWT and older ages were associated with diagnosis delay, which can lead to enlargement of the tumor, an increased risk of preoperative tumor rupture and advancement of the tumor stage. Although only 3% of ERWT cases were metastatic according to previous reports, 2 of 5 patients (patients 1 and 4) with older age, larger tumor size and preoperative tumor rupture had recurrence and metastases in the current study. Thus, patients with poor prognoses often require aggressive combination treatments, and more attention is needed in terms of the recurrence, metastases and fatality of ERWT. ERWTs are rare tumors and can coassociate with congenital gastrointestinal and genitourinary system anomalies. The prognosis of ERWT is comparable to that of Wilms tumor located at normal anatomical sites.

Impact of Nutrition Support Team on Postoperative Nutritional Status and Outcome of Patients with Congenital Gastrointestinal Anomalies.

BACKGROUND The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome. METHODS A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs. RESULTS Median weight gain and the amount of calorie delivered during NICU stay in subjects of NSTsupported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant. CONCLUSION NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.

Genetic counseling for fetal gastrointestinal anomalies.

Congenital gastrointestinal anomalies are common findings with relatively established methods of treatment. However, the genetic cause of how these defects occur and how that may impact a child's lifelong care is less established. Genetic testing has improved significantly in recent years, yet reviews documenting prenatal genetic counseling and testing guidelines have not been comprehensively updated. Congenital anomalies of the foregut, such as tracheoesophageal fistula carry a high association with genetic disorders, both in isolation and syndromic forms. Duodenal atresia remains highly associated with Trisomy 21 but is not enriched in other genetic conditions. Disorders of the midgut, such as omphalocele often have a genetic cause and may require both cytogenetic and panel testing to obtain a diagnosis. The etiologic basis of hindgut malformations remain largely unknown, though imperforate anus as well as Hirschprung's disease have been associated with many micro deletion syndromes as well as in association with other birth defects as part of larger syndromes. Prenatal diagnostic genetic testing through amniocentesis or chorionic villus sampling can be offered to every patient who wants to learn genetic information about their fetus. Cytogenetic testing, such as microarray is a first tier test to assess cause for these conditions and can provide meaningful answers. When a gastrointestinal anomaly is identified in association with an additionally affected organ system next-generation sequencing and defect-specific genetic testing panels can be necessary to understand cause as well as prognosis to best prepare families for the medical management that lies ahead.

Growth from Birth to 30 months for Infants Born with Congenital Gastrointestinal Anomalies and Disorders.

This study aimed to investigate growth among neonates with gastrointestinal disorders. Inclusion criteria included neonates with gastroschisis, omphalocele, intestinal atresia, tracheoesophageal fistula, Hirschsprung's disease, malabsorption disorders, congenital diaphragmatic hernia, and imperforate anus born between 2010 and 2018. Anthropometrics were collected for the first 30 months, and a subgroup analysis was performed for gastroschisis infants. In 61 subjects, 13% developed severe growth failure within the first month. One-, four-, and nine-month weight and length z-scores were less than birth weight in all infants (p < 0.05). In infants with gastroschisis, a similar pattern was observed for weight z-scores only (p < 0.05). From birth to 15 months, head circumference z-score increased over time in all infants (p = 0.001), while in gastroschisis infants, weight, length, and head circumference z-scores increased over time (p < 0.05). In a cohort of infants with gastrointestinal disorders, growth failure was followed by catch-up growth.

Antenatal predictors of intestinal pathologies in fetal bowel dilatation.

Fetal bowel dilatation (FBD) in the late trimester of pregnancy can be related with varies of prognosis. Our aims were to obtain antenatal factors that might have relevance for the distinct prognosis with FBD. Seven features of 68 pregnancies presented with FBD were assessed. The best cut-off value to predict intestinal outcomes was selected using receiver-operating characteristics curves, and the effective variables were included into a logistic regression model. The best cut-off valves to predict intestinal pathologies were 14.5 mm of fetus dilated loop and 37.7 weeks of gestational age at delivery, respectively. The congenital gastrointestinal tract anomalies included 24 cases (92.3%) of intestine atresia, 1 case (3.85%) of small intestine volvulus and 1 case (3.85%) of midgut malrotation. Fetal dilated loops and gestational age at delivery are both an independent risk factor for predicting intestinal pathologies of newborns, which should arouse high attention.

Spontaneous perforated Meckel’s diverticulum in adults: a case report

Background: Meckel’s diverticulum (MD) is a common congenital gastrointestinal anomaly in children and is rarely diagnosed in adults. Hemorrhage, obstruction, and inflammation are the three most common complications resulting from Meckel’s diverticulum. Perforated MD is very rare and mimics a perforated appendix on presentation. Case Presentation: We report a case of spontaneous perforated MD in an adult female patient who presented with localized abdominal pain for 2 days. This pain gets worse and is progressively generalized to the whole abdomen. On physical examination her abdomen was distended with guarding. Based on the imaging, a provisional diagnosis of infectious enteritis was carried out. The patient was vitally unstable in which the patient pushed to operating room for exploratory laparotomy. Intraoperative findings of perforated MD were seen. Segmental resection with an end-to-end anastomosis was carried out and the patient uneventfully recovered well. Conclusion: Diagnosis of MD in adults is challenging as its occurrence is rare, but it should be kept in mind. Early diagnosis with proper intervention provides the best outcomes and fewer complications.

Neonates with congenital GI anomalies have growth delays that persist beyond the neonatal intensive care unit

Background: Infants with gastrointestinal (GI) disorders have increased survivorship with advances in intensive care. This population requires a prolonged hospital stay secondary to surgeries and an increased risk for sepsis and necrotizing enterocolitis (NEC). These complications lead to chronic exposure to inflammation and malnutrition that cause serious growth delays that may have far-reaching consequences. Literature on this population has been limited by small sample sizes and short-term follow up. Objective: This study’s aim was to investigate long-term growth among neonates with of GI anomalies or complications during the …

Body composition and cognition in preschool-age children with congenital gastrointestinal anomalies

BackgroundChildren with congenital gastrointestinal anomalies (CGIAs) experience multiple stressors while hospitalized in neonatal intensive care units during an essential time of growth and development. Early stress and inadequate nutrition are linked to altered growth patterns and later neurodevelopmental delays. In other at-risk populations, improved fat-free mass (FFM) accretion is associated with improved cognitive outcomes. ObjectiveTo determine if body composition is associated with cognitive function in preschool-age children with CGIAs. Study designAn observational study examined body composition and cognition in 34 preschool-age children with CGIAs. Anthropometric measurements and body composition testing via air displacement plethysmography were obtained. Measurements were compared with a reference group of healthy, term-born children. Cognition was measured with the NIH Toolbox Early Childhood Cognition Battery. Linear regression was used to test the association of body composition with cognitive function. ResultsCompared with the reference group, children with CGIAs had similar anthropometric measurements (weight, height, and body mass index z-scores) and body composition at preschool-age. Processing speed scores were lower than standardized means (p = 0.001). Increased FFM was associated with higher receptive vocabulary scores (p = 0.001), cognitive flexibility scores (p = 0.005), and general cognitive function scores (p = 0.05). ConclusionsAt preschool-age, children with CGIAs have similar growth and body composition to their peers. In children with CGIAs, higher FFM was associated with higher cognitive scores. Closer tracking of body composition and interventions aimed at increasing FFM may improve long-term outcomes in this population.

Necrotizing Enterocolitis in Moderate Preterm Infants.

Necrotizing enterocolitis (NEC) is a devastating morbidity usually seen in preterm infants, with extremely preterm neonates (EPT ≤28 weeks) considered at highest risk. Moderately preterm infants (MPT 28–34 weeks) constitute a large percentage of NICU admissions. In our retrospective data analysis of NEC in a single regional perinatal center, NEC was observed in 10% of extremely EPT and 7% of MPT, but only 0.7% of late-preterm/term admissions. There was an inverse relationship between postnatal age at onset of NEC and gestational age at birth. Among MPT infants with NEC, maternal hypertensive disorders (29%) and small for gestational age (SGA-15%) were more common than in EPT infants (11.6 and 4.6%, resp.). Congenital gastrointestinal anomalies were common among late preterm/term infants with NEC. SGA MPT infants born to mothers with hypertensive disorders are particularly at risk and should be closely monitored for signs of NEC. Identifying risk factors specific to each gestational age may help clinicians to tailor interventions to prevent NEC.

Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

Aim: The purpose of this study was to analyze the nature of the disease, the surgical procedures, complications, and survival of preterm infants with necrotizing enterocolitis (NEC) from two tertiary care referral neonatal intensive units in central India.Materials and Methods: A prospective study of a cohort of 110 preterm neonates with gestational age less than 36 weeks and weight less than 1600 g infants diagnosed to have NEC were followed for 90 days. All the neonates were born between January 2015 and December 2017 and treated at two neonatal intensive care units. Infants with sepsis, congenital gastrointestinal anomalies, major cardiac problems, and intraventricular hemorrhage were excluded.Results: Mean gestational age in this cohort was 32.40 ± 3.87 weeks, and the mean age of NEC onset was 13.04 ± 3.54 postnatal days. There were 39 neonates with Stage 1, 45 with Stage 2, and 26 with stage 3 NEC. Pneumoperitoneum, positive paracentesis and progressive clinical deterioration were the indications for laparotomy. The most common complications were sepsis 97/110 (88.18%). Post-operative complications occurred in 22 (84.61%) infants, wound infection in 19 (73.07%), intestinal stricture in 9 (34.61%), wound dehiscence in 7 (26.92%), stoma stenosis in 3 (11.53%), ileostomy prolapse in 2 (7.69%), and burst abdomen in 1 (3.84 %). The overall 90-day survival rate was 87.27% (96/110), and the post-operative survival rate was 46.15% (12/26). The age of gestation, weight, and extent of the disease were the main risk factor for mortality.Conclusion: The short-term outcomes for Stage 3 NEC were associated with high morbidity and mortality. The outlook for infants with Stage 1 and 2 NEC was favorable.

Correlation of perceived nursing support with stress and self-confidence among the mothers of infants with congenital gastrointestinal anomalies

Background: Hospitalization of infants with congenital anomalies to undergo surgery is extremely stressful for their family members, particularly their parents. The resultant stress can negatively affect parents' self-confidence. Objectives: The aim of this study was to examine the correlation of perceived nursing support with stress and self-confidence among the mothers of infants with congenital gastrointestinal anomalies. Methods: This correlational study was conducted in June–November 2015 on 120 mothers whose infants were hospitalized due to congenital gastrointestinal anomalies in the surgical ward of Tabriz teaching children's hospital, Tabriz, Iran. Data were collected using a demographic questionnaire, the Nurse Parent Support Tool, the Parental Stress Scale, and the Parenting Confidence Scale. Spearman's correlation analysis was used to assess the correlation of perceived nursing support with stress and self-confidence. Results: Mothers perceived high levels of communicational-informational nursing support and low levels of emotional nursing support. Perceived nursing support had positive correlations with stress (r = 0.22; P = 0.013) and self-confidence (r = 0.35; P

Pre- and neonatal imaging of gastrointestinal complications in congenital diaphragmatic hernia

The initial outcome in infants with congenital diaphragmatic hernia is mainly related to the associated lung hypoplasia. However, these patients frequently present with additional gastrointestinal pathology that also influences their quality of life and final prognosis. Congenital gastrointestinal anomalies are often observed and the displacement of the liver, the stomach and/or the intestines into the thorax may cause distortion of the vascular axis of these organs, increasing the risk of congestion and/or ischemia. Some of these gastrointestinal complications are already visible at imaging studies performed in utero and/or in newborns.This pictorial essay describes the imaging findings of the most frequently detected gastrointestinal complications in fetuses and infants with congenital diaphragmatic hernia, focusing on prenatal exams.

SUN-P015: Impact of Nutrition Support Team on Postoperative Nutritional Status and Clinical Outcome in Pediatric Patients with Congenital Gastrointestinal Anomalies

SUN-P015: Impact of Nutrition Support Team on Postoperative Nutritional Status and Clinical Outcome in Pediatric Patients with Congenital Gastrointestinal Anomalies

Value of ultrasonic diagnosis and analysis of missed diagnosis and misdiagnosis for neonatal annular pancreas

Objective To investigate the clinical value of ultrasonic diagnosis for neonatal annular pancreas, analyze the reasons of missed diagnosis and misdiagnosis, and improve diagnostic accuracy of ultrasonography for this disease. Methods Clinical data of 98 newborns with annular pancreas confirmed by gastrointestinal contrast and surgery were analyzed retrospectively. Preoperative ultrasonogram were compared with the result of gastrointestinal contrast and surgery. Ultrasound images failed to be correctly dignosed were further studied to summarize diagnostic points for this disease. Results Among the 98 cases, 75 were correctly diagnosed by ultrasound with a diagnostic accordance rate of 76.5%, 18 were missed diagnosed and 5 were misdiagnosed with a total misdiagnosis rate of 23.5%. Ten cases associated with other congenital gastrointestinal tract anomalies were missed diagnosed due to ignoring scanning pancreas. Five cases were missed diagnosed due to obvious intestinal cavity flatulence. Three cases were missed diagnosed due to lack of awareness of the disease. Five cases were misdiagnosed for duodenal stenosis or duodenal atresia. Conclusions Ultrasound has important diagnostic value for neonatal annular pancreas, providing the dignostic evidences for clinical treatment. Thus it can be used as the preferred auxiliary examination of the disease. Since annular pancreas is often accompanied by other gastrointestinal malformations and can be interfered by abdominal gas, missed diagnosis and misdiagnosis occurred easily. To improve the accuracy of ultrasonic diagnosis, all causes of neonatal gastrointestinal tract obstructions should be considered during the examination. Key words: Ultrasonography; Annular pancreas; Neonate; Missed diagnosis

Implementation of Universal Postpartum Screening on a High‐Risk L&D Unit Specializing in Delivering Babies with Birth Defects

Objective A postpartum mental health screening tool was implemented within a high‐risk obstetric unit to identify risks experienced among women giving birth to infants with confirmed fetal anomalies. Design A universal screening protocol was implemented into standard postpartum care. Any woman indicating clinical risk was referred to the psychologist for further assessment to determine appropriate treatment and intervention. A cross‐sectional design was used to measure the prevalence of depression, anxiety, and traumatic stress risk reported among this population and further analyses were used to determine demographic factors and/or fetal diagnoses that correlated with greater postpartum mental health risk. Setting The Garbose Family Special Delivery Unit (SDU) opened in 2008 as the first state‐of‐the‐art birthing facility located within a pediatric hospital. Each year approximately 300 to 400 pregnant women carrying fetuses with birth defects and/or complex medical and genetic conditions give birth in the SDU. Sample During the 6‐month study period, 164 women completed a postpartum screening tool on Day 1 postdelivery. Methods On postpartum Day 1, participants were asked to complete screening by their bedside nurses. Those women with clinically significant symptoms were referred to the clinical psychologist for additional triage and intervention prior to their SDU discharge. Results A total of 164 women completed screening tools during the 6‐month study period. The majority of infants in the sample had congenital heart defects (42.1%), neurological defects (19.5%), and gastrointestinal anomalies (9.8%); 32.3% of mothers had clinically significant risk for postpartum depression symptoms, and 5.5% had symptoms of traumatic stress risk in response to seeing their infants for the first time in the intensive care unit (ICU). Conclusion/Implications for Nursing Practice Findings demonstrated that standardized postpartum screening for women with fetuses with confirmed anomalies is paramount. The success of this screening tool is dependent on nurses’ commitment to presenting the tool in a standardized manner as part of routine postpartum care. The information received can assist rapid assessment and implementation of therapeutic interventions prior to a woman's SDU discharge. This could ultimately help promote effective coping skills to manage her emotional well‐being during the neonatal ICU hospitalization and mediate a possible exacerbation of psychological symptoms in the postpartum period. A postpartum mental health screening tool was implemented within a high‐risk obstetric unit to identify risks experienced among women giving birth to infants with confirmed fetal anomalies. A universal screening protocol was implemented into standard postpartum care. Any woman indicating clinical risk was referred to the psychologist for further assessment to determine appropriate treatment and intervention. A cross‐sectional design was used to measure the prevalence of depression, anxiety, and traumatic stress risk reported among this population and further analyses were used to determine demographic factors and/or fetal diagnoses that correlated with greater postpartum mental health risk. The Garbose Family Special Delivery Unit (SDU) opened in 2008 as the first state‐of‐the‐art birthing facility located within a pediatric hospital. Each year approximately 300 to 400 pregnant women carrying fetuses with birth defects and/or complex medical and genetic conditions give birth in the SDU. During the 6‐month study period, 164 women completed a postpartum screening tool on Day 1 postdelivery. On postpartum Day 1, participants were asked to complete screening by their bedside nurses. Those women with clinically significant symptoms were referred to the clinical psychologist for additional triage and intervention prior to their SDU discharge. A total of 164 women completed screening tools during the 6‐month study period. The majority of infants in the sample had congenital heart defects (42.1%), neurological defects (19.5%), and gastrointestinal anomalies (9.8%); 32.3% of mothers had clinically significant risk for postpartum depression symptoms, and 5.5% had symptoms of traumatic stress risk in response to seeing their infants for the first time in the intensive care unit (ICU). Findings demonstrated that standardized postpartum screening for women with fetuses with confirmed anomalies is paramount. The success of this screening tool is dependent on nurses’ commitment to presenting the tool in a standardized manner as part of routine postpartum care. The information received can assist rapid assessment and implementation of therapeutic interventions prior to a woman's SDU discharge. This could ultimately help promote effective coping skills to manage her emotional well‐being during the neonatal ICU hospitalization and mediate a possible exacerbation of psychological symptoms in the postpartum period.

Routine gastrostomy tube placement in children: Does preoperative screening upper gastrointestinal contrast study alter the operative plan?

BackgroundUpper GI (UGI) studies are routinely ordered to screen for malrotation before routine placement of gastrostomy (G) tubes. However, the usefulness of this study is unknown. MethodsA retrospective review of children with surgically placed G-tubes over a 2year period (2011–2013) was performed. Patients with concomitant fundoplications were excluded. ResultsThree hundred ninety-three patients underwent G-tube placement. Of these, 299 patients (76%) had preoperative UGI, and 11 patients (3.7%) were identified with malrotation on UGI. Five (1.7%) patients underwent a Ladd’s procedure. The remaining 6 either had malrotation associated with gastroschisis (n=5) or were lost to follow-up (n=1). Children <1year did not have different rates of malrotation compared to older children (4.3% vs. 3.2%, p=0.617). Likewise, children with neurologic impairment (NI) had similar rates of malrotation compared to neurologically normal (NN) children (2.6% vs. 3.8%, p=0.692). The only significant difference in malrotation rate was between those with congenital gastrointestinal anomalies (24%) and those without (1.5%) (p<0.001). ConclusionPreoperative screening UGI before routine G-tube placement led to an unexpected diagnosis of malrotation in only 1.7%. Given the added radiation risk associated with an UGI, our data suggest that an UGI is unnecessary prior to routine G-tube placement. A larger prospective study is warranted to validate these results.

An unusual appearance of giant Meckel’s diverticulum

Meckel's diverticulum (MD) results from incomplete involution of the proximal portion of the vitelline duct. Although MD is the most commonly diagnosed congenital gastrointestinal anomaly, it is estimated to affect only 2% of the population worldwide. Most cases are asymptomatic, and diagnosis is often made following investigation of unexplained gastrointestinal bleeding, perforation, inflammation or obstruction that prompt clinic presentation. While MD range in size from 1-10 cm, cases of giant MD (B5 cm) are relatively rare and associated with more severe forms of the complications. Herein, we report a 43-year-old male patient presented at the Emergency Department with a complaint of abdominal pain, associated with fever (38,5C), nausea and anorexia. The clinical examination revealed pain in the right lower quadrant, as well as abdominal guarding and rebound tenderness. The leucocyte count was elevated at 18 × 109/L. Plain abdominal xray depicted multiple air-fluid levels. An abdominal and pelvic CT scan revealed a fluid-filled structure in the pelvis adjacent to the distal small bowel. The surgical method of exploration can be either by laparoscopy or through an open incision. Exploratory laparotomy was performed and revealed oedema throughout the entire small bowel, dilation of small bowel segments, and a giant Meckel's diverticulum (10 cm long) with mushroom appearance on the antimesenteric border of the small bowel at 70 cm proximal to the ileocaecal valve . Resection of the small bowel was performed with a linear stapler and an ileoileal anastomosis was generated using a 80 mm endo-GIA stapler. Patient was discharged on post-operative day 4 without any complications. Histopathologic examination indicated Meckel's diverticulitis without gastric or pancreatic metaplasia. Pan African Medical Journal 2015; 21

Preoperative predictive factors in the surgical treatment of congenital gastrointestinal anomalies

Preoperative predictive factors in the surgical treatment of congenital gastrointestinal anomalies

Giant Meckel’s diverticulum: An exceptional cause of intestinal obstruction

Meckel's diverticulum (MD) results from incomplete involution of the proximal portion of the vitelline (also known as the omphalomesenteric) duct during weeks 5-7 of foetal development. Although MD is the most commonly diagnosed congenital gastrointestinal anomaly, it is estimated to affect only 2% of the population worldwide. Most cases are asymptomatic, and diagnosis is often made following investigation of unexplained gastrointestinal bleeding, perforation, inflammation or obstruction that prompt clinic presentation. While MD range in size from 1-10 cm, cases of giant MD (≥ 5 cm) are relatively rare and associated with more severe forms of the complications, especially for obstruction. Herein, we report a case of giant MD with secondary small bowel obstruction in an adult male that was successfully managed by surgical resection and anastomosis created with endoscopic stapler device (80 mm, endo-GIA stapler). Patient was discharged on post-operative day 6 without any complications. Histopathologic examination indicated Meckel's diverticulitis without gastric or pancreatic metaplasia.