Diverticulum In Children Research Articles

Endovideosurgical interventions in the bladder diverticulum in children

Introduction. Among congenital and acquired malformations in the urinary system organs, one of the topical issues is the choice of management modalities in bladder diverticulum. Modern equipment and development of minimally invasive techniques have expanded the variability of curative approaches, which is especially important for children with comorbidities.Purpose. To optimize surgical treatment of children with bladder diverticulum using minimally invasive surgical interventions, to reduce the rate of intraoperative and postoperative complications as well as to improve endovideosurgical access for the successful implementation of reconstructive interventions based on the authors' analysis of their own material on treating children with bladder diverticula.Material and methods. Five patients of different age having a bladder diverticulum with various anatomical features and with comorbidities were treated at the surgical department of St. Luka Clinical Research Specialized Center for Children (Moscow, Russia) in 2021–2022. The researchers could find the principle for selecting a proper surgical modality after they had assessed positive and negative aspects of each type of surgical access.Results. While choosing the type of surgical access in the discussed patients, the authors took into account anatomical features, concomitant pathologies, findings of instrumental diagnostics. As a result, all patients had good outcomes. The authors demonstrated a successful application of endovideosurgical techniques in the management of patients with congenital bladder diverticula after they had analyzed their own clinical material. They also described effective techniques for reconstructing ureterovesical anastomosis area with consideration of its place in relation to the diverticulum.Conclusion. The pneumovesicoscopic access for congenital bladder diverticulum removal is the most rational one, as it allows to accurately restore the relationship of anatomical structures.

Robot-assisted bladder diverticulectomy in a 9-year-old boy

Pediatric urologists rarely encounter bladder diverticulum in children. If the bladder diverticulum has clinical manifestations such as pain, urinary tract infection, hematuria, voiding dysfunction, vesicoureteral reflux, or obstruction of the ureterovesical anastomosis, then surgical treatment is indicated. Recently, numerous publications began to appear on the removal of the bladder diverticulum using laparoscopic or vesicoscopic access. Several foreign publications have reported on the removal of a bladder diverticulum in children using a robotic approach. A 9-year-old boy who was diagnosed with a bladder diverticulum underwent robot-assisted bladder diverticulectomy in January 2020 at the Almazov National Medical Research Centre. Ports of da Vinci 12 and two 8-mm ports, as well as an assistant 5-mm port, were used, which were installed in typical places for lower abdominal surgery. The duration of the operation was 135 min, and the console time was 75 min. The blood loss volume was 20 mL. The patient was in the intensive care unit for 1 day. The urethral catheter was removed on day 7 after the operation. Urination independence, delays, and incontinence were not noted. The patient was discharged on postoperative day 9 in satisfactory condition. At the control examination after a year at the patients residence, she had no complaints, urination was not disrupted, and there were no pathological changes in the ultrasound of the kidneys and bladder. Robot-assisted bladder diverticulectomy in children is a feasible, effective, and safe treatment option in expert centers with extensive experience in robotic surgery. The described clinical case of bladder diverticulectomy is the first in Russia, which was performed using a robotic system in pediatric practice.

UNCOMMON PRESENTATION OF MECKEL DIVERTICULUM IN AN INFANT

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Painless intestinal hemorrhage is a frequently occurring complication that relates to Meckel's diverticulum in children. Bowel obstruction is a rare complication of Meckel's diverticulum in children. This is to report a case of 1 month old male infant presented with sudden history of abdominal distention and not passing stool for 4 days

Congenital anterior urethral diverticulum in children: case series and review of the literature

BackgroundCongenital anterior urethral diverticulum (CAUD) is a rare condition in children. This condition can present at any age; however, it is more commonly identified in infants and older children. The patient may present with difficulty in micturition, dribbling of urine, poor urinary stream, or urinary tract infection. Children with large anterior urethral diverticulum with poor spongiosal support may also complain of cystic ventral penile swelling during micturition.MethodsIn this series, we report seven such cases of congenital anterior urethral diverticulum treated over a period of 12 years (2008–2020). All cases presented to the Pediatric Surgery Department with dysuria, dribbling of urine, recurrent urinary tract infection, and/or fluctuant ventral penile swelling. They were further evaluated with retrograde urethrography with micturating cysto-urethrogram and cysto-urethroscopy.ResultsThree cases had anterior urethral valves that were managed by cystoscopic fulguration of valves. Surprisingly, all these three cases had concomitant posterior urethral valves, while the other four cases presented with relatively larger and saccular anterior urethral diverticulum required excision of the diverticulum and primary urethral reconstruction.ConclusionsThe cases with congenital anterior urethral diverticulum secondary to anterior urethral valves may also be associated with posterior urethral valves as seen in our case series. Surgeons should be aware of this association, and both valves should be fulgurated in the same sitting. A larger and saccular anterior urethral diverticulum requires excision and urethroplasty as a definitive procedure.

Necrotizing fasciitis complicating perforated Meckel's diverticulum in a patient with acute lymphoblastic leukemia relapse: A case report

The occurrence of necrotizing fasciitis in children with acute lymphoblastic leukemia (ALL) has been reported with malignancies during granulocytopenic episodes from chemotherapy. Perforation of Meckel's diverticulum in children with leukemia is very rare. Only one case has been reported in the literature till now. A 10-year-old male presented with acute abdomen and was diagnosed with perforation peritonitis due to a perforated Meckel diverticulum receiving chemotherapy for relapse of B-cell ALL. In addition, the patient was a known case of celiac disease. Intraoperatively, due to the hemodynamic instability and thrombocytopenia, it was decided to perform a resection of the ileum bearing the pathology with a double-barrel ileostomy. He developed necrotizing fasciitis of the anterior abdominal wall due to Group A streptococci and overwhelming Gram-positive sepsis. The patient was managed comprehensively with multiple platelets concentrates, fasciotomy of the abdominal wall, and multiple debridements under the cover of broad-spectrum antibiotics. Histopathology of the resected Meckel's diverticulum showed ectopic gastric mucosa. Two months later, split-thickness skin grafting was performed. Early diagnosis and prompt surgical management may prevent mortality associated with both the delayed presentation of bowel perforation and necrotizing fasciitis in ALL patients.

Different clinical symptoms and surgical treatment of Meckel's diverticulum in children

Objective: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually identified incidentally during surgery for other reasons, upon radiological workup while investigating another disease or during autopsy. Among certain major symptoms of Meckel's diverticulum include gastrointestinal bleeding, volvulus, diverticulitis, intussusception, Littre's hernia or stool discharge from the umbilicus. In this study, we examined pediatric patients who were operated on for Meckel's diverticulum presenting with different clinical symptoms.
 Methods: The files of pediatric patients who were operated for Meckel's diverticulum in the pediatric surgery clinic between July 2002 and July 2017 were retrospectively reviewed. Patients who underwent incidental diverticulectomy were excluded from the study.
 Results: The 47 patients included in the study were 34 boys, 13 girls, and their mean age was 4.8 (1 day, 16 years). 49% of the patients were younger than 2 years old. The most common symptom observed in the patients was abdominal pain (63.8%). The most common indication for surgery was intestinal obstruction (53.2%). Intussusception was the cause in 64% of the patients in whom intestinal obstruction was the initial diagnosis. We detected gastrointestinal (GI) bleeding complaint in 12.8% of the patients. Segmentary bowel resection (46.8%) was the most common surgical procedure. In the pathological examination, ectopic tissue was found in 27 (57.4%) pathological specimens. While postoperative complications developed in 9 patients, 4 patients were treated conservatively and 5 patients were treated surgically.
 Conclusion: Establishing a preoperative diagnosis of Meckel's diverticulum may be difficult non other than rectal bleeding with currant jelly stool. In symptomatic Meckel's diverticulum, simple diverticulectomy, wedge resection or segmental bowel resection should be planned according to the complication caused by the diverticulum.

A case report of renal calyceal diverticulum with hypertension in children and review of literature

BackgroundRenal calyx diverticulum refers to a cystic lesion covered with the transitional epithelium in the renal parenchyma. Although there is no clear evidence that calyx diverticulum can cause hypertension, there exists a close association between the two, and there are few related reports. Herein, we reported the case of a child with renal calyx diverticulum complicated with hypertension and summarized the diagnosis and treatment.Case presentationPhysical examination of the patient, an 11-year-old child, revealed a left renal cyst with hypertension (155/116 mmHg). There were no related symptoms. Routine urine and blood biochemical examinations showed no abnormalities. Imaging revealed left renal cyst compression causing the hypertension. She underwent renal cyst fluid aspiration and injection of a sclerosing agent into the capsule, but her blood pressure increased again 3 days postoperatively. Color Doppler ultrasonography showed that the size of the left renal cyst was the same as that preoperatively. To further confirm the diagnosis, cystoscopic retrograde ureteropyelography was performed to confirm the diagnosis of renal calyx diverticulum. Subsequently, renal calyceal diverticulum resection and calyx neck enlargement were performed. The operation went smoothly and the blood pressure returned to normal postoperatively. No abnormalities were noted at the 7-month postoperative follow-up.ConclusionThere exists an association between renal calyx diverticulum and hypertension. Therefore, hypertension can be considered a surgical indication for renal calyx diverticulum. Moreover, renal calyceal diverticulum in children can be easily misdiagnosed as a renal cyst. Therefore, it is important to be vigilant to prevent a series of complications, such as postoperative urine leakage, in such cases.

Gigant Morgagni Congenital Hernia Associated with Intestinal Malrotation and Meckel Diverticulum in Child with Down Syndrome- Clinical Case Presentation and Literature Review

Gigant Morgagni Congenital Hernia Associated with Intestinal Malrotation and Meckel Diverticulum in Child with Down Syndrome- Clinical Case Presentation and Literature Review

Value of sonographic pseudogestational sac sign in the diagnosis of Meckel diverticulum in children presenting with bleeding per rectum: a 15-year prospective study

BackgroundMeckel diverticulum is the most common congenital abnormality of the gastrointestinal tract. Gastrointestinal bleeding is the most common complication of Meckel diverticulum in the paediatric population; the bleeding mostly occurs in the first 2 years of life. Because the diverticulum is seldom seen in clinical practice, misdiagnosis and delayed diagnosis are not uncommon. CT and nuclear studies are the most used diagnostic tools in clinical practice. However, radiation and sensitivity concerns remain an issue. Ultrasound has been suggested as an alternative diagnostic tool in diagnosing Meckel diverticulum with mixed results. The aim of our study is to assess the value of using a new sonographic sign, the pseudogestational sac sign in diagnosing Meckel diverticulum in children presenting with bleeding per rectum. Ultrasound was performed for all children. Results were correlated with nuclear studies, histopathology and clinical follow-up findings.ResultsSeventy-three children were included in our study. The pseudogestational sac sign was present in 46 (63%) and absent in 27 (37%) cases. Forty-five children were ultimately diagnosed as Meckel diverticulum. The age ranged from 2 months to 9 years with a mean of 2.3 years. The boy-to-girl ratio was 4.6:1 with 60% of children presenting during their first 2 years of life. The ultrasound performance using the pseudogestational sac sign revealed a sensitivity of 91.1%, specificity of 82.1%, positive predictive value of 89.1%, negative predictive value of 85.2%, positive likelihood ratio of 5.1, negative likelihood ratio of 0.11 and accuracy of 87.7%.ConclusionThe sonographic pseudogestational sac sign is a reliable diagnostic tool for diagnosing Meckel diverticulum in children presenting with bleeding per rectum. The sonographic diagnosis of Meckel diverticulum complies with the international standards of “Image Gently”.

Спайкова кишкова непрохідність як ускладнення дивертикула Меккеля в дітей

Meckel’s diverticulum (DM) is a formation of the ileum caused by incomplete obliteration of the omphalomesenteric duct in the developing embryo. This is one of the most common anomalies of the digestive tract in children. Most DM develops completely asymptomatically. Clinical symptoms develop in only 16% of cases, and 50–60% of them are children under 10 years, an average of 2.5 years of age. The severity of clinical symptoms in DM is associated with the development of complications: intestinal bleeding, intestinal obstruction (intussusception, strangulation intestinal obstruction), diverticulitis with perforation and peritonitis, etc. The article presents a clinical case of adhesive intestinal obstruction in an 8-year-old, which occurred after DM in the anamnesis. As the adhesive intestinal obstruction is an extremely rare complication of DM in children, the presence of patients with acute surgical pathology of the abdominal cavity requires pediatric surgeons to clearly understand the occurrence of such complications in the perspective of the development of intestinal tube defect – DM and the need for the immediate radical treatment tactics in the event of this problem. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, Meckel’s diverticulum, complications, adhesive intestinal obstruction.

The Clinical Manifestation Variety and Management Choice of Meckel's Diverticulum with Complication: A Single Center Experience.

Background The study was to analyze the clinical manifestation variety and management choices of symptomatic Meckel's diverticulum in children. Methods From July 2008 to October 2018, 28 cases of Meckel's diverticulum with a variety of complications were admitted to our hospital. The clinical data included age, gender, symptoms and signs, investigations, intraoperative and pathological findings, and outcome. Results The ratio of males to females was 2.5 : 1. The diagnoses were made by 99mTc-pertechnetate scan (in 5 cases) and by exploratory laparotomy (in 2 cases). The initial diagnosis in the other cases includes intussusception (in 4 cases), acute appendicitis (in 5 cases), intestinal obstruction (unknown origin), peritonitis, and even shock in 12 cases. Laparoscopic surgery was performed in 8 cases; 18 cases underwent open surgery. Excision of partial bowel segment with diverticulum and primary anastomosis was done in 22 cases and wedge resection of diverticulum in 4 cases. Two other cases received nonoperative therapy and went to other hospitals to receive surgical management. Ectopic gastric mucosa in the diverticulum was found in 9 cases, including 6 cases with lower gastrointestinal bleeding. Conclusion The clinical characteristics of Meckel's diverticulum varied. Children with hematochezia, peritonitis, and intestinal obstruction without history of prior abdominal operation should be suspected with this disease until proven otherwise. Hematochezia is often associated with ectopic gastric mucosa in the diverticulum. Laparoscopic surgery should be one of the choices for the diagnosis and treatment of Meckel's diverticulum with complications.

Clinicopathologic Characteristics and Treatment Outcomes of Symptomatic Meckel's Diverticulum in Children

Clinicopathologic Characteristics and Treatment Outcomes of Symptomatic Meckel's Diverticulum in Children

Complicated Meckel's Diverticulum in Children: Clinical Presentation, Diagnostic Work-Out, Surgical Approach and Postoperative Complications.

IntroductionMeckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of cases are asymptomatic and in cases with complications, the diagnosis may be a challenge and the surgical approach is not obvious. The primary aim of the present study was to evaluate the diagnostic process and surgical approach in relation to clinical presentation. The secondary aim was to evaluate the severity of postoperative complications. MethodsA two-center, retrospective analysis of all children below the age of 15 years, operated for complications to MD during the period from January 2003 to December 2016.ResultsA total of 58 patients were included. In the 40 patients presenting with an acute abdomen an average of 2.3 preoperative diagnostic investigations was performed. In only five cases an MD was recognized preoperatively. In the 18 patients presenting with rectal bleeding or melaena an average of 3.2 preoperative investigations were performed and in only one case the MD was recognized preoperatively. Laparoscopy was the surgical approach in 36 patients (62%) with a conversion in 8. Postoperative complications were seen in two patients (Clavien-Dindo II and IIIb).ConclusionDespite extensive diagnostic work-out an MD was recognized in only a few patients preoperatively. Laparoscopy was the surgical approach in two-thirds of the patients.

Symptoms Investigate the Frequency of Various Presentations of the Meckel’s Diverticulum and Help Identify Sign Promptly

Background: Meckel's diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but could also be symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. This study was performed to assess the frequency of various presentations of the patients who underwent surgery with the diagnosis of Meckel's diverticulum in Children's Medical Center, Tehran, Iran from March 2005 to March 2011. Material and Methods: Since this study is a case series report (retrospective descriptive study) and the purpose is assessing the various presentation of Meckel’s` diverticulum, we express the frequency and percent frequency of each presentation. The data collection tool was a five-part survey form. The first part was related to demographic data, the second part was related to clinical data, the third part was related to diagnostic data, the fourth part was related to treatment data and the fifth part was related to histological data. Data were analysed using SPSS statistical program. Result: We found 49 patients in this period (71% male 29% female). The mean age was 3.5 years (1 month to 9 years). The male to female ratio was 2.5. The most common clinical symptoms were abdominal pain (63%). forty-three percent of patients had single symptoms and the others had combined symptoms such as abdominal pain and hematochezia. Only 8 patients with lower gastrointestinal bleeding had a Technetium scan and all of them were positive. Associated findings during surgery included appendicitis and invagination. Our sonographic imaging findings were nonspecific. In the pathologic report, 6 patients had gangrene in specimens and 2 perforations. The lining was of gastric type in 24 specimens pancreatic in 3 and mixed in 2 specimens. None of those with the gastric type of mucosa showed Helicobacter pylori infection. Conclusion: Regarding our findings, clinical findings of Meckel's diverticulum in our study were rather the same as in the literature. Pathologic examination of specimens revealed that most diverticula were lined by gastric type of mucosa. None of those with the gastric type of mucosa showed Helicobacter pylori infection.

Partial resection of large congenital left ventricular diverticulum in an infant: a case report

BackgroundCongenital left ventricular diverticulum is a rare cardiac malformation usually requiring total resection.Case presentationThis report describes an infant presenting with a large apical diverticulum with a wide ventricle connection. Given the vicinity of the left anterior descending coronary artery to the diverticulum and its wide ventricular connection, partial resection was undertaken. The patient remained asymptomatic with good heart function 8 months after surgery. The last follow-up echocardiography did not demonstrate any significant left ventricular outpouching.ConclusionsWe advocate early treatment of left ventricular diverticulum in children given the risk of spontaneous rupture of diverticulum, sudden death, and other serious complications if left untreated. For small patients with a wide connection of diverticulum to ventricle, partial resection is a safe option with favorable short-term outcomes.

Clinical manifestations of Meckel Diverticulum in children: a review of 11-years

Clinical manifestations of Meckel Diverticulum in children: a review of 11-years

Diagnostic accuracy of high-frequency ultrasound in bleeding Meckel diverticulum in children.

Meckel diverticulum is one of the most important causes of small bowel bleeding in children. Reports suggest that ultrasonography can be used as an alternative examination for children with negative radionuclide scanning results or children with atypical clinical manifestations. To evaluate the diagnostic accuracy of high-frequency ultrasound in children with bleeding Meckel diverticulum. We collected the data of children who were admitted to our hospital for the main symptom of bloody stool from February 2006 to December 2017. Ultrasonography was performed in all children. The final diagnosis was confirmed by pathological analysis or clinical follow-up observation. We evaluated the diagnostic performance of ultrasonography according to the final diagnosis. A total of 784 eligible children were enrolled in the study. Presenting symptoms or findings included black and red stool in 528 (67.3%), bright red stool in 51 (6.5%) and obscure or occult bloody stool in 205 (26.1%). Anemia was diagnosed in 489 (62.4%). Ultrasonography diagnosed Meckel diverticulum with a sensitivity of 93.6% (95% confidence interval [CI] 91.0-95.6%) and a specificity of 98.1% (95% CI 95.9-99.3%). High-frequency ultrasound diagnosis of Meckel diverticulum in children has high sensitivity and specificity.

Laparoscopic resection of a bladder diverticulum in children

Introduction. Recently, there have been publications devoted to laparoscopic removal of a bladder ear. The article sums up the multi-center experience in laparoscopic diverticulectomy.Materials and methods. Case histories of 30 children who underwent surgeries from 2012 to 2019 in 7 outpatient clinics were analyzed retrospectively. 22 boys (73.3%) and 8 girls (26.7%) were operated. At the time of the surgery, the mean age of the patients was 53.5 months. 15 (50.0%) children had right-sided diverticulum, 13 (43.3%) children suffered from left-sided one, and 2 had bilateral diverticulum (6.7%). The disease onset was presented by acute urinary tract infection in 25 (83.3%) children and urination dysfunction in 5 (16.7%). The laparoscopic access technique was used in all children. An isolated diverticulum was excised and the wall of the urinary bladder was restored. When the diverticulum was combined with a vesicoureteral reflux or ureterovesical anastomosis, ureteral reimplantation was added. Results. No conversions were found during the laparoscopy. Following the surgery, 3 (10.0%) children developed stent-associated pyelonephritis. No patient had complications during the observation that lasted from 6 months to 6 years. Conclusion. Laparoscopic technique is an effective and safe approach of treating a bladder ear in children.

Clinical Effect of Single-Site Laparoscopy in the Treatment of Meckel's Diverticulum in Children

Purpose: To observe the clinical effect of laparoscopic surgery on Meckel's diverticulum in children with (MD). Method: The clinical data of 20 children were analyzed retrospectively. All children were treated with laparoscopic surgery at single part of the umbilical cord, and the operation, clinical effects and postoperative complications were observed. Result: All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusion: Umbilical laparoscopy is effective in the treatment of pediatric MD with less trauma, simple operation, short operation time and quick recovery after operation. Background Meckel's diverticulum is the most common congenital developmental malformation of the gastrointestinal tract, which is a mesenteric malformation caused by embryonic yolk tube degeneration. The incidence in the population is 2.0%, most patients have no clinical symptoms, occasionally found in autopsy, laparotomy, clinical diagnosis is more difficult. The clinical manifestations of its complications are easy to be confused with other diseases such as intussusception, colonic polyps, necrotizing enteritis and acute appendicitis perforation. Date sources Based on the progress in the treatment of Meckel's diverticulum in children at home and abroad, the clinical data of 20 children with Meckel's diverticulum treated in our hospital were analyzed retrospectively to observe the clinical effect of laparoscopy-assisted operation in the treatment of Meckel's diverticulum in children. Results All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusions Surgical resection is the first choice for symptomatic Meckel diverticulum in children, and laparoscopic surgery is the first choice. The operative method of laparoscopic treatment of Meckel diverticulum in children with single part of umbilical cord has the advantages of less trauma, simple operation, short operation time and quick recovery after operation, and the operative effect is good.

腹腔镜下利用套扎器治疗小儿梅克尔憩室

腹腔镜下利用套扎器治疗小儿梅克尔憩室