In spite of the finding of Meckel's diverticulum in 1 to 2 per cent of all necropsies (1, 2), its preoperative roentgen diagnosis constitutes a rarity. Stein et al. (2), in a review of the English literature found only 33 instances in which the diagnosis of Meckel's diverticulum had been made preoperatively. They report 5 additional cases in adults, bringing the total to 38 at the time of their publication. Two cases of Meckel's diverticulum in children with preoperative roentgen diagnosis will be reported here. These were consecutive cases studied with this possibility in mind in an interval of three weeks. The presenting complaint in each was periumbilical abdominal pain. This symptomatology and absence of demonstrable disease in the upper gastrointestinal tract prompted distal small bowel study in an attempt to demonstrate a Meckel's diverticulum. Report of Cases Case I: D. C., a 6-year-old white boy, was first seen on May 11, 1959, complaining of intermittent dull aching periumbilical pain during the past year. He frequently had to stop even play activity and lie down until the pain disappeared. During the past three weeks the pain had become more frequent and severe, occurring both day and night. He had vomited on only one occasion, the night prior to the initial visit. The patient was placed on medication and seen four days later, at which time his complaint was the same except that the abdominal pain had become more or less constant. At this time physical examination revealed mild tenderness in the periumbilical area but was otherwise normal. Urinalysis was normal. The white blood count was 7,300, with 27 per cent neutrophils, 50 per cent lymphocytes, 5 per cent monocytes, and 10 per cent eosinophils. Roentgen study was done on May 18. Since the esophagus, stomach, and duodenum appeared normal, it was decided to observe the distal small bowel in an attempt to demonstrate a Meckel's diverticulum. Fluoroscopy was done after an interval of one hour, at which time the barium had advanced to the cecum. At once a diverticulum-like structure was identified, originating from the prepelvic portion of the ileum and directed laterally across the terminal ileum approximately 5 cm. proximal to the ileocecal junction. This appeared as a pouch 2 cm. in diameter, somewhat lobulated in configuration and constricted at the neck at the point of junction with the prepelvic section of the ileum (Fig. 1). On this evidence a roentgenologic diagnosis of Meckel's diverticulum was made. Surgery was undertaken one week after the roentgen demonstration of the diverticulum. At laparotomy, through a right lower quadrant incision, a Meckel's diverticulum was found approximately 35 cm. proximal to the ileocecal valve, measuring approximately 7 cm. in length and 1 cm. in diameter (Fig. 2). A band-like structure tended to draw the diverticulum toward the cecum and probably accounts for the position as observed at fluoroscopy and demonstrated on the spot-film.
Read full abstract
Nov 1, 1988
A G Lachaux + 3
