Gangrenous Meckel's Diverticulum Research Articles

The uncommon complications of Meckel's diverticulum: A single center case series study and literature review

Introduction and importanceMeckel's diverticulum is the most common congenital true diverticula of the gastrointestinal tract with 4–9% life time risk of complications. It is difficult to diagnose preoperatively other than having high index of suspicion. Therefore, the aim of this case series is to present the rare presentation of this disease and create awareness for clinician to deliver early intervention so that associated mortality and morbidity will be minimized. Case presentationHere we present four cases of Meckel's diverticulum managed in single center during a period of one year. Two cases were presented as isolated gangrenous Meckel's diverticulum with small bowel obstruction. The remaining two were: an adult male patient operated for generalized peritonitis as a result of perforated Meckel's diverticulitis and a child with intussusception in which Meckel's diverticulum was secondarily obstructed. Clinical discussionThe less frequent complications of Meckel's diverticulum are more challenging to diagnose. It carries higher rate of morbidities since early diagnosis is difficult; especially, isolated axial torsion of the Meckel's diverticulum that we are presenting in this case series. Therefore it is prudent to consider for a pain originating from central abdomen which gets diffuse in the meantime unlike symptoms of complicated appendicitis as symptomatic Meckel's diverticulum. ConclusionThe rare complications of Meckel's diverticulum need high index of suspicion to diagnose as their symptoms mimic other pathologies which cause diffuse abdominal pain. Timely intervention can prevent hospital mortality, morbidity and decrease duration of hospital stay.

Gangrenous Meckel's diverticulum with small bowel obstruction mimicking complicated appendicitis: 'Case report'.

IntroductionThough Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is uncommon in the general population and rare in adults. Its preoperative diagnosis is challenging. While obstruction is the commonest complication, its occurrence with gangrenous Meckel's diverticulum is rare. The aim of this presentation is to report this combination and to create awareness among surgeons and radiologists to increase preoperative diagnosis of Meckel's diverticulum preventing morbidity and mortality from delay in intervention.Presentation of the caseA twenty-years-old male presented with periumblical pain that later shifted to lower abdomen, vomiting and fever of 10 h durations. He has no history of smoking or diabetes. Physical examination showed tachycardia, fever, and lower abdominal tenderness. Exploratory laparotomy revealed gangrenous Meckel's diverticulum and ileal obstruction by a band arising from the tip of diverticulum to ileal mesentery. We did segmental resection of the ileum containing Meckel's diverticulum and end-to-end anastomosis with the excellent outcome.DiscussionPreoperative diagnosis of Meckel's diverticulum is challenging because of non-specific clinical presentations and less sensitivity and specificity of imaging investigations. A high index of suspicion can improve its diagnosis. Axial torsion with gangrenous Meckel's diverticulum is the rarest complication. Management of symptomatic Meckel's diverticulum is surgery. Treatment of silent Meckel's diverticulum is controversial with no strong evidence to treat or not to treat.ConclusionGangrenous Meckel's diverticulum causing small bowel obstruction is rare. Surgeons must have a high index of suspicion to increase preoperative diagnosis of complicated Meckel's diverticulum.

Systematic review of Meckel's diverticulum in pregnancy.

Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future. The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed. Twenty-seven cases were included. Average age=26.9 years. Average gestation=25.1 weeks. Occurrence: first trimester=3.7%; second trimester=48.1% and third trimester=48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms=3.4 days. Diagnostic imaging modalities utilised: ultrasound=40.7%; CT=25.9%; MRI=14.8%; abdominal X-ray=11.1% and endoscopy=7.4%. All cases required definite surgical management: laparotomy=65.4%; laparoscopy=15.4%; C-section=19.2% and unreported=3.8%. Main intra-operative findings: perforated MD=40.7%; intussusception with MD as a lead point=11.1%; bleeding MD=11.1%, inflamed MD=11.1%; small bowel obstruction=11.1%; gangrenous MD=3.7%; volvulus=3.7% and unspecified=7.4%. Mean length from ileocolic junction=51.7cm. Average length of stay was 7.1 days. T-test (p-value=0.12) when comparing management strategy. Three maternal complications and two foetal mortalities. MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.

A surgical surprise: meckel’s diverticulum complicating as littre’s hernia

Background: Meckel's diverticulum (MD), a true diverticulum with all 3 layers, is the most common congenital anomaly of the gastrointestinal tract is due to the failure of the obliteration of the vitellointestinal duct during the 5th to 9th week of gestation life. MD can present as haemorrhage, obstruction, diverticulitis, intussusceptions or perforation. Here we present a case of strangulated Littre's hernia in the right inguinal region. Case report: A 19-year-old male presented with a right groin swelling of 1-month duration. His swelling was not reducible for the past 1 day. He had associated vomiting of 1-day duration. On examination he was febrile and with a heart rate of 96 per minute. His groin examination revealed a 6 x 4 cm swelling which was tense and tender with absent cough impulse. His Chest X-ray and abdomen were within normal limit. His blood investigation was within normal limits except for a leucocytosis. A provisional diagnosis of strangulated inguinal hernia was made and patient was taken up for surgery. A right inguino-scrotal incision was made. The hernia sac was opened at the fundus. 5ml of toxic fluid was let out. The content was a gangrenous Meckel's Diverticulum which was 8cm in length and about 60 cm from ileocaecal junction. Resection of the gangrenous MD was done with end-to-end anastomosis of the ileum. Postoperative period was uneventful and he was discharged on the 9th post-operative day. Conclusion: Meckel's Diverticulum is one of the rare contents of the hernial sac. Diagnosis is usually intraoperative. Management includes resection of the diverticulum

Intestinal obstruction caused by gangrenous Meckel's diverticulum encircling terminal ileum: a case report with emphasis on image findings

Mickel's diverticulum is considered the most prevalent congenital anomaly of the gastrointestinal tract. here, we report a rare occurrence where a gangrenous Mickel's diverticulum formed a loop with a part of small bowel herniated through causing bowel obstruction requiring bowel resection, in a 17-year-old patient.

Perforated gangrenous Meckel's diverticulum due to round worm bolus presenting as acute abdomen

Meckel's diverticulum is the most common congenital malformations of the gastrointestinal tract and is usually asymptomatic. But in patients with intestinal ascariasis, Meckel's diverticulum may pursue a silent course or may be complicated by diverticulitis, gangrene and perforation. Perforation due to impacted round worm bolus is a rare complication. This report presents a rare complication of Meckel's diverticulum due to impacted round worm bolus.

Laparoscopic resection of a huge gangrenous Meckel’s diverticulum in an adult

This report highlights the rare occurrence of a huge gangrenous Meckel's diverticulum in an adult, which was managed successfully with laparoscopic resection. A 45-year-old woman presented with a one-day history of right iliac fossa pain with fever and vomiting. Computed tomography showed a huge gangrenous Meckel's diverticulum. The patient underwent laparoscopic exploration and extracorporeal stapled resection of the Meckel's diverticulum. This case serves to highlight the safety and feasibility of performing a laparoscopic resection of a huge gangrenous Meckel's diverticulum in an adult.

English

Littre's hernia is uncommon clinical entity. We are presenting a case of Strangulated Littre's Hernia. A 19 years old male, came with pain and swelling in right inguinal region, which turned out to be an obstructed inguinal hernia with gangrenous Meckel's diverticulum. Gangrenous Meckel's diverticulum was resected and anastomosis of ileum was done. Hernial defect was repaired. Detailed review of literature reveals that although Meckel's diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, and hernias are also common, but a Strangulated Littre's Hernia (where a Meckel's diverticulum is the content of a hernial sac) is very uncommon.

Meckel Divertikülünün Aksiyal Torsiyonu ve Gangreni: İlk Bebek Olgu Sunumu

Axial torsion of Meckel's diverticulum (MD) is very rare and has been reported in only 9 children and 23 adults within the past 40 years. Herein, we report the first known infant case of axial torsion and gangrene of MD. A 6-month-old male patient presented with acute abdomen. Ultrasonography showed a perihepatic cystic mass and minimal free fluid. Exploratory laparotomy revealed a gangrenous MD measuring 7 × 6 cm due to axial torsion. MD wedge resection was performed and the patient was asymptomatic during 2 years of follow-up. MD and its torsion and gangrene should be considered in surgical cases of acute abdomen.

Intestinal obstruction caused by torsed gangrenous Meckel’s diverticulum encircling terminal ileum

Meckel's diverticulum (MD) is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage, obstruction, and inflammation. Obstruction of various types is the most common presenting symptom in the adult population. Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications. The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies. Delay in the diagnosis of a complicated MD can lead to significant morbidity and mortality. Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum. To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.

Gangrenous meckel's diverticulum in a strangulated umbilical hernia in a 42 year-old woman: a case report

IntroductionMeckel's diverticulum affects 1 - 3% of general population and is known as the most common anomaly of gastrointestinal tract. However, its estimated lifetime complication rate is approximately 4%. Intestinal obstruction is most common complication of Meckel's diverticulum in adult population.Case presentationIn the present study, we reported a 42-year-old female patient with a gangrenous Meckel's diverticulum in a strangulated umbilical hernia sac treated by dissection of diverticulomesenteric bands and diverticulectomy. In 36 months follow-up, there was neither any complication nor recurrence of hernia.ConclusionThis case represents a gangrenous Meckel's diverticulum in a strangulated umbilical hernia sac diagnosed in case of emergency. Although it is a very rare phenomenon, we should be vigilant for this entity especially in case of emergency.

Meckel′s diverticulumstrangulated in an umbilical hernia

Strangulated Meckel's diverticulum (MD) in an umbilical hernia (UH) is a rare event. We present herein a case of strangulated MD in UH in a child. An 18-month girl was admitted with clinical features suggesting upper intestinal strangulation since seven days. Many attempts of reduction were done before admission. She was resuscitated and had exploratory laparotomy, which revealed the hernia sac containing a completely gangrenous MD. She had bowel resection and had an uneventful postoperative period. An MD may be the content of a strangulated UH. Bowel resection of the segment bearing the diverticulum is advisable if the latter is gangrenous.

Meckel’s diverticular complications in children: is laparoscopy the order of the day?

Meckel's diverticulum (MD), a seemingly innocuous anomaly of the gastrointestinal tract, presents distinctive challenges to a clinician, as it is prone to varied complications that are frequently elusive to diagnosis with conventional diagnostic modalities. This case series illustrates the diverse presentations and advantages of laparoscopic-assisted management of Meckel's diverticular complications in children. Between October 2002 and April 2006, 36 patients (27 males and 9 females) aged 1.5 to 16 years (median 10 years) underwent laparoscopic-assisted trans-umbilical Meckel's diverticulectomy (LATUM). Sixteen (44.4%) patients presented with lower gastrointestinal bleeding (14 with painless bleed and 2 with perforated peptic ulcer in the ileum adjacent to the MD), six (16.7%) patients presented with intestinal obstruction (four due to a mesodiverticular band and one each due to intussusception and floppy giant cystic dilatation of MD causing intestinal compression) and four (11.1%) patients presented with features masquerading as appendicitis (one with Meckel's diverticulitis and perforation, one with perforated peptic ulcer adjacent to MD and two with a torted and gangrenous MD). In ten (27.8%) patients, incidental MD with a narrow base was noted at laparoscopic exploration for suspected appendicitis. All patients underwent successful LATUM along with appendicectomy in 15 (41.7%) patients. The operative duration ranged from 72 to 266 min (mean 125.9+/-48.4). There were no intra-operative complications and none required conversion to open surgery. The hospital stay was 3 to 9 days (mean 5.3+/-1.2). There were three (8.3%) cases of postoperative adhesive intestinal obstruction; two underwent successful laparoscopic adhesiolysis and one necessitated conversion to suprapubic laparotomy to release the pelvic adhesions. There were no other complications during the follow-up (median 16 months). LATUM is a safe, effective and an esthetic procedure offering timely diagnosis and cure for diverse Meckel's diverticular complications. The technique also allows palpation of the MD and avoids usage of expensive staplers.

GANGRENE OF MECKEL'S DIVERTICULUM SECONDARY TO AXIAL TORSION: A RARE COMPLICATION

A Meckel's diverticulum may result in a number of complications including hemorrhage, obstruction, and inflammation. We report a case of a gangrenous Meckel's diverticulum secondary to axial torsion, which has been reported only four times in adults and once in children in the past 28 years.