Inflamed Meckel's Diverticulum Research Articles

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.

Strangulated Meckel’s Diverticulum in a Littre’s Hernia: A Rare Complication

Meckel’s diverticulum occurs in 2-3% of general population and can presents as Littre’s hernia. We are reporting an 88-year-old female referred to our surgical unit with a painful right groin hernia 2 weeks, associated with vomiting, fever and diarrhoea. Physical examination showed an irreducible tender lump in the right groin with overlying erythematous skin. Plain radiograph showed dilated small bowel with a loop of bowel seen within the right groin region. A diagnosis of strangulated right femoral hernia was made preoperatively. Right inguinal incision initially employed, however, after a grossly inflamed Meckel's diverticulum with adjacent bowel perforation was found, a midline laparotomy ensues. Meckel's diverticulum was resected together with the perforated segment of small bowel. A primary anastomosis was then performed. In managing Meckel’s diverticulum the proposed treatment for is wedge resection and primary repair of the ileum. If there is oedema or inflammation at the base of the diverticulum, resection and anastomosis of a segment of the ileum may be necessary. Meckel’s diverticulum may be found in any type of abdominal hernia and thus an incarcerated hernia should not be attempted to manually reduce.

Meckel's Diverticulitis as a Cause of an Acute Abdomen in the Second Trimester of Pregnancy: Laparoscopic Management.

Introduction. Meckel's diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision. Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel's diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique. Discussion. Meckel's diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective.

Perforation of Meckel’s diverticulum by a fish bone presenting as acute appendicitis: a case report

IntroductionMeckel’s diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Most of them are asymptomatic but can rarely present with forms of complications such as bleeding, obstruction, diverticulitis, intussusception and neoplasm. Patients with a perforation of Meckel’s diverticulum by a foreign body are rare and may present with right iliac fossa pain, which mimics acute appendicitis.Case presentationA 64-year-old Greek man presented with an eight-hour history of right iliac fossa pain. On examination, our patient had tenderness in his right iliac fossa. A provisional diagnosis of acute appendicitis was made. He was taken to theatre with the option of an appendicectomy. His appendix was found to have an about normal appearance. An inflamed Meckel’s diverticulum that had been perforated by a fish bone was found to be the cause of the abdominal pain. A Meckel’s diverticulectomy was performed. Our patient made an uneventful recovery and was discharged after two days.ConclusionsComplications of Meckel’s diverticulum can be difficult to diagnose and early recognition and timely operative intervention must occur in order to provide the best outcome for these patients. This is an interesting and unusual case of perforation of Meckel’s diverticulum that highlights the importance of considering Meckel’s diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

Unique Presentation of Meckel Diverticulum in the Form of Cocoon Managed Successfully by Laparoscopic Surgery

We report a case of complicated Meckel diverticulum presenting with subacute intestinal obstruction in a 21-year-old man managed successfully by laparoscopic surgery. Despite a diagnostic laparoscopy and laparotomy performed elsewhere in the past, main pathology was missed. Diagnostic laparoscopy in our center revealed a fusiform mass arising from terminal ileum, which was treated by laparoscopic-assisted resection and end-to-end ileo-ileal anastomosis. Gross and microscopic examination revealed an encapsulated localized cocoon containing 40 cm of ileum entangled around an inflamed Meckel diverticulum. His intestinal obstruction and hematochezia got relieved.

Laparoscopic treatment of acute small bowel obstruction*

BACKGROUND: Symptoms of obstruction in the intestinal tract involve the small intestine in three quarters of cases and the large intestine in one-quarter. The most common causes of an acute small intestinal obstruction are postoperative adhesions (64.8%) and strangulated hernias (14.8%). The overall incidence of postoperative small bowel obstruction is 4.6%. Because it offers a conservative and targeted means of removing the obstruction, laparoscopy is increasingly used for acute small bowel obstruction. With proper selection of patients, the success rate is very high. This work presents the selection criteria, technique and results for a three-year period. METHODS: Twenty-one patients, 13 men and 8 women aged 28 to 69 years, underwent surgery between January 2008 and December 2010. Selection criteria for a laparoscopic procedure were anesthesia risk of not more than ASA 3, diameter of the dilatated loop of small intestine of not more than 5 cm, radiological image of a change in caliber as an indication of a focal passage disorder, exclusion of paralytic ileus, and no history of diffuse peritonitis. The patients underwent surgery in general anesthesia. The approach for the first trocar was umbilical in 18 cases and in the right or left flank in three cases, but always with open technique. Three trocars were always used. RESULTS: In 7 patients, there was an isolated band from a previous operation, usually an appendectomy; in 5 cases there were postoperative adhesions and a band. Three patients had a volvulus and in one of them, a 20 cm segment of the small intestine was already gangrenous. Two patients had an incarcerated hernia, one inguinal and one Bochdalek. Two patients had a stenosing tumor in the terminal ileum, one of which was a carcinoid and the other, the first manifestation of a lymphoma. One patient had an endometriosis focus as stenosis focus and another had a massively inflamed Meckel's diverticulum that obstructed passage in the small intestine. Two patients – the volvulus with small intestinal gangrene and the Bochdalek hernia – required conversion to open technique. One patient with diffuse adhesions and a band had to undergo open surgery 10 days later. There was no case of an intraoperative accidental intestinal injury. All the patients who underwent laparoscopy were discharged within a week. Hospitalization was significantly longer for the converted patients. The patient with the Boachdalek hernia died after 26 days of irreversible cardiopulmonary failure. CONCLUSIONS: With strict selection, laparoscopic treatment of small intestinal obstruction is a valuable option in visceral acute surgery. Patients with an isolated focal obstruction seem to benefit from laparoscopic surgery on the basis of reduced perioperative morbidity and short hospitalization.

Gastrointestinal: A gastrointestinal stromal tumour (GIST) arising in a Meckel's diverticulum

A 39-year-old man who had 4 years previously undergone a laparoscopic appendicectomy for acute appendicitis was admitted with sudden onset severe lower abdominal pain. Initial examination revealed focal peritonism in the right iliac fossa, temperature of 39°C and tachycardia (96 bmp). White blood cell count was 16 × 109/l. Contrast enhanced abdominal CT was done 10 hrs after admission. The coronal reformatted image of the CT scan (Figure 1) demonstrated a segment of thickened ileum, inseparable from which was a blind ending loop of small bowel with a mixed attenuating mass within the lumen (arrow). There were no features of small bowel obstruction or free intraperitoneal fluid or air. A diagnosis of an inflamed Meckel's diverticulum or a small bowel tumour was suggested. At laparotomy, a large inflamed Meckel's Diverticulum was seen arising from the antemesenteric border of the ileum (Figure 2a). The diverticulum was resected along with a segment of ileum and a side-to-side ileo-ileal anastomosis was performed. Histological examination with haematoxylin and eosin stain (Figure 2b, magnification ×40) revealed a well-circumscribed lesion in the wall of the small bowel composed of fascicles of bland spindle cells with a central cystic area lined by inflamed small intestinal and pyloric epithelium. Immunohistochemistry confirmed an intermediate risk gastrointestinal stromal tumour (GIST) with positive staining with antibodies to CD34, CD117 and delay of gestation 1 (DOG1) antigen (Figure 2c, magnification ×10), and a Ki-67 proliferation index of 5%. A connection of the central cyst to the bowel lumen was not demonstrable, but in view of the appearance and position of the lesion the features were thought to be consistent with a GIST originating in a Meckel's diverticulum and occluding the neck of the diverticulum. Well differentiated endocrine carcinoma (carcinoid) is the most common tumour in this location and only 11 cases of GIST arising in a Meckel's diverticulum have been reported in the last decade. In the majority of histologically suspected GISTs a combination of CD117 and DOG1 immunostaining is sufficient to confirm the diagnosis. Modes of presentation including gastrointestinal bleeding, perforation, paraneoplastic deep vein thrombosis and incidental finding upon imaging or laparotomy. The patient made an uncomplicated recovery and as the GIST was completely excised and had a low proliferation index, no further therapy was necessary. He remains well two years postoperatively. Contributed by

Meckel's Diverticulum with Small Bowel Obstruction Presenting as Appendicitis in a Pediatric Patient

Meckel's diverticulum is a congenital anomaly resulting from incomplete obliteration of the omphalomesenteric duct. The incidence ranges from 0.3% to 2.5% with most patients being asymptomatic. In some cases, complications involving a Meckel's diverticulum may mimic other disease processes and obscure the clinical picture. This case presents an 8-year-old male with abdominal pain, nausea, and vomiting and an examination resembling appendicitis. A CT scan revealed findings consistent with appendicitis with dilated loops of small bowel. During laparoscopic appendectomy, the appendix appeared unimpressive, and an inflamed Meckel's diverticulum was found with an adhesive band creating an internal hernia with small bowel obstruction. The diverticulum was resected after the appendix was removed. The incidence of an internal hernia with a Meckel's diverticulum is rare. A diseased Meckel's diverticulum can be overlooked in many cases, especially in those resembling appendicitis. It is recommended that the small bowel be assessed in all appendectomy cases for a pathological Meckel's diverticulum.

Inflamed Meckel's diverticulum secondary to a giant faecalith: a rare presentation of acute abdominal pain in an adult.

Meckel’s diverticulae can present with symptoms and signs mimicking acute appendicitis. We present the case of a healthy 35-year old male who was suspected of having acute appendicitis but at operation was found to have an inflamed Meckel’s diverticulum containing a giant faecalith, which had caused ischaemic necrosis due to a pressure effect. Post-operatively the patient admitted to a year of recurrent bouts of severe colicky abdominal pain, when running.

Meckel’s Diverticulitis With Associated Enterloith Formation: A Rare Presentation of an Acute Abdomen in an Adult

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, occurring in 2-3% of the population. Enterolith formation associated with MD is a rare entity. We present the case of a 35-year-old active duty sailor who presented with a 24-hour history of worsening abdominal pain and nausea. His exam revealed lower abdominal peritonitis. An abdominal and pelvic CT scan revealed a fluid-filled structure in the pelvis adjacent to the distal small bowel with associated calcifications. Exploratory laparotomy was performed, which revealed an acutely inflamed MD associated with enterolith formation. Consideration of this condition in the differential upon presentation of an acute abdomen is essential, secondary to the morbidity that can accompany it when misdiagnosed.

Appendicitis in pregnancy: Experience of thirty-eight patients diagnosed and managed at a tertiary care hospital in Karachi

Objective To evaluate the clinical presentation, diagnosis, management, and outcome of acute appendicitis complicating pregnancy at a tertiary care hospital in Karachi. Materials and methods This was a retrospective analytical case note review of all patients clinically diagnosed with acute appendicitis during pregnancy at the Aga Khan University Hospital (AKUH), Karachi from January 01, 1990 to July 31, 2006. Results During the review period, 38 pregnant patients were diagnosed with acute appendicitis; a total of 43,134 deliveries took place in the maternity department of the hospital during the same period. The mean age at presentation was 26 years and 66% of patients were multigravida. Thirty percent were in the 1st trimester, 37% in 2nd trimester, and 34% in the 3rd trimester. Abdominal pain was the chief complaint in all patients with the right lower quadrant being the commonest site (74%). Tenderness on physical examination was also mainly located in the same area (87%). Eighty-two percent patients had leukocytosis at presentation. An abdominal and pelvic ultrasound identified an inflamed appendix in 39%. Appendectomy was performed in 37 (97%) cases. One patient was managed conservatively. Thirty-five (95%) had an inflamed appendix on histology. Two patients were found to have a normal appendix, though one of these had an inflamed Meckel's diverticulum. Six (16%) patients developed postoperative complications; of these wound infection and pulmonary embolism were the most common and significant. Adequate deep venous thrombosis (DVT) prophylaxis with heparin was given in 8 (21%) patients. Preterm contractions developed in 5 (13%) patients and 3 (8%) patients had preterm delivery. There was no maternal mortality; however one fetal death was noted. Conclusion Timely diagnosis of acute appendicitis in pregnancy can be difficult. In most cases a correct diagnosis can be arrived at on the basis of a history and physical examination with supportive routine laboratory tests. Urgent surgery is the treatment of choice but delay continues to be a common problem. Infective complications are well recognized in appendicitis; similarly this group of patients is at a higher risk of venous thrombosis and embolism, and routine prophylaxis should be considered in all.

Ungewöhnliche postoperative Bauchwandfistel, verursacht durch einen mit der Nahrung ingestierten, nach Darmperforation in die Bauchwand eingewanderten Holzspieß

Abdominal fistula caused by an ingested wooden spit, which penetrated the intestinal wall and remained in the abdominal wall: a laparascopy was performed in a 41-year-old man suffering from acute appendicitis and an inflamed Meckel's diverticulum. After removal of the appendix and the diverticulum, a fistula developed in the excision channel of the left quadrant of the abdominal wall post-operatively. Despite repeated incision of the abscess in the course of 2 months, the fistula did not heal. Ultrasound examination of the abdominal wall was therefore performed. The postoperative status was without conspicuous findings. We could, however, detect a foreign body, a few centimetres long and 2-3 mm thick, displaying a smooth surface, deep down in the abdominal wall. A fistulography confirmed the diagnosis. After removal of the wooden spit, complete healing of the fistula in the abdominal wall was observed. Subsequently, the patient reported to have eaten a beef roulade, fixed with a wooden spit, 7 weeks before the abdominal operation.

Carcinoid of the Meckel′s diverticulum: Case report and review of literature

We report a 19-year-old female admitted to the Emergency Room with excruciating right lower abdominal pain of 1-day duration. The abdominal examination revealed a soft, lax abdomen with rigidity and guarding in her right iliac fossa without abdominal defense. Apart from a leukocytosis of 18.3/mm3, the rest of her baseline investigations and imaging, including abdominal X-rays, abdominal and pelvic ultrasound and abdominal CT scan were unremarkable. Patient's persistent pain prompted the treating surgeon to undertake exploratory laparotomy, which disclosed an inflamed Meckel's diverticulum and a normal-looking appendix. Meckel's diverticulectomy along with appendectomy was performed. The histopathological report demonstrated carcinoid tumor in the Meckel's diverticulum with free resection margins, whereas appendix was reported to be normal. The patient had an uneventful recovery and was discharged home on the sixth postoperative day.

CT of Meckel's Diverticulitis in 11 Patients

This study reviews the CT findings of Meckel's diverticulitis in 11 patients and, to our knowledge, represents the largest series of such cases reported to date. The inflamed Meckel's diverticulum may be visualized on CT in most patients, appearing as a blind-ending pouch of variable size and mural thickness and containing fluid, air, or particulate material with surrounding mesenteric inflammation. The location of the diverticulum may vary from the right lower quadrant to the mid abdomen, with most cases in this series located near midline. Optimal luminal opacification of the ileocecal bowel with oral contrast material facilitated detection of the diverticulum and also proved invaluable in enabling identification of the normal appendix. The diagnosis is most difficult in the setting of secondary intestinal obstruction.

Sonographic findings of Meckel's diverticulitis in children.

We know of only one previous study that has described the sonographic appearances of the inflamed Meckel's diverticulum in several cases (nine patients). Our study reviews sonographic, clinical, and pathologic findings in 10 patients with an inflamed Meckel's diverticulum. We also describe unique findings on color Doppler sonography for two of our patients. Sonographic findings of an inflamed Meckel's diverticulum may mimic findings for acute appendicitis or intestinal duplication. In patients with rectal bleeding due to diverticulitis, the visualization of a tubular hyperechoic structure on sonography is suggestive of Meckel's diverticulum. The inflamed Meckel's diverticulum may present as a cyst, but its mucosal layer is more irregular than that found in an intestinal duplication. We found that routine color Doppler sonography revealed anomalous vessels and signs of inflammation on the wall of the Meckel's diverticulum.

The ileosigmoid knot

The ileosigmoid knot (ISK) is a rare cause of intestinal obstruction. Unfamiliarity with the condition could have disastrous consequence at surgery. Over the past 20 years, we have encountered seven cases. Analyzing the data gathered from these, and on reviewing the literature, we found it possible to arrive at a preoperative diagnosis in two patients. Four patients were women, two of whom developed the obstruction in the postpartum period. One of the males was found to have an inflamed Meckel's diverticulum included in the knotting. The symptoms and the clinical findings were nonspecific. The characteristic x-ray findings of a double closed loop obstruction, was seen in only three patients. Resection of gangrenous bowel with anastomoses was feasible in four. Unlike in other series, primary anastomosis of the large gut was undertaken. There were two deaths early in the series. Guidelines to the management have been suggested.

Sonographic manifestation of an inflamed Meckel's diverticulum: a case report

Sonographic manifestation of an inflamed Meckel's diverticulum: a case report

Acute intestinal obstruction caused by an intramural hematoma secondary to an inflamed Meckel's diverticulum

Intestinal obstruction is an infrequent complication of Meckel's diverticulum. It may be caused by bands, knots, volvolus or intussusception. This report deals with a patient with Meckel's diverticulitis causing a large intramural hematoma and obstruction.

Acute Appendicitis Occurring during the Course of Other Diseases

THE diagnosis of acute appendicitis is usually considered whenever a patient develops symptoms or signs suggesting an acute intra-abdominal inflammatory lesion. There are many contributions dealing with the differential diagnosis of abdominal symptomatology, in which many diseases that mimic appendicitis are enumerated and classified. The inference usually drawn is that laparotomy on the basis of an erroneous diagnosis of acute appendicitis is warranted if some morbid process is encountered to account for the clinical picture, such as a twisted ovarian cyst, inflamed Meckel's diverticulum, regional ileitis, neoplasm, volvulus or intussusception. Emphasis is usually placed, however, on the dangers of operating . . .