Meckel's Diverticulum Research Articles

Meckel's Diverticulum in Its Occlusive Form

Meckel's diverticulum is a remnant of the omphalomesenteric duct. This diverticulum can lead to complications such as perforation, inflammation, or intestinal obstruction. We report the case of an 18-year-old female who presented with a febrile subocclusive condition lasting more than 48 hours. She was urgently admitted to the operating room due to worsening clinical and laboratory findings that were unresponsive to standard resuscitation measures. Imaging indicated a small bowel obstruction without signs of bowel ischemia, with prominent air-fluid levels upstream of a non-specific inflammatory disparity zone. During surgery, after meticulous dissection focused on the previously identified disparity zone on imaging, it was concluded that the obstruction occurred upstream of a Meckel's diverticulitis. The surgical procedure involved resection and ileoileal anastomosis. Postoperative recovery was uneventful, with the resumption of liquid diet and bowel movements on the third day. This case will be presented, labeled, and discussed in relation to the existing literature.

An adenocarcinoma in an inverted Meckel’s diverticulum with intussusception

BackgroundAdenocarcinoma in an inverted Meckel's diverticulum with intussusception has not been reported to date. We discuss the clinical issues concerning this rare condition and review the relevant literature.Case presentationA 71-year-old Japanese female was referred to our hospital for further investigation of severe anemia. Computed tomography revealed a tumorous lesion in the terminal ileum. Capsule endoscopy did not provide detailed images. Exploratory laparoscopy revealed intussusception in the terminal ileum. An intraluminal tumor 70 cm proximal to the ileocecal valve was observed to be the lead point. Partial resection including the tumor was performed. Macroscopically, a polypoid tumor at the tip of an inverted diverticulum-like structure was observed. The tumor was histologically composed of adenocarcinoma accompanied by gastric and pyloric gland metaplasia in the background mucosa, which was confirmed by immunohistochemical staining. Based on these characteristics, this tumor is considered to have developed from the ectopic gastric mucosa in a Meckel's diverticulum.ConclusionsWhen we encounter patients with unfamiliar lesions in the small bowel, we need to differentiate Meckel's diverticulum related disease. Meckel's diverticulum can invert into the lumen of the small bowel and cause an intussusception, and has potential of malignant transformation.

Torsion of the whole ileum and hemorrhagic necrosis because of a giant Meckel’s diverticulum in a 9-month-old child

Abstract Intestinal ischemia caused by torsion of a freely hanging Meckel’s diverticulum (MD) resulting in the need for resection is an uncommon complication. We present an extraordinary case of a 9-month-old male with acute abdominal symptoms because of intestinal ischemia and necrosis that necessitated resection of the entire ileum. This was caused by torsion around a particularly large MD.

Non-steroidal anti-inflammatory drug-induced perforation of Meckel’s diverticulum

Meckel’s diverticulum (MD) is commonest congenital gastrointestinal anomaly, the common complications associated with MD are hemorrhage, ulceration, intestinal obstruction, diverticulitis, umbilical anomalies, and neoplasm. Perforation of Meckel’s diverticulum is a rare entity and there’s very less documentation regarding the incidence of Meckel’s perforation. MD perforation is usually a life-threatening complication and is associated with high mortality, perforation is usually due to diverticulitis, peptic ulcer disease occurring in the ectopic gastric mucosa which might be present in MD. NSAID intake associated with Merkel’s perforation has been documented in a few studies. NSAID intake and gastric perforation have been well established but a relation between NSAIDs and heterotrophic gastric mucosa of MD has not been documented. With NSAIDs use becoming very common it is, therefore, important to document this association.

Management of Littre Hernia-Case Report and Systematic Review of Case Reports.

Littre hernia is a rare type of hernia in which a Meckel diverticulum is found in the hernia sac. Given the rare nature of this disease, little data on demographics and surgical management exists. In this article, we provide a case report of a strangulated inguinal Littre hernia and perform a systematic review of the literature. The PubMed database was searched on 5 March 2022, and all cases of Littre hernia in adults that had English abstracts or full-text were analyzed. Our primary objective was to evaluate the surgical management and outcomes of this particular type of hernia, and our secondary objectives were to assess demographic characteristics, presentation particularities, and recurrence rates. We identified 89 articles with 98 cases, including our own. Results show a high prevalence of complications described intraoperatively, with strangulation being present in up to 38.46% of patients. The laparoscopic approach was utilized in patients with femoral, inguinal, and umbilical hernias. The most commonly performed type of resection was MD resection, followed by bowel resection, while a minority of cases (5.48%) remained unresected. Mesh repair was more frequently performed in patients with MD resection. A mortality rate of 8.7% in patients who underwent bowel resection was found. A relatively high number of reports of ectopic tissue (21.21%), ulceration (12.12%), and tumors (9.09%) were found. The average follow-up was 19.5 ± 10.29 months, with no hernia recurrence. In conclusion, most cases are admitted in an emergency setting, and intestinal obstruction is frequently associated. A minimally invasive approach can be an option even for complicated hernias. MD resection or bowel resection is usually employed, depending on the extent of ischemic lesions. Patients undergoing bowel resection may be prone to worse outcomes.

Development of active jejunal glucose absorption in broiler chickens

Growth in chickens, especially meat-type chickens (broilers), is extremely rapid, but studies on the regulatory mechanism of intestinal glucose absorption with growth are few, contradictory, and unclear. Here, we investigated the regulation of intestinal glucose absorption with growth in broiler chickens using oral glucose gavage, intestinal Evans blue transit, intestinal glucose absorption, scanning electron microscopy, and glucose absorption- and cell junction-related gene expression analyses. Peak blood glucose levels after oral glucose gavage occurred at 10 and 50 min in chickens at 1 wk (C1W) and 5 wk (C5W) of age, respectively. The area under the curve for glucose levels was greater for the C5W than the C1W (P=0.035). The stain ratio in the small intestine in the C5W was lower than that in the C1W (P=0.01), but there were no differences in the tissue regions stained with Evans blue and the migration distance of Evans blue from Meckel's diverticulum. In everted sac and Ussing chamber experiments, we observed reduced intestinal glucose uptake and electrogenic glucose absorption in the jejunum of the C5W. Phloridzin, an inhibitor of sodium/glucose cotransporter 1 (SGLT1), suppressed the glucose-induced short-circuit current in the C1W (P=0.016) but not the C5W. Although the addition of NaCl solution stimulated the glucose-induced short-circuit current in the C1W, no differences between the treatments were observed (P=0.056), which was also the case in the C5W. Additionally, tissue conductance was diminished in the C5W compared with that in the C1W. Moreover, in the C5W, the intestinal tract was more developed and the jejunal villi were enlarged. In conclusion, glucose absorption throughout the intestine could be greater in C5W than in C1W; however, reduced SGLT1 sensitivity, decreased ion permeability, and intestinal overdevelopment lead to decreased local glucose absorption in the jejunum with growth in broiler chickens. These data provide a detailed analysis of intestinal glucose absorption in growing broiler chickens, and can contribute to the development of novel feeds.

A Rare Case of Perforated Meckel's Diverticulum Coexisting with Acute Appendicitis

A Rare Case of Perforated Meckel's Diverticulum Coexisting with Acute Appendicitis

Commentary on the article “Primary intestinal anastomosis in a child with perforation of Meckel's diverticulum and peritonitis”

Commentary on the article Morozov KD, Sharkov SM, Kozlov MYu, Mordvin PA, Ayrapetyan MI, Morozov DA Primary intestinal anastomosis in a child with perforation of Meckels diverticulum and peritonitis published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2023;13(1):105112. (In Russ.) DOI: https://doi.org/10.17816/psaic1498
 After reading the article under discussion, serious doubts were raised about the presence of diffuse peritonitis (there was no typical response of the body to a severe inflammatory process in the abdominal cavity), and the mild course of diffuse peritonitis in surgical practice is unknown. Primary intestinal anastomosis in peritonitis cannot be recommended for pediatric surgeons to present its wide introduction in clinical practice.

Commentary on the article “Primary intestinal anastomosis in a child with perforation of Meckel's diverticulum and peritonitis”

Commentary on the article Morozov KD, Sharkov SM, Kozlov MYu, Mordvin PA, Ayrapetyan MI, Morozov DA Primary intestinal anastomosis in a child with perforation of Meckels diverticulum and peritonitis published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2023;13(1):105112. (In Russ.) DOI: https://doi.org/10.17816/psaic1498
 Performing a primary anastomosis in a child with Meckels gangrenous-perforative diverticulitis in the presence of peritonitis may be the operation of choice only in the early stages of the development of peritonitis.

Small-bowel capsule endoscopy in patients with Meckel's diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study.

Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July2021. Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n= 49 [71%]), visible entrance into the MD (n= 49 [71%]), mucosal webs (n= 30 [43.5%]), and bulges (n= 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n= 36). In 63.8% of patients (n= 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n= 27). Mean percent SB transit time for the first indicative image of MD was 57% of the total SB transit time. Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.

VERY RARE COMBINATION OF PATENT VITELLOINTESTINAL DUCT WITH PATENT URACHUS

Introduction - The vitelline duct is the embryological narrow channel connecting the yolk sac with the intestine. During the foetal life, vitelline duct tends to obliterates itself till to disappear. The partial failure of this obliteration can lead to the development of a duct, a ligament, or a diverticulum known as a Meckel's diverticulum. A Patent omphalomesenteric duct occurs because of the complete lack of vitelline duct.[3] The urachus is an embryological remnant of the allantois. Between the fourth and fth month of gestation, the foetal bladder tends to descend gradually and its apical portion creates the urachus. The urachus obliterates itself, becoming the median umbilical ligament. Its persistence after intrauterine life can manifest as urachal remnants. A patent urachus is because of complete lack of obliteration of urachus [1,3]. The incidence of these anomalies PU was 1-2 per 10000 while PVD is 1 in 5000 to 8000 deliveries [1,3,5]. The association of both anomalies is very rare [7]. Case discussion- A 12-years-old male presented with complaints of pain in abdomen, multiple episodes of vomiting. Patient was tachycardiac with tenderness in right iliac fossa with palpable lump with ultrasonography suggestive of perforated appendix with lump formation and was managed conservatively and asked for interval appendicectomy with CECT abdomen. CECT was suggestive of normal and compressible appendix with infected urachal cyst. But after 4weeks patient had similar complaints hence posted for emergency operation with McBurney's incision not by midline incision to avoid injury to urachal cyst. Intra operative ndings-1) patent Vitello intestinal duct 2) patent urachus 3)15cc pus discharge near umbilical end of urachus 4) normal appendix and small bowel. Resection of Vitello intestinal duct and urachus with ileoileal anastomosis done and specimen sent for histopathology which was suggestive of patent vitello intestinal duct with changes of gangrene. The Patent Vitello Conclusionintestinal duct with patent urachus is very rarely seen in combination and its diagnosis may be missed preoperatively and should be kept as a possibility in patients with patent urachus with or without infection

Inverted Meckel Diverticulum in a 13-Year-Old Boy.

Özbey, Hüseyin MD; Professor; Morozov, Dmitry Anatolievich MD; Professor, Chairman Author Information

Long Meckel's Diverticulum as the Cause of Recurrent Subileus over a 5-Year Period.

Long Meckel's Diverticulum as the Cause of Recurrent Subileus over a 5-Year Period.

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

Histopathological Study Of Various Neoplastic And Non-neoplastic Lesions Of Small Intestine At Tertiary Care Centre Of South Gujarat

Introduction: Small intestine, the longest part of digestive tract, makes up about 75% of the total length and can be affected by various developmental, inflammatory or neoplastic conditions. Non neoplastic lesions like abdominal tuberculosis are frequently seen in small intestine. Although small intestine is an uncommon site for tumour nearly twothirds of these tumours are malignant, with most of them being adenocarcinoma. To study the histopat Objective: hology of various neoplastic and non-neoplastic lesions of small intestine and to evaluate their frequency and pattern with respect to age, sex, anatomical sites and clinical findings. This observational cross-sectional Materials and Methods: study was conducted on a total of 101 small intestinal specimens including biopsies and surgically resected specimen received for histopathological examination over a period of two years in the Department of Pathology affiliated with tertiary care hospital. In addition to Haematoxylin and Eosin staining, Immunohistochemistry and special stains were also done in required cases. This study showed a male is to female ratio of 1.97:1. Peak incidence of Results: cases was seen in the 31-40 years age group. Out of total 101 pathological lesions 87 cases were non -neoplastic that included Infective lesions like tuberculous enteritis, Inflammatory lesions like Non-specific Enteritis, Necrotising Enteritis and Congenital lesions like Meckel's diverticulum, Enteric Duplication cyst and Celiac disease while only 14 cases were neoplastic that included benign neoplastic lesions like various types of polyps and malignant neoplastic lesions like adenocarcinoma, GIST, neuroendocrine tumour and B cell NHL. This study showed a characteristic Conclusion: distribution of cases in the three different parts of small intestine and highlighted the clinical importance of timely detection of intestinal pathology by the means of detailed clinical study combined with radiological and histopathological examination.

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.

Incidentally Detected Meckel Diverticulum during Cystectomy: An Unhinging Dilemma?

Meckel's diverticulum is found in 2% of the population, which makes it the commonest congenital abnormality of the gastrointestinal tract. It is diagnosed as an incidental finding during surgery for other reasons. It is found 100 cm from the ileocecal junction, at the antimesenteric border. Other presentations can be abdominal pain, infection, bleeding from ectopic mucosa, recurrent intestinal obstruction, etc. It is formed during the embryonic period due to incomplete obliteration of the omphalomesenteric duct. Treatment of this complication is the removal of Meckel's diverticulum.[1] [2]

Complicated Course of Meckel's Diverticulum as a Cause of Chronic Iron Deficiency Anemia

The paper focuses on a clinical case of a complicated course of Meckel's diverticulum in a 27-year-old patient; the disease was manifested by signs of iron deficiency anemia, without signs of overt or latent bleeding. A brief review of the literature presents major features and potential complications of Meckel's diverticulum. Special attention is paid to specific diagnostic options. The authors discuss the need for surgical removal of uncomplicated Meckel's diverticulum.

SMALL BOWEL OBSTRUCTION DUE TO MECKELS DIVERTICULUM: A CASE REPORT

Meckels diverticulum is the most common congenital anomaly of the small intestine. It results from incomplete obliteration of the vitelline duct leading to the formation of a true diverticulum of the small intestine which is usually located on the antimesenteric border of the ileum. This case report presents the diagnosis and management of a small bowel obstruction due to Meckels diverticulum in a 70-year-old patient. To identify the cause of the small bowel obstruction, The patient underwent computed tomography (CT) scan of her abdomen and pelvis which showed mild dilatation of the small bowels, particularly in the distal jejunum and proximal ileum with no transition point was seen on the CT scan. During the laparotomy, it was revealed a gross distension of the small bowel, and the distal portion of the ileum was markedly compressed by an internal hernia twisted around a giant Meckels diverticulum with a mesodiverticular artery in an area 50 cm from the tip of the ileum.

Intestinal obstruction caused by mesodiverticular band in children: a cohort study

To explore clinical characteristics, pathogenesis, diagnosis and treatment of intestinal obstruction due to mesodiverticular band (MDB) in children in a single center in China. The clinical data of 20 children with acute intestinal obstruction due to MDB between 1998 and 2020 were retrospectively analyzed. The male-to-female ratio was 14:6 in 20 cases. Except one case of 7-month pregnant stillbirth, the cases were aged from 7days to 14years, at the median age of 4.31years. The common symptoms were vomiting, abdominal pain and/or abdominal distension. About 40% (8/20) of patients had both MDB and Meckel's Diverticulum (MD), while 60% (12/20) of patients had MDB only. Only one case died because of total colonic aganglionosis, while other children recovered after surgery treatment. MDB led to the strangulation of necrotic bowel in six cases, intestinal perforation in one case, and intestinal rupture in one case. Pathologic examination showed thick-walled arteries and or thick venous vascular structures in the cord. All cases had no complications during 1-year follow-up. MDB results from the remnant of vitelline vessel, and often causes acute intestinal obstruction without special clinical symptoms. Unexplained abdominal pain and distension without surgery history should be paid attention, especially for strangulated intestinal obstruction. Timely surgical exploration is beneficial to avoid intestinal necrosis or even sudden death, and the pathological examination is important for the diagnosis.