Meckel's Diverticulum Research Articles

Helminth Infections in Children.

Helminth Infections in Children.

Perforated Meckel Diverticulum

Perforated Meckel Diverticulum

MORPHOLOGY OF THE DIGESTIVE CANAL ORGANS AND THEIR IMMUNE FORMATIONS IN THE MULARD DUCKS

It is known that in the immune formations of the digestive canal of birds, which belong to the peripheral organs of hematopoiesis and lymphopoiesis, differentiation of T- and B-lymphocytes occurs under the influence of antigens that cause the development of specific (cellular and humoral) immunity. In this regard, the purpose of this study was to identify the features of the morphology of the digestive canal organs and their immune formations in ducks of the hybrid meat breed “Mulard” aged 150 days during puberty. During histological studies, pieces from different areas (oesophagus, parts of the stomach, intestines with Peyer’s spots, Meckel’s diverticula, and caecum diverticula) were selected, labelled, and fixed in a 10% aqueous solution of neutral formalin and poured into paraffin, according to the generally accepted method. Histological preparations were used to examine the features of the microscopic structure of the digestive canal organs and their immune formations and histotopography, the types of forms of lymphoid tissue were analysed, its area was calculated. It was established that the immune formations of the digestive canal organs of ducks are represented by all levels of structural organisation of lymphoid tissue, which are not equally expressed in certain parts of them. Accumulations of immune formations in the walls of the oesophagus and stomach are located in lamina propria plate of the mucous membrane and submucosal base, and in the intestines – also in the muscle membrane. Lymphoid tissue is best developed in the oesophagal tonsil, caecum diverticula, slightly less in the Meckel diverticula and Peyer’s spots of the intestine. In the wall of the oesophagus and stomach of ducks, only minor accumulations of this tissue are observed. The results obtained on the morphofunctional state of peripheral organs of hematopoiesis and lymphopoiesis allow improving technologies for raising and exploiting birds to ensure their high viability and productivity

Intestinal obstruction due to a rare tumor in the meckel's diverticulum in a 10-month-old boy

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It can cause many complications, such as hemorrhage, intestinal obstruction, intussusception, perforation, and, very rarely, vesicodiverticular fistulae and tumors. Tumors in Meckel's diverticulum are extremely uncommon.These tumors can be benign or malignant. Lipoblastomas are rare benign mesenchymal tumors that arise from embryonic fat cells. Herein, we present the case of a 10-month-old patient with intestinal obstruction due to a benign tumor (lipoblastoma) in the Meckel diverticulum synchronous with volvulus.The tumor was excised completely. Histopathology of this lesion confirmed the lipoblastoma. To our knowledge, this is the first case of a lipomablastoma within a meckel diverticulum in a child that has been reported in English literature.

Concurrent omphalomesenteric duct cyst and ileal diverticulum causing small bowel obstruction; a case report.

Introduction and importanceThe omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature.Case presentationWe present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery.Clinical discussionOMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance.ConclusionPreoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.

Meckel's diverticulum: misdiagnosis and delayed presentation with ureterohydronephrosis

MD occurs in 2% of the population and is the most common congenital malformation of the gastrointestinal tract. Most patients are asymptomatic and complications are found in about 5%. This study reports an exceptional case where a longstanding Meckel's diverticulum (MD) was initially misdiagnosed as inflammatory bowel disease and further complicated with ureterohydronephrosis. A 14-year-old male presented with abdominal pain and fever, minor elevation of inflammatory markers, the ultrasound showed a liquid collection and suggested complicated acute appendicitis. Laparoscopy showed a thickened small bowel segment, low grade inflammation of the appendix and no collection; appendectomy was performed. Follow-up ultrasound showed bowel wall thickening and collections, which further suggested inflammatory bowel disease. One month after discharge, the patient returned with abdominal pain and subfebrile temperature. Imaging studies showed pelvic plastron, purulent fluid, collections and right ureterohydronephrosis. Treatment for complicated inflammatory bowel disease was ineffective, there was worsening of the ureterohydronephrosis, however, the collections were small and persisted roughly unchanged, which suggested a different etiology. Scintigraphy with technetium-99m pertechnetate was positive and surgery was proposed. A MD was found intimately adherent to the posterior abdominal wall, involving the ureter. En bloc enterectomy and primary anastomosis were completed successfully. Follow-up ultrasound 11-days after surgery was normal. After 6-months, the patient was asymptomatic. This case represents a diagnostic challenge since ureterohydronephrosis was never described as a complication of MD and it was an important element in the diagnosis.

Meckel's Diverticulum, A Rare Presentation in a Neonate.

Meckel's diverticulum is commonly symptomatic the first 2years of life. Complications associated with Meckel's diverticulum are due to gastrointestinal (GI) bleeding or obstruction. A 5-day-old male presented to the emergency department (ED) with an episode of bright red blood per rectum (BRBPR) associated with emesis. Vital signs were normal and abdomen soft and non-distended. Serial abdominal radiographs progressed to show distention of small bowel and air fluid levels. Operative intervention was undertaken with diagnosis of intestinal obstruction. On exploratory laparotomy, 24cm of a fibrosed, ischemic closed-loop ileal segment densely adherent to the tip of a Meckel's diverticulum was identified and resected, followed by primary reanastamosis. Histologic findings confirmed ectopic gastric tissue. Symptomatic Meckel's diverticulum is often secondary to intestinal obstruction and hematochezia, findings which are caused by incarcerated inguinal hernia or ileocolic intussusception. Our patient presented with a closed loop, which has not been previously reported.

Twisting of a Giant Cystic Meckel’s Diverticulum in a Toddler: A Case Report and Brief Literature Review

Objective : Herein we report an unusual case of torsed giant cystic Meckel’s diverticulum (MD) in a three-year-old boy, illustrating the rarity of this condition and briefly reviewing the literature on it. Case Report : A three-year-old boy who clinically presented with severe colicky abdominal pain and frequent vomiting. Abdominal ultrasonography showed a cystic lesion in the lower abdomen. Contrast-enhanced CT revealed a well-defined right upper quadrant cystic mass measuring ~5 × 4 cm. The cystic mass appeared to be arising from the small intestine. The radiological features were not suggestive of malignancy. An urgent laparotomy was performed. At operation, he was found to have an incomplete torsed giant cystic MD. Postoperative recovery was uneventful, and the patient was discharged on the sixth postoperative day. A regular, 3-year follow-up revealed no complications. Conclusion : A giant cystic Meckel’s diverticulum represents a rare cause of intra-abdominal/pelvic mass and should be considered in its differential diagnosis. Timely surgical intervention reduces morbidity and provides the best clinical outcome.

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.

Hernia interna por divertículo de Meckel: Una causa rara de obstrucción intestinal

Meckel's diverticulum is the remnant of the omphalomesenteric duct and is considered the most common congenital hernia secondary to a Meckel's diverticulum, a rare cause of bowel obstruction. Keywords: Meckel’s diverticulum; intestinal obstruction; omphalomesenteric duct; congenital gastro-intestinal malformation.

Perforated Meckel\u2019s diverticulum in neonates: a report of six cases and systematic review of the literature

BackgroundPerforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms “Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum.” All reports of perforated MD in the English literature were identified. Details of our 6 cases were analyzed in similar fashion.ResultsA total of 3027 manuscripts were screened and 59 cases including 6 of our own were identified. The vast majority (78%) were female. Fifty patients (84.7%) presented in the newborn period. Half of the cases (52.5%) had associated anomalies and 13 neonates (22%) required oxygen supplementation including CPAP or ventilatory support before surgery. In 73% of the cases, a resection of gut was undertaken. Histopathological assessment in 44 cases (74.6%) revealed no ectopic gastric mucosa. Three cases demised prior to treatment. The outcome in the vast majority was excellent with 84.7% surviving and discharged well.ConclusionPerforated MD is an unusual cause of a pneumoperitoneum in the newborns. Diagnosis is established at laparotomy and it rare to find ectopic mucosa histopathologically. The overall outcome is excellent.

SPONTANEOUS PNEUMOPERITONEUM AND FECALOID PERITONITIS SECONDARY TO PERFORATION OF MECKEL'S DIVERTICULUM

PNEUMOPERITONEUM AND FECALOID PERITONITIS SECONDARY TO MECKEL’S DIVERTICAL PERFORATION NEUMOPERITONEO Y PERITONITIS FECALOIDEA SECUNDARIO A PERFORACIÓN DE DIVERTICULO DE MECKEL A 20-year-old man presents abdominal pain and diffuse peritoneal irritation. The computed tomography reported pneumoperitoneum and peritonitis secondary to hollow viscus perforation. An urgent intervention was performed, showing Meckel's diverticulum with a perforation on its vertex. It was decided the resection of the ileum including the diverticulum, finishing with a manual end-to-end anastomosis. Meckel's diverticulum is caused by the failure of the involution of the omphalomestheric duct. In 4-6% of cases it can cause complications. The preoperative diagnosis is difficult because the radiological and clinical findings can resemble other acute abdominal disorders.

Ileal Crohn's disease fistulating into a Meckel's diverticulum.

Ileal Crohn's disease fistulating into a Meckel's diverticulum.

Angiographic Diagnosis of a Meckel's Diverticulum in a 26-month-old Boy.

A 26-month-old boy presented with recurrent hematochezia. Abdominal examination was normal. Laboratory findings showed hemoglobin of 7.5 g/dL. Abdominal ultrasound (US) for intussusception revealed a short (0.3 cm) segment of wall thickening in the distal ileum and Meckel’s scan was negative. The patient underwent two additional Meckel’s scans, tagged red blood cell scan, CT-angiography, upper endoscopy and colonoscopy, and video capsule endoscopy, but had normal results. Superior mesenteric angiography was performed revealing an area of abnormal vasculature in the terminal ileum (Fig. 1). Subsequently, exploratory laparotomy showed an obvious Meckel’s diverticulum (MD), and Meckel’s diverticulectomy was performed (Fig. 2).FIGURE 1.: Meckel's Diverticulectomy.FIGURE 2.: Meckel’s Diverticulectomy. A) Gross specimen of MD removed from patient and (B) histological examination of MD with the presence of ectopic gastric mucosa.MD is the most common congenital malformation of the gastrointestinal tract, occurring in approximately 2% of the population (1). The gold standard in diagnosing a MD is a Meckel’s scan which detects the accumulation of a radioisotope, Technetium-99m. However, false negatives do occur and this is likely due to insufficient gastric mucosa in the MD (2). The literature on typical angiographic findings for diagnosis of MD are limited to a few individual cases (3–6). Our patient exhibited multiple abnormal corkscrew-like arteries of the ileocolic artery. Angiography can detect MD in the absence of acute bleeding through visualization of the vitelline artery (7). ACKNOWLEDGMENTS A.P. was involved in conception and design, acquisition of data, drafting the work, final approval of the version to be published. M.R.A., P.M., T.R.B., and C.M.S. were involved in conception and design, critical revision of work, final approval of version to be published. L.A. was involved in conception and design, acquisition of data, critical revision of work, final approval of version to be published.

Meckel's diverticulum: Evaluation and management

Meckel's diverticulum: Evaluation and management

Congenital anomalies of the tubular gastrointestinal tract.

SummaryCongenital anomalies of the tubular gastrointestinal tract are an important cause of morbidity not only in infants, but also in children and adults.The gastrointestinal (GI) tract, composed of all three primitive germ layers, develops early during embryogenesis. Two major steps in its development are the formation of the gut tube (giving rise to the foregut, the midgut and the hindgut), and the formation of individual organs with specialized cell types.Formation of an intact and functioning GI tract is under strict control from various molecular pathways. Disruption of any of these crucial mechanisms involved in the cell-fate decision along the dorsoventral, anteroposterior, left-right and radial axes, can lead to numerous congenital anomalies, most of which occur and present in infancy. However, they may run undetected during childhood.Therapy is surgical, which in some cases must be performed urgently, and prognosis depends on early diagnosis and suitable treatment.A precise pathologic macroscopic or microscopic diagnosis is important, not only for the immediate treatment and management of affected individuals, but also for future counselling of the affected individual and their family. This is even more true in cases of multiple anomalies or syndromic patterns.We discuss some of the more frequent or clinically important congenital anomalies of the tubular GI, including atresia’s, duplications, intestinal malrotation, Meckel’s diverticulum and Hirschsprung’s Disease.

A different complication of Meckel's diverticulum: axial torsion

A different complication of Meckel's diverticulum: axial torsion

Haemorrhagic shock secondary to a diffuse ulcerative enteritis after Ipilimumab and Nivolumab treatment for metastatic melanoma: a case report

We provide a unique case of haemorrhagic shock complicating a corticosteroid-resistant diffuse ulcerative enteritis in a patient treated with a combination of an anti cytotoxic T-lymphocyte antigen-4 (CTLA4) and an anti programmed cell death protein 1 (PD-1) for metastatic melanoma. Immunotherapy has changed the perspective for the management of patients with metastatic melanoma but are also responsible for digestive complications mainly represented by immunomediated colitis. Digestive bleeding is common in patients with extensive colonic lesions but has never been described in enteritis independent of colitis. The patient with acute intestinal obstruction related ileitis without evidence of stricture on imaging and then had a gastro-intestinal bleed. In the absence of haemorrhagic lesions on upper gastrointestinal endoscopy, colonoscopy and computed tomography (CT) angiography, a surgical exploration with enteroscopy was performed. This revealed an extensive ulcerated jejunoileitis, with active bleeding, within a Meckel's diverticulum. Management included resection of the Meckel diverticulum with a transient double barrel ileostomy. Two infliximab infusions were given due to persistent bleeding. We observed a dramatic improvement after infliximab treatment with complete cessation of bleeding and no further need for transfusions. A complete mucosal healing has been achieved on enteroscopy at 3 months with disappearance of histological inflammatory lesions. This observation suggests that infliximab represents a therapeutic option in severe enteritis and may be as effective as in more moderate immune-mediated enterocolitis.

Meckel’s Diverticulum as Diverting Stoma in Obstructive Colon Cancers

Background: The surgical management of obstructive colon cancers especially those presenting with acute obstruction, is still challenging. Since, the emergent colectomy in cases of unresectable tumors or frozen abdomen, has been reported with high rates of mortality and morbidity. Application of a diverting stoma significantly alleviates the symptoms and prevents further intestinal necrosis and perforation. Case presentation: In this Report a case of unresectable obstructive colon cancer is presented. During the operation, an asymptomatic Meckel’s Diverticulum (MD) was found which used to be formed as a diverting ileostomy. Conclusion: We advocate our experience of using incidental MD for constructing a diverting stoma for an obstructive colon cancer

Meckel's Diverticulum in Children: A Monocentric Experience and Mini-Review of Literature.

Vitelline duct anomalies (VDA, including Meckel’s diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic versus asymptomatic VDA, analyzing clinico-laboratory data from 73 children, aged 1 day to 17 years, treated at a tertiary Pediatric Surgery Institution from 2002–2017. A male preponderance was obtained (ratio 3.6:1). MD accounted for 85% of VDA. Incidence of symptomatic VDA decreased with older age. Leading symptoms were intestinal obstruction and hemorrhage. Mucosal heterotopia (present in 39% of symptomatic MD) was associated with anemia and lowered CRP-levels. On ROC-analysis, hemoglobin < 8.6 g/dL, CRP < 0.6 mg/dL and MD distance to ileocecal valve >40 cm were predictors of ectopic tissue in symptomatic MD. Our data confirmed known characteristics as male preponderance, declined incidence of symptomatic cases with age and predominance of gastric ectopia in symptomatic MD. Moreover, anemia and prolonged distance of MD to ileocecal valve were predictors of ectopic mucosa in symptomatic MD.