Complicated Meckel's Diverticulum Research Articles

Complications of Meckel diverticulum (MD) in adults: report of 11 cases CHU-Yalgado Ouedraogo in Burkina Faso

Le diverticule de Meckel (DM) est la persistance partielle du canal omphalomésentérique. Ses complications sont rares. Le diagnostic est le plus souvent per opératoire. L'objectif a été de décrire les complications du diverticule de Meckel chez l'adulte dans le service de chirurgie générale et digestive du CHU Yalgado Ouédraogo. Il s'est agi d'une étude transversale descriptive sur 10 ans (janvier 2004-décembre 2013) portant sur les dossiers des patients âgés de plus de 15 ans ayant présenté un DM compliqué. Durant la période d’étude, 11 cas ont été colligés. L'incidence annuelle a été de 11 cas. Nous avons noté une prédominance masculine avec un sex-ratio de 4,5. L’âge moyen des patients était de 29,8 ans. Le diagnostic préopératoire a été dans huit cas une occlusion intestinale aiguë, une appendicite aiguë dans deux cas, une péritonite aiguë généralisée dans un cas. Il a été diagnostiqué en peropératoire une occlusion intestinale dans neuf cas; une diverticulite dans un cas et un cas de perforation du DM. Tous les DM avaient été réséqués dont huit résections segmentaires iléales emportant le DM et trois résections cunéiformes. Tous les DM étaient situés à moins d'un mètre de la jonction iléo-caecale. L'histologie réalisée dans deux cas avait conclu à une diverticulite. Les suites opératoires ont été simples dans neuf cas, compliquées dans deux cas dont une éventration et un décès. Les complications du diverticule de Meckel sont rares. Le diagnostic préopératoire est difficile. Le traitement est essentiellement chirurgical.

Spontaneous perforation of Meckel�s diverticulum: a case report and review of literature

Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

Symptomatic paediatric Meckel's diverticulum: stratified diagnostic indicators and accuracy of Meckel's scan.

The aim of the study was to delineate stratified diagnostic indicants and evaluate the diagnostic accuracy of technetium-99m (Tc)-pertechnetate scintigraphy in children with symptomatic Meckel's diverticulum (MD). This was a prospective linear observational study conducted over a period of 5 years on 73 children with a diagnosis of symptomatic MD. The independent variables assessed were age, sex, weight-for-age z-scores, clinical presentation, complications of MD, laparoscopic findings, haematologic and biochemical results, radiological results, and histological findings. Stepwise multiple logistic regression analysis was performed to determine the diagnostic markers. The sensitivity and specificity of Tc-pertechnetate scintigraphy were assessed. The incidence of MD with complications was 44%. The prevalence of ectopic gastric mucosa in histological specimens was 84%. There was a good correlation between rectal bleeding and the presence of ectopic gastric mucosa [r=0.94; 95% confidence interval (CI): 0.77-0.98]. Haematochezia associated with a drop in haemoglobin (>2 g/dl) was diagnostic of MD with ectopic gastric mucosa in children (n=42, 58%; P=0.006; odds ratio 1.99; 95% CI: 1.14-2.42). Bilious vomiting was diagnostic of complicated MD (n=12, 16%; P=0.007; odds ratio 1.89; 95% CI: 1.12-3.22). The sensitivity of Tc-pertechnetate scintigraphy was 84% and specificity was 22%. The positive predictive value was 0.64 and the negative predictive value was 0.22. The sensitivity and specificity of Tc-pertechnetate scintigraphy were dependent on the quantity and functional quality of the heterotopic gastric mucosa. The preoperative median z-score was -1.4 and the postoperative median z-score was -1.2. Tc-pertechnetate scintigraphy had a truncated predictive value. Its contribution in clinical decision making was poor. Clinical suspicion of MD should be high in children presenting with haematochezia associated with a drop in haemoglobin by more than 2 g/dl. Laparoscopy is an effective diagnostic and therapeutic tool.

English

BACKGROUND: Although Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract; it has varied presentations and often becomes a diagnostic challenge. PATIENTS AND METHODS: This was a retrospective study of all children who had underwent surgery for Meckel's Diverticulum in the department of Pediatric Surgery, S. Nijalingappa Medical college and H.S.K Hospital, Bagalkot between February 2009 and February2013. RESULT: A total of 17 patients (10male and 7 female) aged from 1month to 13 years with a diagnosis of Meckel's Diverticulum were evaluated and analyzed, looking at age, gender, clinical features, investigations, histopathological findings and surgical interventions. All patients were symptomatic and presented with various clinical features like intestinal obstruction(29.4%), perforated Meckel's Diverticulum(23.5%), diverticulitis(17%), intussusceptions(11.7%), patent vitellointestinal duct ( Meckel's prolapse) (11.7%), Littre's hernia(5.8%). All the cases were investigated and underwent surgical intervention Meckel's diverticulectomy/ resection anastomosis and were followed up. Most common post-operative complication was wound infection. CONCLUSION: A Preoperative diagnosis of complicated Meckel's Diverticulum may be challenging because of the overlapping clinical and imaging features of the other acute surgical and inflammatory conditions of the abdomen, hence it is necessary to maintain a high incidence of suspicious in the pediatric age group. INTRODUCTION: Meckel's diverticulum (MD) is one of the most common congenital abnormalities of the gastrointestinal tract, occurring in approximately 2% of the population. Nearly two centuries have passed since its first description by Johan Friederich Meckel. Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. 1 It contains all normal layers of the intestinal wall and, in approximately 50 percent of cases, contains tissue from other sites (ectopic tissue), 60-85% of which is gastric mucosa and 5-16% pancreatic tissue. 2 In the majority of cases, it is asymptomatic. However, it is prone to complications, especially in children, due to ectopic epithelial lining and various bands, reflective of its embryological development. Although the lifetime risk of a Meckel's diverticular complication varies from 4 to 34%, more than 50 to 60% of the patients who develop symptoms are younger than 2 years of age.3 Harper et al. suggested that a bleeding MD should be identifiable scintigraphically using 99mTc pertechnetate, since it is concentrated by gastric mucosa.4 The Tc99 Meckel's scan has a reported sensitivity of 81 to 90%.5 The purpose of this study was to review the various presentations of Meckel's diverticulum, to estimate the epidemiologic features and the extent of this clinical entity at our center and to review the detection techniques and treatment options.

Laparoscopy and complicated meckel diverticulum in children.

Background and Objectives:Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy.Methods:A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum.Results:Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications.Conclusions:Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.

Laparoscopic excision of Meckel's diverticulum in children: What is the current evidence?

Complications aroused from Meckel's diverticulum tend to developed in children. Children presented with abdominal pain, intestinal obstruction, intussusception or gastrointestinal bleeding may actually suffered from complicated Meckel's diverticulum. With the advancement of minimally invasive surgery (MIS) in children, the use of laparoscopy in the diagnosis and subsequent laparoscopic excision of Meckel's diverticulum has gained popularity. Recently, single incision laparoscopic surgery (SILS) has emerged as a new technique in minimally invasive surgery. This review offers the overview in the development of MIS in the management of children suffered from Meckel's diverticulum. The current evidence in different laparoscopic techniques, including conventional laparoscopy, SILS, the use of special laparoscopic instruments, intracorporeal diverticulectomy and extracorporeal diverticulectomy in the management of Meckel's diverticulum in children were revealed.

Complicated Meckel's diverticulum and therapeutic management.

This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckel's diverticulum at our clinics. This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckel's diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012. Fourteen patients with a diagnosis of Meckel's diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckel's diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%). Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckel's diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.

MYSTERY OF RIGHT ILIAC FOSSA PAIN: A REVIEW OF FOUR CASES

A Meckel diverticulum is a vestigial remnant of the omphalomesenteric (vitellointestinal) duct. As a congenital anomaly, it is a true diverticulum that includes all 3 coats of the small intestine. It occurs in about 2% of the population. Prevalence in males is 3-5 times higher than in females. Only 2% of cases are symptomatic, which usually presents among children at the age of 2. It generally remains silent. The fact which makes it an important structure is its life threatening complications. We present four such cases which were presented as right iliac fossa pain and intraoperatively diagnosed as complicated meckel diverticulum.

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.

Magnetic Meckel's: an unusual case report of foreign body ingestion.

Foreign body ingestion in children is common. Most items pass spontaneously, however rarer cases may result in obstruction and or perforation. Ingestion of multiple magnetic items can be more troublesome, as a consequence of the ability of the items to attract across different sections of bowel, or by coalescing to form a larger foreign body. Very few cases of foreign body ingestion have led to the presentation of a complicated Meckel's diverticulum. We present of a case of an adolescent boy with intestinal obstruction secondary to multiple magnetic foreign body ingestion and sequestration within a Meckel's diverticulum.

Divertículo de Meckel ao Doppler em cores: relato de dois casos

O divertículo de Meckel é a anomalia congênita mais comum do trato gastrintestinal e a hemorragia é a complicação mais frequente. Cintilografia, ultrassonografia modo B e com Doppler, e tomografia computadorizada podem ser utilizadas para detectar complicações. Descrevemos dois casos de divertículo de Meckel complicado detectados à ultrassonografia, cujos achados foram diferentes dos descritos na literatura.

Operative Management of Complicated Meckel's Diverticulum Laparotomy and versus Laparoscopic Assisted Surgery

Operative Management of Complicated Meckel's Diverticulum Laparotomy and versus Laparoscopic Assisted Surgery

Life-threatening lower gastrointestinal bleeding in a 2-year-old boy treated by transcatheter embolization: uncommon features of a complicated Meckel diverticulum

A 2.5-year-old boy presented with life-threatening lower gastrointestinal (GI) bleeding. Radiological investigation, including US, CT and 99 m-Technetium (Tc) pertechnate scintigraphy, was negative. Emergency visceral angiography was performed, showing a left-side, non-branching artery, originating from a side branch of the superior mesenteric artery (SMA) with extravasation of contrast material. At the same time, embolization of the bleeding point was performed, resulting in haemostasis. In the days following the procedure the boy developed an intestinal obstruction. At laparoscopy, a complicated Meckel diverticulum was resected.

Complicated Meckel's Diverticulum in Pediatrics: Role of Laparoscopy—Two Rare Cases

Meckel's diverticula are mostly asymptomatic. Even complicated disease is hardly diagnosed preoperatively and hence met with fatal outcomes, if not intervened on immediately. In this paper, we present 2 pediatric cases with complicated Meckel's diverticula that were diagnosed and successfully treated by the totally laparoscopic approach. To the best of our knowledge such cases have not been reported in the literature, so far. Nevertheless, we caution about keeping a high index of suspicion for diagnosing such pediatric cases and stress the need for an early laparoscopy in them.

Hernia interna de divertículo de Meckel como causa de obstrucción intestinal en un senescente

Internal hernia of Meckel diverticulum in elderly patient Meckel Diverticulum is the most frequent gastrointestinal congenital anomaly. General population incidence is 2%. Complications develop in 4 to 30% of the cases, where over 50% present during the first decade. This high incidence progressively decreases to cero in elderly patients, as some authors propose. Bowel obstruction, the most prevalent complication in adults, occurs by different mechanisms; however there is no available publication that mentions an internal hernia of Meckel Diverticulum through colonic mesentery. Meckel Diverticulum complications are rare in elderly patients; moreover an internal hernia generating bowel obstruction is even more infrequent. We present a 75-year-old male patient with bowel obstruction produced by a Meckel Diverticulum herniated through colonic mesentery.

Acute hemiscrotum due to inguinoscrotal Littre hernia: a case report

Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract that is generally asymptomatic and only manifests in a specific way when complications exist. An unusual complication of MD is known as Littre hernia. It comprises less than 1% of all MD. Littre hernia is the protrusion of an MD through a potential abdominal opening. Usual sites of Littre hernia are right inguinal (50% of cases), umbilical hernia (20%), and femoral hernia (20%). We report a case of Littre hernia in a boy who presented with acute scrotal pain and swelling.

Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage

A Meckel diverticulum is an embryonic remnant of the omphalomesenteric duct that occurs in approximately 2% of the population. Most are asymptomatic; however, they are vulnerable to inflammation with subsequent consequences including diverticulitis and perforation. We report an 11-year-old boy who underwent laparoscopic appendectomy for perforated appendicitis at an outside institution. During his convalescence he underwent percutaneous drainage of a presumed postoperative abscess. A follow-up drain study demonstrated an enteric fistula. The drain was slowly removed from the abdomen over a period of 1 week. Three weeks following drain removal the patient reported recurrent nausea and abdominal pain. A CT scan demonstrated a 3.7-cm rim-enhancing air-fluid level with dependent contrast consistent with persistent enteric fistula and abscess. Exploratory laparoscopy was performed, at which time a Meckel diverticulum was identified and resected. This case highlights the diagnostic challenge and limitations of conventional radiology in complicated Meckel diverticulum.

Laparoscopic management of complicated Meckel’s diverticulum in children: a 10-year review

Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract, is prone to develop complications in the pediatric population. The authors report their 10-year experience with the management of complicated Meckel's diverticulum in children using laparoscopy. A retrospective review of all complicated Meckel's diverticulum cases involving children from 1998 to 2007 was performed. The efficacy and safety of laparoscopy used to manage complicated Meckel's diverticulum were assessed. Over a 10-year period, 20 children (17 boys and 3 girls) with a mean age of 5 years (range, 7 months to 13 years) were included in the study. Of the 20 children, 12 presented with gastrointestinal bleeding, 2 had intestinal obstruction, 3 had abdominal pain mimicking acute appendicitis, 2 had inguinal hernia, and 1 had intussusception. Diagnostic laparoscopy was performed for all the patients. Laparoscopically assisted transumbilical Meckel's diverticulectomy was performed successfully for 18 of the children. The operative time ranged from 50 to 190 min (mean, 115 min). All the children had an uneventful recovery except one, who experienced a postoperative wound infection. Ectopic gastric mucosa was found in 14 cases. Diverse pediatric surgical conditions result from Meckel's diverticulum. Laparoscopy is a safe and effective method for the management of complicated Meckel's diverticulum.

Contrast-Enhanced Sonographic Findings of Gangrenous Meckel Diverticulitis

Meckel diverticulum is occasionally associated with several complications, including hemorrhage, inflammation, perforation, and bowel obstruction.1 However, the preoperative diagnosis of Meckel diverticulum is difficult because of the lack of specific physical and laboratory findings. Technetium Tc 99m pertechnetate scintigraphy is useful for identifying patients with a bleeding Meckel diverticulum 2 ; however, this technique is not suitable for patients with an acute abdomen in whom the treatment protocol has to be decided as early as possible. In recent years, several reports have described the usefulness of sonography in detecting a complicated Meckel diverticulum. 3-7 Here, we report a case of gangrenous Meckel diverticulitis with perforation; this condition was detected preoperatively by gray scale and contrast-enhanced sonography. The latter, in particular, was useful for evaluating the viability of the wall of the Meckel diverticulum in our case. To our knowledge, contrast-enhanced sonographic findings of this condition have not been reported in the literature to date. We present the sonographic findings, including those of contrast-enhanced sonographic images, of gangrenous Meckel diverticulitis and correlate these findings with its surgical and pathologic findings.

Laparoscopic Surgery for Complicated Meckel's Diverticulum: Report of Three Cases

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, but only 4% of cases may cause symptoms or develop complications. The complications associated with Meckel's diverticulum are age-related. Children usually have painless gastrointestinal bleeding while adults can develop small intestinal obstruction. Meckel's diverticulitis with or without perforation is also a common complication. It is usually misdiagnosed as acute appendicitis preoperatively. We present three cases of complicated Meckel's diverticulum that were found and treated by a laparoscopic approach under the preoperative diagnosis of acute appendicitis. The literature is also reviewed for the optimal laparoscopic treatment of complicated Meckel's diverticulum.