Meckel's diverticulum Imaging: In and Out.

To evaluate the diagnostic performance of ultrasound in detecting Meckel's diverticulum (MD) and duplication cysts (DC) and to identify factors influencing diagnostic accuracy. Among 66 patients with MD or DCs, we assessed the effect of symptom presence, atypical complications (hemoperitoneum, perforation, or acute pancreatitis), and lesion shape (tubular or cystic) on initial sonographic diagnostic accuracy using Fisher's exact test. Initial ultrasound correctly diagnosed 49.9% (27/66) of cases. Correct diagnosis rates differed significantly between MD and DC (11/17 vs. 33/5, p < 0.001) and between tubular and cystic lesions (13/15 vs. 36/2, p < 0.001). No significant differences were observed for symptomatic versus asymptomatic cases (22/6 vs. 34/4, p = 0.302) or for cases with versus without atypical complications (1/27 vs. 5/33, p = 0.230). However, all DC cases with atypical complications were misdiagnosed on ultrasound. Ultrasound demonstrated reliable diagnostic performance for DCs; however, MDs were more challenging to identify. Consequently, when MDs are suspected on clinical grounds, additional imaging, such as Tc-99m scintigraphy, should be considered. In patients with DCs, atypical complications, such as hemoperitoneum or acute pancreatitis, may obscure sonographic diagnosis. Sonographers should therefore include DCs in the differential diagnosis when these complications arise without an apparent etiology.

Acute appendicitis in an adult with inverted Meckel's diverticulum

Meckel s Diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Schistosomiasis (Bilharziasis) is a parasitic disease caused by infection with parasitic worms, and humans are the primary hosts of the three major species of Schistosomes.

Gastrointestinal Obstruction Due to Fibrous Band with Meckels Diverticulum

A BSTRACT Aim: This research aims to study the clinicodemographic profile of children with bleeding Meckel’s diverticulum (MD) and the role of laparoscopy in their management. Materials and Methods: It is a retrospective analysis of all the patients of painless lower gastrointestinal (LGI) bleeding who underwent diagnostic laparoscopy followed by laparoscopic-assisted resection of MD at a tertiary care pediatric hospital in North India from March 2019 to March 2023. Results: Diagnostic laparoscopy was positive in 17 out of 18 patients (MD = 15, ileal duplication = 2). The mean age of patients with MD was 35.08 ± 27.24 months, with male:female ratio of 2:1 and duration of symptoms ranging from 5 days to 8 months. All of them presented with recurrent bouts of bleeding per rectum and anemia. Seven had hemoglobin &lt;7 g/dl, while 9 needed &gt;2 packed red blood cell transfusions. Three patients presented with shock and needed resuscitation. All the patients underwent laparoscopic-assisted surgical resection with a mean operative time of 72.6 ± 15.4 min; with 2/3 rd of them getting discharged between the 3 rd and 5 th postoperative day, and all of them within 10 days of surgery without any major complications. Conclusions: Laparoscopy has a diagnostic as well as therapeutic role in painless obscure major LGI bleeding in children. Laparoscopic-assisted resection of MD is safe, time-saving, and without major complications.

ABSTRACTMeckel's diverticulum should be considered in cases of unexplained small bowel obstruction, especially in pediatric and adolescent patients. Early recognition and timely surgical intervention can prevent complications and lead to favorable outcomes.

Meckel's diverticulum (MD) is a frequently silent congenital anomaly of the gastrointestinal tract. While complications such as bleeding and obstruction are more common, traumatic perforation remains extremely rare, particularly from penetrating injuries. To date, isolated perforation of MD following self-inflicted abdominal stab wounds has been reported only sporadically. We present the case of a 39-year-old male with a long-standing history of schizophrenia and epilepsy who arrived at the emergency department following his fifth self-inflicted abdominal stab injury over the past decade. On physical examination, a segment of small bowel was found protruding from a 4 cm periumbilical wound. Emergency exploratory laparotomy revealed extensive intra-abdominal adhesions and an isolated perforation of a Meckel's diverticulum located 60 cm proximal to the ileocecal valve. No other visceral injuries or hemorrhage were detected. The diverticulum was resected using a linear stapler, and serosal defects were repaired. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Isolated MD perforation caused by penetrating abdominal trauma is exceedingly rare and diagnostically challenging. When occurring in psychiatric patients with repetitive self-harm behavior, it presents an even more complex scenario. This case underscores the importance of meticulous intra-abdominal exploration in stab wound patients and contributes novel insight to the limited literature on traumatic MD injuries.

A man in his 40s presented with fever and right lower abdominal pain. Laboratory data showed elevated inflammatory markers. Abdominal CT showed a 3 cm mass in the mid-lower abdomen with fluid retention and gas continuity with the small bowel, consistent with diverticulitis. Multiple hepatic nodules were also noted. After antibiotic therapy, laparoscopic surgery was performed on hospital day 3. Intraoperatively, a firm mass was found approximately 30 cm proximal to the ileocecal valve, with extensive adhesions to the mesentery and omentum. Multiple white nodules were observed in both hepatic lobes. We performed partial small bowel resection(approximately 60 cm)and partial liver resection for liver biopsy. The pathological diagnosis was adenocarcinoma arising from Meckel's diverticulum with multiple liver metastases(pT3pN1bpM 1a, pStage Ⅳa). We decided to introduce systemic chemotherapy similar to that used for colorectal cancer in small bowel cancer, and we started systemic chemotherapy with mFOLFOX6 at 8 weeks after surgery. Bevacizumab was added from the fourth course due to progressive liver metastasis on CT imaging. After 15 courses, a partial response(PR)of the liver metastases was achieved with no local recurrence or new lesions. Meckel's diverticular adenocarcinoma is extremely rare, and no standard chemotherapy has been established. We have observed relatively good results with mFOLFOX6 plus bevacizumab in this setting.

Objective. Limited evidence is available concerning the surgical outcomes of patients with congenital gastrointestinal malformations and perioperative SARS-CoV-2 infection. This study examines the scientific evidence on SARS-CoV-2 infection and congenital gastrointestinal malformations requiring surgery in children. Material and Methods. We performed a systematic review of studies reporting data on children with congenital gastrointestinal malformations and SARS-CoV-2 infection, published in international databases (PubMed and Embase) from pandemic inception up to August 2024. Studies not reporting data on the SARS-CoV-2 infection status on patients with congenital digestive malformation were excluded. We assessed the quality of the included studies according to the Joanna Institute (JBI) appraisal checklist, adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and registered the protocol with the PROSPERO database (CRD42024550744). Results. From the 902 titles retrieved, eight observational studies met the inclusion criteria comprising 29 patients from countries with different socioeconomic statuses. Most patients were neonates (75%) with a median age of 3 days at diagnosis and male to female ratio of 2:1. In total, 18 (62%) presented upper gastrointestinal tract anomalies, including esophageal atresia ± tracheoesophageal fistula (n = 10, 34.48%), duodenal atresia (n = 3, 10.3%), and congenital hypertrophic pyloric stenosis (n = 5, 17.2%). Lower digestive tract malformations (11, 38%) included anorectal malformations (n = 6, 20.6%), intestinal atresia (n = 3, 10.3%), Hirschsprung disease (n = 1, 3.44%), and Meckel's diverticulum (n = 1, 3.44%). Surgeries were primarily emergency or urgent procedures and only pyloromyotomy (5/5) was consistently operated minimally invasively. SARS-CoV-2 infection was identified mainly on routine screening (>95%). Of 29 patients, 85% were discharged home, and no postoperative surgical mortality and significant complications directly associated with COVID-19 were identified, although routine postoperative morbidity not linked to SARS-CoV-2 was observed. Conclusions. Pediatric patients with congenital gastrointestinal malformationsand perioperative SARS-CoV-2 infection typically have mild illness and favorable surgical outcomes. SARS-CoV-2 positivity alone should not delay essential surgery when infection control measures are ensured. Standardized, multicenter studies are needed to clarify perioperative risks to and inform management of this high-risk group.

Acquired diverticular disease of the small bowel is often seen in the duodenum. It is an uncommon but under-recognized entity in the jejunum and the ileum. Meckel's diverticulum, a true diverticulum arising in the distal ileum, although the most common congenital abnormality of the gastrointestinal tract, is rare and occurs in about 2% of the population. Most of the time, diverticular disease of the small bowel is asymptomatic. Common complications of small bowel diverticular disease include diverticulitis and hemorrhage. Diverticulitis of the small bowel is an uncommon cause of acute abdomen and may be misdiagnosed if not included in differential considerations based on the imaging features. Certain specific complications can occur related to the location of the diverticulum or due to other factors associated with the diverticulum. For example, obstructive jaundice (Lemmel syndrome) can occur in the setting of a duodenal diverticulum, and intestinal obstruction can occur in the setting of a Meckel's diverticulum. Familiarity with the different imaging manifestations of small bowel diverticular disease complications can help with appropriate diagnoses, thereby improving patient management.

Plexiform fibromyxoma (plexiform angiomyxoid myofibroblastic tumour) is a rare mesenchymal tumour primarily located in the gastric antrum. Rare cases of plexiform fibromyxoma located in the oesophagus, duodenum, gallbladder and jejunum have been reported in the literature. Histologically, this tumour is characterized by a spindle to ovoid cell proliferation with a plexiform and multinodular architecture. The stroma is myxoid, fibromyxoid or collagenous with arborizing proliferation of thin-walled capillaries. There are few mitoses, no atypia and no necrosis. Immunohistochemically, the tumour cells are positive for smooth muscle actin (SMA) and vimentin. They may be positive for CD10, desmin, caldesmon and calponin. However, they are negative for DOG1, CD117 (C-Kit), EMA, ALK, S100, CD34, and B-catenin. Here, we report the first case of plexiform fibromyxoma located in the distal ileum. This plexiform fibromyxoma was also found encompassing a probable Meckel diverticulum with foci of high-grade epithelial dysplasia without invasive carcinoma. This case report highlights the importance of considering plexiform fibromyxoma in the differential diagnosis of distal small bowel spindle cell tumours with a myxoid background.

Abstract Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete obliteration of the embryonic omphaloenteric (vitelline) duct. Although its prevalence is estimated at approximately 2% of the population, it remains a rare cause of acute abdomen requiring surgical management. A retrospective, population-based study was conducted using data from the National Health Information Centre (NCZI) of Slovakia for the years 2015–2023. All cases coded under ICD-10 Q43.0 (Meckel’s diverticulum) were included. Variables analyzed comprised demographic characteristics, admission type, treatment modality, length of stay, rehospitalizations, and healthcare reimbursements, with all costs adjusted for inflation. A total of 233 patients were identified, of whom 172 were hospitalized (4.3 per 100,000 inhabitants). Most patients were male (65.7%), and acute admissions accounted for 83.7% of cases. Surgical treatment was performed in 77.9%, with a median hospital stay of 5 days. MD occurred predominantly in the 0–4 and 5–14-year groups, confirming its congenital nature. The regional distribution was uneven, with the Prešovský region showing the highest standardized hospitalization rate. Annual hospitalizations remained stable (15–23 per year), while total reimbursements varied substantially, from approximately €44,238 in 2020 to €126,500 in 2023. The average cost per patient ranged between €3,686 and €7,443, and inpatient care accounted for 80–90% of total expenditures. No significant associations were found between sex, surgical treatment, admission type, or rehospitalization, though a borderline trend suggested slightly higher rehospitalization rates after surgery (p = 0.053). After adjusting for inflation, per-patient costs showed no significant linear (p = 0.46) or monotonic (p = 0.76) trend, although 2023 costs were higher than the 2015–2022 average (p = 0.11). MD remains a rare but clinically significant condition, predominantly affecting children and young males, with a high rate of surgical intervention and low recurrence. Despite its low overall frequency, MD demonstrates substantial variability in per-patient costs, reflecting diverse clinical presentations. These national data provide the first comprehensive epidemiological and economic overview of Meckel’s diverticulum in Slovakia and establish a foundation for further clinical and health policy research.

BackgroundThere are a limited number of clinical reports addressing intussusception resulting from uncomplicated Meckel’s diverticulum (MD). This paper examines the clinical characteristics and treatment strategies for intussusception secondary to MD, synthesizes clinical experiences, and offers reference value for clinicians in selecting appropriate surgical approaches. MethodsA retrospective study was conducted involving thirty patients diagnosed with intussusception secondary to MD, who underwent surgical intervention in the Department of Pediatric Surgery at Linyi People’s Hospital between June 2016 and June 2025. The patients were categorized into two groups based on the presence or absence of ectopic tissue within the diverticulum: the ectopic tissue group (Group A, 10 patients) and the non-ectopic tissue group (Group B, 20 patients). A comparative analysis of the clinical data between the two groups was performed. The results indicated that Group A included six patients with ectopic gastric mucosal gland tissue and four patients with ectopic pancreatic tissue. It was observed that, in female patients with MD, the ectopic tissue predominantly originated from gastric glands, whereas in male patients, it predominantly originated from pancreatic tissue (P = 0.035). Furthermore, compared to Group B, patients in Group A exhibited a greater distance from the ileocecal valve (P = 0.006) and increased diverticulum length (P = 0.017). However, no significant differences were found between the groups concerning age, gender, clinical symptoms, or diverticulum width (P > 0.05). ConclusionsThe clinical presentation of intussusception secondary to MD is atypical, necessitating surgical exploration and postoperative histopathological examination for a definitive diagnosis. The findings of this study indicate that ectopic tissue is not the primary etiological factor in intussusception secondary to MD. However, diverticula containing ectopic tissue tend to be marginally longer and are located at a greater distance from the ileocecal valve compared to those lacking ectopic tissue.

Acute intussusception secondary to Meckel's diverticulum

Hematochezia due to Meckel's diverticulum in a young male.

Introduction: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, originating from the incomplete obliteration of the omphalomesenteric duct. Although often asymptomatic, its complications, particularly hemorrhage, pose a significant diagnostic challenge. Case Report: We present the case of a 4-year-old male who was admitted to the emergency department with generalized abdominal pain. Initial labs and an ultrasound were suggestive of appendicitis. However, a follow-up exam revealed a drop in hemoglobin, prompting an exploratory laparotomy. The surgery identified a bleeding Meckel's diverticulum, which was resected. The patient experienced hemorrhagic shock requiring blood transfusions but had an excellent postoperative recovery. Discussion: This case highlights the clinical variability of Meckel's diverticulum, which can mimic common abdominal pathologies like appendicitis, leading to a delay in diagnosis and severe complications. The presence of ectopic gastric tissue, a frequent feature, is a key factor in the pathogenesis of hemorrhage. Conclusion: High clinical suspicion is crucial for a timely diagnosis. The definitive treatment for symptomatic Meckel's diverticulum is surgical, and a positive prognosis is common with appropriate management. Continued medical education is vital to improve diagnostic accuracy and patient outcomes.

Patient: Male, 62-year-oldFinal Diagnosis: Perforated Meckel diverticulumSymptoms: Abdominal painClinical Procedure: —Specialty: SurgeryObjective: Rare diseaseBackgroundMeckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. It results from incomplete obliteration of the vitelline duct, leading to the formation of a true diverticulum of the small intestine, and is often clinically silent. However, complications can occur, including gastrointestinal bleeding, bowel obstruction, Meckel’s diverticulitis, or perforation.Case ReportWe present the case of a 62-year-old male patient in good health, with no prior history of surgery, who presented with abdominal pain in the right iliac fossa and elevated C-reactive protein levels. An abdominal ultrasound showed signs of acute appendicitis. During surgical laparoscopic exploration, which was converted to a median laparotomy, an inflamed perforated Meckel diverticulum caused by a foreign body was discovered. Due to the inflammation, a segmental small bowel resection with an ileo-ileal latero-lateral anastomosis was performed.ConclusionsThe surgical management of Meckel diverticulum depends on several factors, including the presence of inflammation, perforation, infection, and the size of the diverticulum. Diverticulectomy, which can be easily performed laparoscopically, typically has a lower complication rate. Nevertheless, in cases of bleeding or severe inflammation, a small bowel resection may be needed to ensure that all heterotopic mucosa is removed. This report highlights a rare case of perforation caused by a foreign body of vegetal origin.

BackgroundAdenomyomas are rare benign lesions of the gastrointestinal tract, mostly found in the biliary tract and stomach. Their occurrence in the small bowel, particularly in children, is exceedingly rare. This report presents two pediatric examples of small bowel adenomyomas, including one within a Meckel diverticulum, a notably rare occurrence.Case Report 1An 11-month-old boy presented with intussusception. Surgical exploration revealed a pathologic lead point in the ileum.Case Report 2A 12-year-old boy also presented with intussusception. A Meckel diverticulum, acting as a lead point, was identified and excised. Histopathology of both lesions showed cystically dilated glands surrounded by smooth muscle bundles, consistent with adenomyoma, the second within the diverticulum's lesion.ConclusionSmall bowel adenomyomas, although rare, should be considered in intussusception with a pathological lead point. Both case reports highlight the importance of histopathological examination for diagnosis. This lesion within a Meckel diverticulum represents the fourth pediatric example ever reported, contributing valuable insight into the pathogenesis of this rare entity. Surgical excision remains both diagnostic and curative.

Small bowel obstruction in virgin abdomen (SBO-VA) is rarely encountered and there is no standard treatment strategy. Even though nonoperative management is advocated in recent studies, studies evaluating the outcomes and results of laparoscopic surgery in these patients are lacking. This study aimed to compare the results of laparoscopic and open surgeries in SBO-VA patients. Thirty-five patients, ≥18 years old, who were admitted to the Hacettepe University Faculty of Medicine, General Surgery Department between January 2018 and December 2023 with virgin abdomen intestinal bowel obstruction and underwent open surgery and laparoscopic surgeries, were analyzed retrospectively. The demographic and clinical characteristics of patients were analyzed from hospital records. For 19 patients, laparoscopic surgery was conducted; for 16 patients, open surgery was conducted. Adhesions (60%) were the most common underlying etiology followed by Meckel diverticulum (17.4%). Pathological examination revealed malignancy in 4 (11.43%) patients. The diagnostic accuracy of computed tomography performed preoperatively was calculated as 34.3%. In the laparoscopic surgery group, the length of incision, Clavien-Dindo Classification score, pain score 24 hours after surgery, and length of hospital stay were statistically significantly lower compared with open surgery group (P < .001, P = .01, P < .001, P = .001, respectively). Although it was statistically insignificant, median time to oral intake after surgery was shorter in laparoscopic group when compared with the open surgery group (48 hours [48–72] vs 72 hours [48–72], P = .056). Laparoscopic surgery in SBO-VA seems to be more advantageous than open surgery due to its favorable postoperative outcomes as well as diagnostic and therapeutic effectiveness.