Meckel's Diverticulum Research Articles

Axial torsion of Meckel's diverticulum on imaging: a rare but important complication to consider.

Axial torsion of Meckel's diverticulum on imaging: a rare but important complication to consider.

Gastroschisis with malrotation, gut duplication and Meckel's diverticulum; a rare association

Gastroschisis is defined as a congenital anterior abdominal wall defect which is rarely associated with other congenital anomalies. Gastrointestinal anomalies are the most common associations including malrotation. Other gut anomalies like intestinal duplication and Meckel's diverticulum are very rare. Our report a rare case of gastroschisis who is associated with malrotation, intestinal duplication and Meckel's diverticulum.

Perforated Meckel's diverticulum as a cause of pneumoperitoneum in a VLBW new-born

We report the case of a preterm weighting 755g who showed a massive pneumoperitoneum 14 hours after birth without clinical signs of an Necrotizing enterocolitis (NEC). In surgery, a round hole with everted edges was found in the middle course of the small bowel without surrounding ischemic necrosis or significant peritonitis. The child was successfully treated with resection and anastomosis, with uneventful short-term postoperative recovery. Both macroscopic and microscopic features were consistent with a perforation of the Meckel remnant. The theoretical etiopathogenesis of this uncommon pathology and the predisposing factors in the preterm population are discussed as well as the treatment. The few cases reported in literature, including the present case, which is the smallest one described to date, encourage consideration of a perforated Meckel's diverticulum as one of the possible causes of free peritoneal air in preterm new-borns, separate from the consequences of an NEC.

SYMPTOMATIC MECKELS DIVERTICULUM IN THE NEWBORN: REVIEW OF THE LITERATURE

Meckels diverticulum accounts for 2 to 3% of gastrointestinal tract malformations in children. It is a distal remnant of the incompletely obliterated omphalo mesenteric duct that occurs at 4 weeks gestation, and is located approximately 40 to 60 cm from the last ileal loop. In the majority of cases, its presentation is asymptomatic and discovery is incidental. The symptomatic form represents 4% and is rare in children, including bleeding, occlusion, inflammation and intermittent umbilical oozing. The symptomatic form is exceptional in newborns. This work is a descriptive study of the literature regarding reported cases of newborns diagnosed with symptomatic Meckels diverticulum either as a picture of intestinal obstruction or by spontaneous perforation of the DM The objective of our study is to describe the cases of newborns operated in emergency for symptomatic Meckels diverticulum and to evaluate the surgical management.

Meckel’s diverticulum and its plethoric presentation in paediatric surgery: a case series

Meckel’s diverticulum (MD) is a congenital abnormality of the gastrointestinal tract resulting from incomplete obliteration of the vitellointestinal duct by 5th to 7th week of gestation. Incidence is 2% in the general population with a 2:1 male to female ratio. The various presentations of MD include gastrointestinal bleeding, intestinal obstruction, diverticulitis and intestinal perforation. Majority of the MD is asymptomatic however the potential risk of developing complication it's about 4-6%. Preoperative diagnosis of MD is challenging. We present 6 cases of MD managed at our centre over the course of 1 year. Two cases presented as intestinal obstruction secondary to mesodiverticular band from MD, one case with bleeding, two cases with intussusception and one case of meckel’s diverticulitis.

Ileal Perforation and Enteric Fever: Implications for Burden of Disease Estimation.

BackgroundIleal perforation occurs in about 1% of enteric fevers as a complication, with a case fatality risk (CFR) of 20%–30% in the early 1990s that decreased to 15.4% in 2011 in South East Asia. We report nontraumatic ileal perforations and its associated CFR from a 2-year prospective enteric fever surveillance across India.MethodsThe Surveillance for Enteric Fever in India (SEFI) project established a multitiered surveillance system for enteric fever between December 2017 and March 2020. Nontraumatic ileal perforations were surveilled at 8 tertiary care and 6 secondary care hospitals and classified according to etiology.ResultsOf the 158 nontraumatic ileal perforation cases identified,126 were consented and enrolled. Enteric fever (34.7%), tuberculosis (19.0%), malignancy (5.8%), and perforation of Meckel diverticulum (4.9%) were the common etiology. In those with enteric fever ileal perforation, the CFR was 7.1%.ConclusionsEnteric fever remains the most common cause of nontraumatic ileal perforation in India, followed by tuberculosis. Better modalities of establishing etiology are required to classify the illness, and frame management guidelines and preventive measures. CFR data are critical for comprehensive disease burden estimation and policymaking.

Spontaneously perforated Meckel's diverticulum due to diverticulitis with histopathological finding of gastric mucosa in an adult female - A case report.

Introduction and importanceMeckel's Diverticulum (MD) is the most occurring congenital anomaly of the gastrointestinal tract. It characterizes a patent remnant of the omphalomesenteric duct. Despite remaining asymptomatic most of the time, the rarity of its occurrence is reflected by the scarcity of data involving it in the literature. Gastrointestinal bleeding, bowel obstruction, and inflammation are the most prevalent complications of MD. Perforation of MD is very rare.Case presentationWe present the case of a previously healthy 32-year-old female, who presented to the emergency department with a 2-day-history of generalized abdominal pain. Radiological analysis suggested a perforated viscus and an inflamed Appendix.Clinical discussionOur patient was diagnosed preoperatively with perforated hollow viscus and an exploratory laparotomy was indicated. Intraoperatively, a perforated MD was found and treated by surgical excision of the affected loop of bowel with end-to-end anastomosis and the specimens were sent for histopathological analysis. Histopathology revealed a perforated MD containing gastric mucosa. The patient had successful recovery.ConclusionEarly recognition with swift surgical intervention must take place to provide therapeutic outcome for patients and to limit the resulting morbidity. This case highlights the necessity of considering MD as core differential diagnosis in patients with acute abdomen. Due to the scarcity of data on perforated MDs in adult females, it's worthy of studying to highlight its incidence. Due to the rarity of a perforated MD in an adult female, it's worthy to consider such cases to explore preoperative assessment techniques, surgical interventions options, and postoperative complications.

Meckel's Diverticulum Diagnosed by Balloon-Assisted Enteroscopy: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID).

Background and Aims Patients with Meckel's diverticulum (MD) are difficult to preoperatively diagnose because of its endoscopic inaccessibility. Balloon-assisted enteroscopy (BAE) allows endoscopic access to the entire small intestine. The aim of the current study was to investigate patients with MD diagnosed by BAE in Taiwan. Methods We conducted a retrospective, multicenter study of patients with MD who were diagnosed by BAE in Taiwan. The clinical characteristics, endoscopic features, histopathological findings, treatment methods, and outcomes were analyzed. Results A total of 55 patients with MD were enrolled (46 males and 9 females). The mean age at diagnosis was 34.1 years. Overt gastrointestinal bleeding (87.3%) was the primary indication for BAE, followed by abdominal pain (9.1%), suspected small bowel tumor (1.8%), and Crohn's disease follow-up (1.8%). The mean distance between the ileocecal valve and MD was 71.6 cm (regarding diagnostic yields: BAE—100%, capsule endoscopy—40%, Meckel's scan—35.7%, computed tomography—14.6%, small bowel series—12.5%, and angiography—11.1%; regarding endoscopic features of MD: a large ostium—89.1%, a small ostium—7.3%, and a polypoid mass—3.6%). Surgical treatment was performed in 76.4% patients, and conservative treatment was performed in 23.6% patients. The mean length of MD in 42 patients who underwent surgical resection was 5.2 cm (in 43 patients of MD with available histopathology: heterotopic gastric tissue, 42.4%, heterotopic gastric and pancreatic tissues, 7%; heterotopic pancreatic tissue, 4.7%; heterotopic colonic tissue, 2.3%; and a neuroendocrine tumor, 2.3%). Conclusions The current study showed BAE is a very useful modality for detecting MD compared with other conventional modalities.

Gigant Morgagni Congenital Hernia Associated with Intestinal Malrotation and Meckel Diverticulum in Child with Down Syndrome- Clinical Case Presentation and Literature Review

Gigant Morgagni Congenital Hernia Associated with Intestinal Malrotation and Meckel Diverticulum in Child with Down Syndrome- Clinical Case Presentation and Literature Review

Meckel’s Diverticulum, A Unique Presentation in the Neonate

Meckel’s diverticulum (MD) is the most prevalent gastrointestinal congenital malformation, occurring in 2% to 4% of all live births. Typical symptoms of MD include intestinal bleeding and bowel obstruction, but MD can also present with many atypical symptoms of varying severity, posing a diagnostic challenge with severe complications if left untreated. Neonates presenting with symptomatic MD are uncommon. In this report, we describe a neonatal case of MD in which the patient presented with atypical symptoms including distended abdomen and constipation mimick necrotizing enterocolitis. This case emphasizes the importance of clinically correlating a provisional diagnosis while maintaining a broad differential, including uncommon conditions in this age group such as MD.

Management of Symptomatic Meckel's Diverticulum in Infants and Children

Objectives The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome. Materials and Methods This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum at the author's institute and included data from January 1, 2000 to December 31, 2020. Results Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period. The ratio for males to females was 3:1. This study consisted of infants, (n = 22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n = 43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n = 59, 70.23%), (2) perforation peritonitis (n = 17, 20.23%), (3) lower gastrointestinal bleeding (n = 4, 4.76%), and (4) incidental finding (n = 4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n = 17) of Meckel's diverticulum was responsible for the secondary intussusception. The surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n = 36, 42.85%); (2) Meckel's diverticulectomy (n = 32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n = 12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n = 4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period. Conclusion Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.

A case of intestinal obstruction caused by a mesodiverticular band in Meckel's diverticulum with ectopic pancreas treated by laparoscopic surgery.

IntroductionWe report a case of a patient who underwent laparoscopic surgery for intestinal obstruction caused by the mesodiverticular band of Meckel's diverticulum, with pathological specimens showing ectopic pancreas.Presentation of caseA 56-year-old woman presented to our hospital with complaints of abdominal pain and vomiting. Upon close examination, we suspected strangulated intestinal obstruction, and performed an emergency surgery. An internal hernia with a band leading to a Meckel's diverticulum was noted. Focusing on the attachment of the band, leading to the Meckel's diverticulum, we suspected a mesodiverticular band and deemed it necessary to be resected. Surgery was completed with resection of the band to relieve the intestinal obstruction, with simultaneous resection of the Meckel's diverticulum. It was necessary to resect Meckel's diverticulum simultaneously for histopathological examination. Histopathological examination revealed a mesodiverticular band in the resected band and ectopic pancreas in the Meckel's diverticulum.DiscussionWe chose to perform a complete laparoscopic resection because of the presence of simple intestinal obstruction caused by mesodiverticular bands or diverticula. We believe that small laparotomy can be opted in less severe cases, regardless of laparoscopic completion.ConclusionWe suspected adherent bowel obstruction and detected a band. We focused on band attachment and determined that the band should be resected if it was attached to Meckel's diverticulum. The resection method should be carefully selected, and the specimen should be histopathalogically examined.

Perforated Meckel's diverticulum causing in utero small bowel obstruction

Meckel's diverticulum is a congenital anomaly involving a true diverticulum of the ileum. These diverticula can present in a variety of ways. They can be asymptomatic and discovered incidentally or can present with symptoms of infection, bleeding or obstruction. Typically, patients present around age 2. We present a case of an in utero perforation of a Meckel's diverticulum causing a small bowel obstruction diagnosed on prenatal imaging. • In utero bowel perforation discovered during prenatal ultrasound. • A change from dilated to decompressed bowel on subsequent prenatal ultrasound revealing perforated bowel. • Perforated Meckel's diverticulum causing internal hernia and subsequent bowel obstruction.

FOREIGN BODY PERFORATION OF MECKEL'S DIVERTICULUM IN A CASE OF ACUTE APPENDICITIS - TWIN PATHOLOGY : A RARE CASE REPORT

Meckel's diverticulum is a remnant of embryologic omphalomesenteric duct. It is the most common congenital anomaly in gastrointestinal tract with the incidence of about 2% in the population. About 80% of them are asymptomatic and remaining can present with complications such as bleeding, ulcer, intestinal obstruction, intussusception, diverticulitis and perforation. Meckel's diverticular perforation by a foreign body is a rare complication. Here we report a case of Meckel's diverticular perforation by a foreign body in a case of acute appendicitis. A 50 year old male patient presented to emergency department with signs and symptoms of acute appendicitis . Abdomen opened through Mc Burney's incision, appendix found to be inammed and a sh bone perforating the Meckel's diverticulum was incidentally found, appendicectomy and Meckel's diverticulectomy was performed. Perforation of Meckel's diverticulum by a foreign body is a diagnostic challenge pre operatively. It is suggested to make it a routine practice to look for the presence of Meckel's diverticulum in all lower abdominal surgeries.

Omphalomesenteric Duct Anomalies in Children: A Multimodality Overview.

The omphalomesenteric duct is an embryologic structure that connects the yolk sac with the primitive midgut of the developing fetus. Omphalomesenteric duct anomalies include a group of entities that result from failed resorption of the omphalomesenteric duct. These anomalies include Meckel diverticulum, omphalomesenteric fistula, fibrous bands, cysts, and umbilical polyps. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic. Symptoms develop when Meckel diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. Hemorrhage is the most common complication of Meckel diverticulum, and technetium 99m-pertechnetate scintigraphy is the imaging modality of choice for detecting acute bleeding. US and CT are commonly used for the evaluation of patients with other complications such as obstruction and inflammation. Nevertheless, the diagnosis of these complications can be challenging, as their clinical manifestations are usually nonspecific and can masquerade as other acute intraabdominal entities such as appendicitis, inflammatory bowel disease, or other causes of bowel obstruction. There are other umbilical disorders, such as urachal remnants and umbilical granuloma, that may present with symptoms and imaging findings similar to those of omphalomesenteric duct anomalies. An accurate preoperative diagnosis of omphalomesenteric duct anomaly is crucial for appropriate management and a better outcome, particularly when these anomalies manifest as a life-threatening condition. The authors review the anatomy, clinical features, and complications of omphalomesenteric duct anomalies in children, describing the relevant differential diagnoses and associated imaging findings seen with different imaging modalities. ©RSNA, 2021.

Idiopathic Meckel's diverticulum perforation presenting at birth

Although symptomatic Mickel's Diverticulum (MD) in infants is rare, we report a case of perforated (MD) at birth in a full term male with signs of peritoneal irritation. Because of the rareness of perforated (MD) in infants, predicting the preoperative diagnosis is so difficult, but it doesn't affect the prognosis.

Nonsurgical treatment of intussusception in pediatric patient

Purpose: In this study, to show that the pre-diagnosis of intussusception should be kept in mind if there is a suspicious appearance in the abdominal X-ray in pediatric patients with intermittent abdominal pain or discomfort in the form of colic, even though there is no rectal bleeding and bile vomiting. Material and methods: In this retrospective, single-center, cross-sectional descriptive study, we examined the records of 33 patients who were followed up due to intussusception between the ages of 0-18 at Pamukkale University Faculty of Medicine Pediatric Surgery Clinic between September 2017 and September 2020. Patients were evaluated in terms of demographic data, hospital admission times, data on imaging methods, pneumatic reduction and surgery. Results: The average age was 37.4±18.8 months. The time from the onset of the patients' complaints to admission to the hospital was 57.3±66.1 hours. 10 patients had ileus findings on abdominal radiography. 30 patients had the image of a champagne glass, typical of intussusception. Ultrasonography showed mesentery lymphadenopathy in 20 patients, and leading point in 3 patients. Ultrasonography of 1 patient was normal, but when the abdominal radiography of this patient was evaluated, there was a suspicion for intussusception. When this patient was evaluated under fluoroscopy and pneumotic reduction was performed. 3 patients who had leading point. Meckel's diverticulum was detected in 1 of 3 patients, Burkitt's lymphoma in 1, and neurofibroma in 1. Conclusion: Pneumatic reduction is more preferred as it is a method that the surgeon can do in the operating room, under fluoroscopy and alone. Another advantage of trying pneumatic reduction under fluoroscopy in the operating room is to try the nonoperative technique in a controlled manner in patients with ileus findings and late arrivals.

MECKEL'S DIVERTICULITIS: A CASE FROM URGENT SURGERY. CLINICAL CASE

Background. Meckel's diverticulum is an ileal diverticulum, formed as a result of incomplete reduction of the yolk duct, occurs on average in 2% of the population. Up to 25% of cases of this pathology are symptomatic or have complications (up to 16%), while more often it manifests in children under 2 years of age. Destructive diverticulitis is the least common complication of Meckel's diverticulum, requiring urgent surgical intervention.Clinical case. A 28-year-old patient with a clinical picture of acute appendicitis came to the emergency room. Intraoperatively, destructive diverticulitis and widespread fibrinous-purulent peritonitis were identified. Conversion to a laparotomic approach and expansion of the volume of the main stage of the operation to appendectomy, segmental resection of the ileum were performed. The postoperative period was uneventful. The patient received complex conservative therapy, was discharged on the 10th day in a satisfactory condition.Conclusion. Destructive diverticulitis requires the surgeon to be vigilant in conducting a diagnostic search in the clinical picture of acute appendicitis in adult patients. If a correct intraoperative diagnosis is established, a radical and least traumatic operation should be selected from a rational approach (if necessary, it should be converted to a laparotomic one). It is necessary to emphasize the importance of an individual approach in choosing intraoperative tactics and planning perioperative complex therapy

A case of primary adenocarcinoma of Meckel’s diverticulum presenting as ovarian mass and literature review

Meckel’s diverticulum (MD) is the most common congenital anomaly affecting the gastrointestinal tract. It is located on the anti-mesenteric border of the small intestine and occurs due to incomplete obliteration of the omphalomesenteric duct during embryogenesis. Tumors, particularly cancers, are rare complications of MD. Carcinoids are the most common malignancies in this site. Adenocarcinomas are extremely rare and carry a poor prognosis. Here, we present the case of adenocarcinoma of MD presenting as Krukenberg tumor in a 42-year-old lady and causing a diagnostic dilemma. Pelviabdominal examination revealed large bilateral adnexal masses along with ascites and computed tomography-guided fine-needle aspiration cytology from the right adnexal mass was suggestive of adenocarcinoma. At exploratory laparotomy, a MD was found with hard intramural growth palpable at the tip of MD adnexal deposits and omental caking. Immunohistochemistry revealed CK 7- and CK 20+ve and also CDX2 positive. The rarity of presentation of bilateral adnexal mass due to primary adenocarcinoma of MD urges us to report this case.

Meckel's diverticulum and the introduction of the intestines ''

Meckel's diverticulum, according to various statistics, is found in cases of celiac disease in approximately 0.1-1.0% of patients. PN Yurovskaya observed 14 cases of Meckel diverticulum among 1126 patients who underwent laparotomy. During gluttony, the specified diverticulum comes across not only as an accidental find, but often turns out to be the cause of catastrophes in the abdominal cavity: intestinal obstruction, peritonitis, intestinal bleeding, etc. T. Bachinskaya and others).