Meckel's Diverticulum Research Articles

Intussusception with ischemia secondary to Meckel's Diverticulum in a 13 year old

This case demonstrates a rare presentation of a 13 year old boy who attended a rural Emergency Department with severe epigastric pain, nausea and vomiting. On arrival he was hypertensive and clinical examination found him to have tenderness most pronounced in the right iliac fossa leading to presumed diagnosis of appendicitis. However, upon surgical review it was felt his clinical examination and symptoms were inconsistent with those typically found in acute appendicitis. Ultrasound and abdominal x-ray were performed which did not clearly identify a cause for the patient's presentation however formal reports were not readily obtainable as this occurred after hours at our rural facility. Due to his clinical appearance and a significantly raised white cell count the decision was made to perform a diagnostic laparoscopy as it was evident he had a serious intra-abdominal pathology. Intra-operatively we determined the patient to have ischaemic bowel secondary to intussusception. Following resection of the affected bowel we identified an inverted Meckel's diverticulum to have been the lead point. This case is of clinical significance due to its unclear initial presentation as well as the patient being beyond the normal age range for both intussusception and symptomatic Meckel's Diverticulum.

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 inammation 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 65 year-old female, who presented since 2 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever and nausea. On physical examination her abdomen revealed diffuse tenderness, more over the right iliac fossa and the hypogastric region with guarding in the right iliac fossa. A provisional diagnosis of appendicular perforation was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A resection of ileum with meckels diverticulum with end to end anastomosis of ileal loops were performed. Heterotopic mucosa of diverticulitis was conrmed on histopathology. The patient made an uneventful recovery postoperatively . 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.

Outcomes of Laparoscopic Versus Open Resection of Meckel's Diverticulum

BackgroundMeckel's Diverticulum (MD) is a common congenital anomaly accounting for half of pediatric gastrointestinal bleeds. No large-scale studies exist comparing open and laparoscopic surgery and conversion rates remain high. We sought to compare postoperative outcomes associated with each approach and to determine risk factors for conversion. Materials and MethodsNSQIP-Pediatric was used to identify patients who underwent a MD resection from 2012 to 2018. Outcomes between patients treated with a laparoscopic versus open versus laparoscopic converted to open (LCO) surgery were compared. Chi-square tests and adjusted logistic regression analysis were used to determine significance and factors associated with conversion. ResultsSix hundred eighty-one patients were identified, 295 (43.3%) underwent open, 267 (39.2%) laparoscopic, and 119 (17.5%) LCO resection. Patients undergoing laparoscopic compared to open procedures had shorter length of stay (LOS; 3 versus 4, P= 0.009), and similar morbidities (10.5% versus 16.6%, P= 0.164) and operative times (71.6 versus 76.6 mins, P= 0.449) on adjusted analysis. Patients with LCO compared to open procedures had similar LOS (4 versus 4, P= 0.334) and morbidities (14.3% versus 16.6%, P= 0.358), but longer operative times (90.1 versus 76.6 mins, P= 0.002) on adjusted analysis. Patients with laparoscopic and LCO procedures had fewer unplanned intubations compared to open procedures (0.0% versus 0.0% versus 2.4%, P= 0.011) and lower mortality (0.0% versus 0.0% versus 1.7%, P= 0.046) on univariate analysis. ConclusionsLaparoscopic MD resection has shorter LOS and similar complications and operative time compared to an open approach while LCO resection increases operative time but not LOS or morbidities.

Meckel's Diverticulum Perforation by Foreign Body: A Case Report.

Meckel’s diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 reported cases of Meckel’s diverticulum perforation by chicken bone. We report a case of a 24-year-old man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel’s diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged after 5 days. Although rare, its clinical presentation might be similar to acute appendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel in order to investigate a possible Meckel’s diverticulum complication in the differential diagnosis.

Patterns and Surgical Outcome of Pediatric Intestinal Obstruction in Pakistan

Background: Intestinal obstruction in children is a very common cause of admission in hospitals with usually a high mortality andmorbidity rate. There is a geographical variability in patterns of intestinal obstruction in pediatric population around the globe.Objectives: To evaluate patterns of presentation and surgical outcome of pediatric intestinal obstruction in Pakistan.Material and Methods: A prospective observational study with non-probability sampling technique was done in the departmentPediatric Surgery (East Surgical Unit), The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, from January to December 2017. Operated cases of intestinal obstruction from 1 day to 12 years were included. Age,patterns of presentation, sign and symptoms, surgical intervention, complications, outcome and correlation between variableswere studied.Results: Total cases were 316 (231 males, 85 females). Congenital Causes of intestinal obstruction in descending order wereAnorectal Malformations(75),Jejuno-Ileal Atresia(28), Hirschsprung Disease(27), Meckel's Diverticulum(17), DuodenalAtresia(16), Malrotation(12), Meconium Ileus(11), Midgut Volvulus(8), Mesenteric cyst(1) and Rectal Atresia(1).Acquired causeswere Intussusception(40), Perforated Appendix(20), Infantile Hypertrophic Pyloric Stenosis(14), Band Obstruction(12), BluntAbdominal Trauma(10), Obstructed Inguinal hernia (9), Worm infestation(9), Enteric Perforation(3), Necrotizing Enterocolitis(3).The overall mortality rate was 3.5% and postoperative complications rate was 40.8%. Statistically significant relationship wasfound between Age and post operative complications (P=0.048), Age and outcome (P=0.002) and between post operativecomplications and outcome (p<0.001).Conclusions: Causes of intestinal obstruction vary according to the age and geographical area. Accurate and timely diagnosis ofthe cause of intestinal obstruction along with prevention and treatment of sepsis can reduce morbidity and mortality.Key words: Intestinal obstruction; Children; Congenital; Acquired Causes; Neonate; Pakistan

Patterns and Surgical Outcome of Pediatric Intestinal Obstruction in Pakistan

Background: Intestinal obstruction in children is a very common cause of admission in hospitals with usually a high mortality andmorbidity rate. There is a geographical variability in patterns of intestinal obstruction in pediatric population around the globe.Objectives: To evaluate patterns of presentation and surgical outcome of pediatric intestinal obstruction in Pakistan.Material and Methods: A prospective observational study with non-probability sampling technique was done in the departmentPediatric Surgery (East Surgical Unit), The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad,Pakistan, from January to December 2017. Operated cases of intestinal obstruction from 1 day to 12 years were included. Age,patterns of presentation, sign and symptoms, surgical intervention, complications, outcome and correlation between variableswere studied.Results: Total cases were 316 (231 males, 85 females). Congenital Causes of intestinal obstruction in descending order wereAnorectal Malformations(75),Jejuno-Ileal Atresia(28), Hirschsprung Disease(27), Meckel's Diverticulum(17), DuodenalAtresia(16), Malrotation(12), Meconium Ileus(11), Midgut Volvulus(8), Mesenteric cyst(1) and Rectal Atresia(1).Acquired causeswere Intussusception(40), Perforated Appendix(20), Infantile Hypertrophic Pyloric Stenosis(14), Band Obstruction(12), BluntAbdominal Trauma(10), Obstructed Inguinal hernia (9), Worm infestation(9), Enteric Perforation(3), Necrotizing Enterocolitis(3).The overall mortality rate was 3.5% and postoperative complications rate was 40.8%. Statistically significant relationship wasfound between Age and post operative complications (P=0.048), Age and outcome (P=0.002) and between post operativecomplications and outcome (p<0.001).Conclusions: Causes of intestinal obstruction vary according to the age and geographical area. Accurate and timely diagnosis ofthe cause of intestinal obstruction along with prevention and treatment of sepsis can reduce morbidity and mortality.Key words: Intestinal obstruction; Children; Congenital; Acquired Causes; Neonate; Pakistan

The diagnostic and treatment values of double-balloon enteroscopy in children's Meckel's diverticular bleeding.

The diagnostic and treatment values and safety of preoperative double-balloon enteroscopy (DBE) for Meckel's diverticula (MD) bleeding in children by retrospective review and analyses.The clinical data were collected and analyzed from 10 cases of children with MD receiving preoperative DBE examination and postoperative pathological confirmation. The diagnostic and treatment values and safety were assessed through the comparison of the DBE results and intra-operative observations and subsequently postoperative pathological results.Total cases are 10, 7 males and 3 females. The male to female ratio is 2.3 to 1. The youngest patient is 3.3 years old and oldest 12.1, the average age is 7.4 ± 3.0. The lowest body weight is 12.6 kg and the average is 32.5 ± 18.9 kg. The hematochezia was the main clinical manifestation in all patients with anemia and moderate to severe anemia were common (9/10, 90%). All patients had and tolerated the DBE procedures via anal route with 100% success rate. There were no observable complications during the examinations and post operations. All patients were diagnosed with MD by DBE. Exploratory laparoscopy and surgical operations were subsequently performed. All surgical samples were confirmed by pathology as bleeding MD. The postoperative follow-ups up to April 2019 (from 3 to 12 months) do not show any bleeding sign. Pathological examinations found ectopic gastric mucosa in 9 patients (90%) and one case had both ectopic gastric mucosa pancreatic tissue (10%). The distance of MD to ileocecal valve was from 60 to 100 cm (average 81.0 ± 16.0 cm) by DBE examinations. Surgery showed similar findings from 30 to 100 cm (average 71.0 ± 18.5) consistently to DBE. There is no statistical significance between 2 methods (Ζ = 1.715, Ρ = .086).DBE examination proves to be a safe method for diagnosing children's MD disease and can reliably determine the bleeding lesions in children's MD, providing valuable guidance for surgical treatment of children's MD bleeding.

A Rare Case Report of Waugh Syndrome in an Eight Months Old Male

The author reports a case of Waugh syndrome in an 8-monthold baby boy. Although Waugh's Syndrome is rare, most of thedocumented cases are in children. Waugh syndrome, first described in 1991 by Georges Waugh, is an intussusception associated with abnormal bowel rotation (Behera, C. R., & Mohanty, S. K. 2014; & Henderson, A. A. et al., 2013). Less than 100 cases have been described so far worldwide. Intussusception is one of the most common causes of bowel obstruction in pediatrics. Although this intussusception is idiopathic in 81% of cases, it can sometimes be secondary to various etiologies such as Meckel's diverticulum, congenital bridles, gastroenteritis, polyposis and intestinal lymphomas. The authors discuss treatment options and discussthe probability of Waugh's Syndrome during any intussusception in children (Behera, C. R., & Mohanty, S. K. 2014).

Mesenteric Meckel's diverticulum in a 17 month old female

Meckel's diverticulum is a common gastrointestinal anomaly that is a remnant of the omphalomesenteric duct which typically remains on the antimesenteric border of the small intestine. Mesenteric variation of the Meckel's diverticulum are uncommon and only 22 cases have been reported in the literature. We report a case of a 17 month old female presenting with a symptomatic lower gastrointestinal bleed and an ambiguous mesenteric lesion on ultrasound subsequently found to be a mesenteric Meckel's diverticulum. The existing literature was reviewed to understand age and presentation of mesenteric Meckel's diverticulum cases. We also review the differential, including presentation and epidemiology for mesenteric lesions in children.

Uncommon Cause of Intestinal Obstruction: Umbilical Littré’s Hernia

Introduction: Meckel's diverticulum occurs in 0.3-3% of the world population. This is the embryological remnant due to the lack of obliteration of the omphalomesenteric duct at the fifth week of gestation. The complication of Meckel's diverticulum that protrudes through any hernial orifice is called Littré's hernia. In this case, it presents through an umbilical defect. Objective: Report a case of umbilical Hernia Littré given its low incidence. Case Report: A 26-year-old male with no significant history. The physical examination revealed an umbilical defect measuring 1 cm in diameter with no evidence of incarceration or strangulation. Conservative decompressive management was established, nasogastric tube with initial expenditure of 400 milliliters of gastrobiliary content; however, after 12 hours there was no clinical improvement. Surgical management was decided, an exploratory laparotomy was performed, as findings of little free fluid with an inflammatory appearance, 1 cm umbilical defect with a hernial sac containing a Meckel diverticulum. Conclusion: The presentation of these clinical cases enriches the literature and gives us the opportunity to identify more of these rare clinical cases.

Diverticula in the gastrointestinal tract

The prevalence of diverticula varies depending on the location within the gastrointestinal tract. Diverticula of the esophagus, stomach and small intestine are rare, more frequent are peripapillary diverticula and colonic diverticula. Meckel diverticula can also be of relevance in adults. Diverticula have to be differentiated from intramural pseudodiverticulosis of the esophagus and bile duct cysts. An endoscopic and radiological diagnostic work-up is only necessary for symptomatic diverticula or complications. In some cases additional functional diagnostic tests, such as high-resolution esophageal manometry to detect underlying motility disorders (Zenker's diverticulum, epiphrenic diverticulum) or the hydrogen breath test to detect bacterial overgrowth in the small intestine (diverticula of the small intestine) are mandatory. Effective treatment requires the close interdisciplinary cooperation between different specialist disciplines. Therapeutic modalities include pharmacotherapy, endoscopy and surgical methods.

Extra-appendicular neuroendocrine tumors: A report from the TREP project (2000-2020).

Extra-appendicular neuroendocrine tumors (NETs) are very rare tumors. While diagnostic and therapeutic guidelines are well established for adults, data on children and adolescents are lacking. Patients with a diagnosis of extra-appendicular NET registered on the Tumori Rari in Età Pediatrica - Rare Tumors in Pediatric Age (TREP) from 2000 to 2020 were analyzed. Clinical characteristics including patients' presentation, tumor features, treatment, and outcome were reviewed. Twenty-seven patients with extra-appendicular NET registered on TREP with a median age of 173months. The primary site was the pancreas (12) or bronchi (10) in the majority of cases. Other primary sites included the thymus, Meckel's diverticulum, and liver. Thirteen (48%) of tumors extended beyond the organ of origin: four invaded neighboring organs and/or regional nodes and nine involved distant metastases. The 3-year event-free survival (EFS) for those with localized disease was superior to those with metastatic disease (66.6% 95% CI 5-95% vs 33% 95% CI 5-68%, respectively; P=.005). A complete resection was feasible in 17 patients. The 3-year EFS in these patients was superior to those with no or incomplete resection (R0 vs R1/R2, respectively; P=.007). Overall, 16 children had no evidence of disease at follow-up, and one is alive with disease; five died, and five were lost to follow-up. Data from our experience demonstrated a wide heterogeneity of presentation and outcome of these tumors. Localized disease and complete surgical resection were the main prognostic factors of good outcome. Other therapies may have a role in prolonging survival in metastatic disease.

Intussusception caused by Burkitt's lymphoma - a clinical case.

Background: Intussusception is one of the most frequent causes of intestinal occlusion in children under 3 years of age, and it is mainly idiopathic. In adolescence and adulthood it is rare, but often presents a pre-existing pathology, such as Meckel's diverticulum, intestinal polyps, neurofibromas or malignant diseases.

A rare Meckel’s diverticulum complication in inguinal hernia: case report of Littre hernia

Abstract Meckel’s diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract resulted from incomplete closure of the omphalomesenteric tube between 5th-7th intrauterine week. The incidence of MD is reported to be around 2% in the general population. MD is generally asymptomatic during life and symptoms are observed in around 1% of patients. MD is rarely found within hernial sac which is known as Littre hernia (LH). The incidence of this extremely rare condition, LH, is less than 1% in all MD cases. It is difficult to diagnose LH preoperatively. A 63 years old male patient applied to our hospital with the complaints of swelling in both of his inguinal regions for the last six months. In the right hernia sac of the patient, Meckel’s diverticulum was seen which became evident during surgery. In this study, this very rare MD case observed and treated in our patient and known in the literature as a Littre hernia is presented.

Inverted Meckel's diverticulum associated with heterotopic pancreatic tissue causing intestinal obstruction: a case report

BackgroundMeckel’s diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It can invert or invaginate into the small intestine lumen. It is usually associated with heterotopic tissue elements.Case presentationWe present a case of inverted Meckel's diverticulum, clinically and radiologically diagnosed as intestinal obstruction due to intussusceptions. The diagnosis was suspected due to target sign shown on radiological examination. Pathologically, it was inverted Meckel's diverticulum obstructing the lumen in parallel plan mimicking the telescoping appearance, with heterotopic pancreatic tissue formed of exocrine and ductal components only.ConclusionsInverted Meckel’s diverticulum may present by vague symptoms and may simulate other causes of intestinal obstruction.

Intestinal obstruction on necrotic Meckels diverticulum: a case report with a review of the literature

Background: Meckel's diverticulum is the most common congenital anomaly of the small intestine. It is a remnant of the omphalomesenteric duct. Case presentation: We report a case of a 22 years old patient admitted for intestinal obstruction whose surgical exploration revealed an intestinal obstruction of the small bowel by strangulation on a necrotic Meckel's diverticulum. Our patient underwent segmental resection with anastomosis. Conclusion: The Meckel's diverticulum is clinically latent except in the case of complications, which would justify its search and resection during an abdominal approach for other pathology.

Axial torsion of a giant Meckel’s diverticulum

Introduction: Meckel’s diverticulum (MD) is an outpouching in the terminal ileum formed due to the persistence of the omphalomesenteric duct. Usually asymptomatic, only about 5% of the cases develop complications such as hemorrhage and perforation. Axial torsion, which occu

Complicated Littre hernias

BACKGROUND: Meckel’s diverticulum (MD) is the most prevalent congenital anomaly of the gastrointestinal tract with an estimated prevalence ranging from 2% to 4%. The diverticulum is a remnant of the vitelline duct, which leads to the formation of a true diverticulum containing all the layers of the small intestine. The condition is usually clinically silent; however, it can present with unusual symptoms and signs and therefore can result in a delayed diagnosis, particularly in adults. The aim of this study is to review the most updated literature reporting Littre hernias (LHs) in adults, the diagnostic approach, and its subsequent management. This is a literature review, complemented by an unusual clinical case of an adult who presented with a complicated umbilical LH which required emergency surgery. MATERIALS AND METHODS: Literature reviews using PubMed, Web of Science, and other reliable sources use the possible combinations of the following keywords: Meckel’s diverticulum, Littre hernia, umbilical hernia, adults, complications, surgical treatment. RESULTS: The herniation of an MD through a potential opening in the abdominal wall is defined as an LH, representing a rare complication of the diverticula. Due to their rarity, they remain underdiagnosed, often leading to suboptimal treatment with substantial morbidity and mortality. CONCLUSION: An MD, despite being a rare clinical entity in adults, can theoretically be found in any hernia, with patients experiencing a wide range of potential complications.

An uncommon location of a Meckel's diverticulum mimicking small intestinal duplication cyst

An uncommon location of a Meckel's diverticulum mimicking small intestinal duplication cyst

Clinicopathologic Characteristics and Treatment Outcomes of Symptomatic Meckel's Diverticulum in Children

Clinicopathologic Characteristics and Treatment Outcomes of Symptomatic Meckel's Diverticulum in Children