Meckel's Diverticulum Research Articles

Tubercular Meckel diverticulitis mimicking acute appendicitis

Meckel's diverticulum (MD) is usually silent and asymptomatic. Acute diverticulitis, perforation, intestinal obstruction, hemorrhage, and other complications are seen in <4% of cases of MD. 27 year old female, presented with complaints of pain in her abdomen, clinically suspected of acute appendicitis, and finally diagnosed with tubercular Meckel diverticulitis. A clinical and laboratory diagnosis of Meckel's diverticulitis is challenging as it mimics appendicitis and is generally observed during surgical procedures. Meckel's diverticulitis should be suspected and explored, especially when the appendix appears normal in an acute abdomen. The presence of intestinal tuberculosis (TB) in unusual locations should be closely monitored, particularly in countries where TB is endemic.

Divertículo de Meckel: aspectos clínicos e cirúrgicos em um hospital pediátrico de referência

OBJECTIVE: To evaluate the epidemiological profile of symptomatic Meckels diverticulum in patients admitted to a specialized childrens hospital from January 2009 to December 2018. METHODS: This retrospective study analyzed the medical records of patients admitted to a childrens hospital in Curitiba (Paraná-Brazil) from 01/01/2009 to 31/12/2018. RESULTS: We found an incidence of 5.3 cases of symptomatic Meckels diverticulum per year. Of the 43 medical records, there was a predominance of male patients (69.7%) and 21 (48.8%) were less than 1-year-old. As for the clinical presentation,15 patients presented acute abdominal inflammation (34.8%), 9 acute abdominal hemorrhage (21%), and 6 acute abdominal obstruction (14%). 13 patients (30.2%) presented unspecific condition and were not classified. Regarding treatment, 41 patients (95.2%) underwent segmental enterectomy with enteroanastomosis. Ectopic mucosa was found in 19 anatomopathological examinations, 16 of which were gastric in origin, 1 pancreatic, and 2 had both mucosae. Post-operative complications included wound dehiscence (4.6%), paralytic ileus (4.6%), and peritonitis (2.3%). Of the 41 patients, 38 were discharged (88.4%), and 5 (11.6%) died. CONCLUSION: Meckels diverticulum had a propensity to manifest in children who were breastfeeding, most often with inflammation and hemorrhage. Of the 9 patients who manifested hemorrhage, 7 (78%) showed ectopic mucosa, which indicates a likely relationship between the presence of ectopic mucosa and hemorrhage. The percentage of patients who died is higher in our sample than in the literature; those who died were predominantly male and 4 (80%) were younger than 1

Acute Intestinal Obstruction due to Ileo-Ileal Knotting Secondary to Meckels Diverticulum

Acute Intestinal Obstruction due to Ileo-Ileal Knotting Secondary to Meckels Diverticulum

Gastrointestinal Bleeding in a Child: Is It a Meckel Diverticulum?

A 2-year-9-month-old boy with multiple episodes of melena and hematochezia with unclear cause was admitted to our hospital. Laboratory tests showed iron deficiency anemia (hemoglobin of 5 g/dL) and positive fecal occult blood test. Single-operator double-balloon enteroscopy (DBE) through the anal route was performed and revealed multiple patchy mucosal eminence consisted of ectopic gastric pit and loss of villi observed by electronic stain in the distal jejunum, approximately 2 m from the ileocecal valve. The bowel cavity was deformed like a maze in the distal jejunum. There are several mucosal bridging structures and focal stricture, making it difficult to determine the direction of the lumen. Two irregular deep ulcers were found near the stricture (A [a–f] and Video 1). Emission computer tomography Tc99m pertechnetate scan showed multiple areas of radioisotope uptake in the middle and lower abdomen. At laparotomy, a 46-cm-long cyst was noted on the mesentery aspect that protruded alongside from the distal jejunum (B [a–c]). Resection of 58 cm of the jejunum was performed including the cyst. Pathology showed a duplication cyst located on the mesenteric aspect with ectopic gastric mucosa (C). The postoperative diagnosis was a duplication cyst of the jejunum. The patient was discharged 14 days after surgery and remained symptom-free thereafter. Intestinal duplication cysts are rare congenital malformations that can appear anywhere in the gastrointestinal tract. The preoperative diagnosis of a duplication cyst is difficult and can be easily misdiagnosed as Meckel diverticulum. Duplication cysts usually locate on the mesenteric aspect as in our case, in contrast to Meckel diverticulum that localizes on the antimesenteric aspect. In our case, the deformed intestine was found approximately 2 m from the ileocecal valve, which was not common in Meckel diverticulum. To the best of our knowledge, this is the first reported tubular type of jejunal duplication cyst case with an DBE video. DBE can be a useful tool for the diagnosis of intestinal duplication in young children. Watch the Video, Supplementary Digital Content 1, https://links.lww.com/AJG/C853. (Informed consent was obtained from the patient to publish these images.)

Inverted Meckel Diverticulum Diagnosed, Treated, and Followed Up by Enteroscopy.

Inverted Meckel Diverticulum Diagnosed, Treated, and Followed Up by Enteroscopy.

Acute Intestinal Obstruction and Localized Peritonitis From a Perforated Meckel's Diverticulum in a Child.

Acute Intestinal Obstruction and Localized Peritonitis From a Perforated Meckel's Diverticulum in a Child.

AN INTERESTING CASE OF MECKELS DIVERTICULUM CAUSING INTESTINAL OBSTRUCTION

Meckels diverticulum is a persistent remnant of the vitellointestinal duct, and is one the most commonly diagnosed congenital surgical conditions. It occurs in 2% of the population, is usually two inches long, two feet proximal from the ileocaecal junction and in approximately 20% cases it is seen to contain heterotropic epithelium. Its most common clinical presentations are usually in the form of haemorrhage, diverticulitis and rarely may complicate causing intestinal obstruction. We hereby present one such case of intestinal obstruction in a young adult male, secondary to small bowel volvulus around a vitellointestinal band extending from a meckels diverticulum to the anterior abdominal wall. The presentation and management of this case, which had presented to the Emergency Department of our hospital, is elaborated in detail.

INVERTED MECKEL DIVERTICULUM – RARE CAUSE OF SECONDARY INTUSSUSCEPTION IN CHILDREN- CASE REPORT

Introduction Inverted Meckel diverticulum has been identied as the lead point for intussusception in adult in about 4%, very rare in pediatric age group and very few cases has been reported so far. Modern imaging helps but imaging and operative discordance are not reported. It is difcult to diagnose inversion of Meckel diverticulum preoperatively To report a case of 18-month-old girl presented with multiple ep Aims And Objective- isodes of bilious vomitings, pain abdomen and grossly distended abdomen, diagnosed with intussusception upon performing exploratory laparotomy there was an inverted Meckel diverticulum acting as a lead point for intussusception DiscussionMechanism of inversion of Meckel diverticulum is not clearly understood. It is presumed that abnormal peristaltic movement around the diverticulum and non-xity of the diverticulum itself. The inverted diverticulum itself can cause luminal compromise and acts as a lead point for intussusception leading to obstruction Intussusception due to Conclusion- inverted Meckel diverticulum is rare in children and can only be detected intraoperatively. A denitive preoperative clinical or radiological diagnosis is difcult. However inverted Meckel diverticulum is a denite clinical entity and may cause intussusception in children

Inverted Meckel's diverticulum: A case report and role of Radiological Imaging

Inverted Meckel's diverticulum: A case report and role of Radiological Imaging

PERFORATION OF MECKEL'S DIVERTICULUM - A RARE ENTITY

Meckel's Diverticulum is the most common congenital anomaly of the small bowel found in 2% of population . perforation of Meckel's diverticulum is rare complication occurring in less than 7% of patients complicated by meckel's diverticulum that can often mimic appendicitis's. Majority of the meckel's diverticulum remain silent and are diagnosed incidentally during investigations or procedures done for unrelated conditions , or until complications arise from the diverticulum. 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 unusual case of Meckel's diverticulum

MESODIVERTICULAR BAND OF MECKELS DIVERTICULUM CAUSING INTERNAL HERNIATION ANDINTESTINAL OBSTRUCTION IN A GERIATRIC MALE

Background - Meckels diverticulum is a congenital malformation caused by malabsorption of the yolk intestine. It has been reported that the left and right yolk arteries, which are nutrient vessels, can become mesodiverticular bands and cause intestinal obstruction in symptomatic Meckels diverticulum.Intestinalobstruction due to meso-diverticular band of Meckels diverticulum is one of the rarest complications of Meckels diverticulum.Mesodiverticular band is a rarely reported cause of small bowel obstruction in Meckels diverticulum in geriatric population in medical history. Case report - We present a 78 years old male presenting as acute intestinal obstruction caused by meso-diverticular band adhesion causing obstruction. Xray abdomen showed multiple air fluid levels suggestive of intestinal obstruction and emergency laparotomy was done which showed that the cause of intestinal obstruction was mesodiverticular band adherent to Meckels diverticulum causing internal herniation and obstruction in intestinal loops. Adhesiolysis was done and Meckels diverticulum was resected along with the mesodiverticular band. The patient recovered well. Summary - The mesodiverticular band of Meckels diverticulum causing mechanical small bowel obstruction is a rare complication of this congenital anomaly. It should be considered in the differential diagnosis of a small bowel obstruction.

Meckel's Diverticulum Mimicking Inflammatory Bowel Disease

AbstractIntermittent abdominal pain is the most common gastrointestinal (GI) complaint in the pediatric age group. When basic investigations and sonograms do not give etiological basis, functional GI disorders are diagnosed. Meckel's diverticulum (MD), being the common GI surgical condition, can be missed in absence of classical symptoms. Clinical presentation varies based on the size, location, and presence of ectopic gastric mucosa. We report a case of an adolescent female with MD presenting as chronic abdominal pain. Abdominal ultrasonogram was normal. Abnormal fecal calprotectin level and colonoscopy directed for a suspicion of inflammatory bowel disease. Persistence of symptoms with increasing severity prompted a relook into the diagnosis. The presence of intussusception on abdominal scan during one of the painful episodes warranted emergency exploratory laparotomy. Intraoperatively, the lead point for intussusception was identified as MD, which was resected. Postoperative period was uneventful. There are no abdominal symptoms since a year during the follow-up period.

Imaging congenital anomalies of the ileum in adults:a pictorial review.

The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.

A (Not So) Rare Cause of Obscure Gastrointestinal Bleed in Elderly

A 76-year-old woman presented with a 1-day history of bleeding per rectum and a syncopal episode. Her past medical history was notable for 2 episodes of melena in the previous 8 months, and evaluation by upper and lower endoscopy and computed tomography angiography had not identified a source of bleeding. The physical examination revealed pallor and there was maroon-colored stool on rectal examination. Her hemoglobin level was 6.3 g/dL at presentation. After resuscitation, urgent upper endoscopy and colonoscopy up to 10 cm of ileum followed by multidetector computed tomography angiography did not reveal any bleeding source. A videocapsule endoscopy showed blood in the ileum with no bleeding source. Novel motorized spiral enteroscopy revealed a solitary diverticulum in distal ileum, suggestive of Meckel diverticulum (Figure A). Meckel scan confirmed the presence of ectopic gastric mucosa. During laparoscopy a large wide-mouthed Meckel diverticulum was identified and excision with primary anastomosis was performed (Figures B and C). Gastrointestinal bleeding as a result of Meckel diverticulum should be considered as a differential diagnosis even in elderly patients. A high index of suspicion is necessary for diagnosis. Novel motorized spiral enteroscopy may be useful in the evaluation of patients with obscure overt gastrointestinal bleeding when a small bowel source is suspected. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkY2M1OWYyYWVmMWZmZTU5ZjVmNGNlMWU1MTA5NzNlOCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcyNTg3NzM0fQ.lP1rEC6Iy8N8YO69yqraGvWInBM0vPA8-AejgJRSFCKXA-pTgvJie207Rdn0R-68N90NO51Ea1845F0kkixsLijMM51V4a2rdoN_FqbD4xdGHUoRNKT2XXWQqN7v4UJWrK79sC0BXjJjKT-cxbihMb9dqe1WbUI9DqsxSPemQZzWFKw8btIQGv67-48gUxAH41tAIRcE_uJSjZwmGMi3gbexcnkMS2X7xnWGBfFq-p9M5SoF8Yf1JOWjRUy1fwI5_6oyc64R56mIKUR9335XdHehtHutczoyor132WSSLX6WabJhPfxP19b2m0dHqf5eRIpA929sByObeiVPEBAAAA Download .mp4 (5.38 MB) Help with .mp4 files Supplementary Video

Initial Results of a Phase 1 Study of Daratumumab, Ixazomib, and Dexamethasone in Newly Diagnosed and Previously Treated AL Amyloidosis

Background: Systemic light chain (AL) amyloidosis is a rare disease that is characterized by the tissue deposition of misfolded protein aggregates, leading to progressive organ dysfunction and significant morbidity and mortality. Novel therapeutic combinations with improved safety, tolerability, and efficacy profiles remain a paramount need. We herein report initial results of a phase 1 investigator-initiated study evaluating the safety and preliminary efficacy of the novel combination of the anti-CD38 monoclonal antibody (mAb) daratumumab, the oral proteasome inhibitor ixazomib, and dexamethasone (DId) in AL amyloidosis (NCT03283917). Methods: This phase 1, single center, open-label study enrolled AL amyloidosis patients (pts) who were either treatment naïve or previously treated with evidence of clonal relapse or with refractory disease defined as less than a hematologic very good partial response (VGPR) to prior therapy. Key exclusion criteria included NT-proBNP ≥8500 ng/L, clinically overt myeloma (hypercalcemia and/or bone lesions), and previous ixazomib or anti-CD38 mAb therapy. Treatment was administered on a 28-day cycle for up to 12 cycles with daratumumab weekly x 8 weeks, then every other week x 16 weeks, and then every 4 weeks thereafter. Daratumumab was initially administered intravenously (16 mg/kg) but later changed to subcutaneous injection (1800 mg) with a protocol amendment. Ixazomib was administered orally 4 mg on days 1, 8, and 15, and dexamethasone administered 20 mg weekly for cycle 1 and increased to 40 mg weekly for cycle 2 and beyond depending on patient tolerance. The primary study endpoint is to confirm the safety and tolerability of DId in AL amyloidosis. Key secondary endpoints include hematologic response rate and organ (cardiac and renal) response rates. Planned enrollment is 20 pts with toxicity monitoring in cohorts of 5 pts. Results: A total of 18 pts have been dosed to-date including 13 treatment-naïve pts and 5 previously treated pts with a median of 1 prior line of therapy. Baseline characteristics are summarized in the Table. Median age was 66 (range 39-75), 8 (44%) pts were female, and 3 (17%) pts were Black. Median baseline difference between the involved and uninvolved free light chain (dFLC) was 194 mg/L (range 71-2787), and 6 of 17 (35%) pts with available FISH testing had t(11;14). Median number of organs involved was 2 (range 1-4), including 9 (50%) pts with cardiac involvement and 11 (61%) pts with renal involvement. Overall hematologic response rate (≥PR) on treatment was 100%, ≥VGPR rate 72%, and complete response (CR) rate 11%. Cardiac response rate was 43% among 7 response evaluable pts (baseline NT-proBNP ≥650 ng/L), and renal response rate was 36% among 11 pts. Among 5 previously treated pts, there were 4 hematologic VGPRs and 1 hematologic CR. The median number of DId treatment cycles was 8.5, with 7 (39%) pts completing all 12 treatment cycles, and treatment is ongoing in 3 (17%) pts. Intent to proceed with high dose chemotherapy and autologous stem cell transplantation was the most common reason for early treatment discontinuation (4 pts, 22%). The most common treatment emergent adverse events (TEAEs) of any grade regardless of attribution were anemia (56%), thrombocytopenia (56%), dyspnea (56%), fatigue (56%), hypoalbuminemia (56%), and nausea (56%). The most common grade 3 or 4 TEAEs (≥20%) were lymphopenia (33%), lung infection (22%), and thrombocytopenia (22%). Treatment emergent peripheral neuropathy (PN) was 28% (all grade 1 and 2), among whom 4 of 5 pts had baseline amyloid PN, other PN, and/or prior bortezomib exposure. There were 3 deaths on study, all unrelated to treatment (1 related to post-operative complications from small bowel obstruction due to congenital Meckel's diverticulum, 1 related to progressive hepatic amyloidosis, and 1 related to pulmonary embolus in setting of COVID-19 infection). Conclusion: Treatment with DId in both newly diagnosed and previously treated AL amyloidosis pts is safe at standard doses of daratumumab and ixazomib with a predictable and manageable AE profile compatible with the expected toxicities of the individual study drugs. Preliminary efficacy is seen with deep (≥VGPR) hematologic responses attained in the majority of pts. These results support the use of DId as a therapeutic option in AL amyloidosis with longer follow-up needed to assess the depth and durability of hematologic and organ responses. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Meckel diverticulum scintigraphy: technique, findings and diagnostic pitfalls.

Meckel diverticulum, the most common congenital anomaly of the gastrointestinal tract, results from the aberrant involution of the omphalomesenteric duct and accounts for more than 50% of unexplained lower gastrointestinal bleeding in the pediatric population. The most accurate imaging tool to identify a Meckel diverticulum containing ectopic gastric mucosa is the Technetium-99m pertechnetate Meckel scan, a scintigraphic study with a reported accuracy of 90% in the pediatric population. In addition to depicting a Meckel diverticulum with ectopic gastric mucosa, careful attention to the normal biodistribution of the radiotracer can lead to the identification of unexpected pathology with implications for patient management. This article serves to review the embryological origin and anatomical features of Meckel diverticulum, highlight the role of scintigraphy in evaluating Meckel diverticulum, and discuss the proper imaging technique when performing this test. We will focus on pitfalls that can lead to an erroneous diagnosis as well as incidental findings that can affect patient management.

Un diverticolo (dav)vero sanguinante

Meckel diverticulum has been suspected and then diagnosed at laparoscopic exploration of the abdomen in a severely anaemic 16-month-old child with acute intestinal bleeding. The surgical indication of all unexplained intestinal bleedings is discussed.

Acute intussusception of Meckel’s Diverticulum in a 15-year-old boy: Clinical, imaging and laparoscopy aspects

Acute intussusception on Meckels diverticulum (MD) is a rare cause of abdominal pain requiring emergency surgery. The aim of this study, is to provide an adequate level of clinical knowledge

S2586 Don’t Get 2 Comfortable: A Rare Case of Meckel’s Diverticulum Causing Hemorrhagic Shock in an Adult

Introduction: Meckel’s diverticulum (MD) is a true diverticulum that results from incomplete obliteration from the vitelline duct during embryonic development. It is a one of the most common congenital disorders of the gastrointestinal (GI) tract. Often characterized using “The Rule of 2’s”: MD occurs in approximately 2% of the population, is 2 inches long, is within 2 feet from the ileocecal valve, is twice as common in males than females, can contain 2 types of tissue (gastric or pancreatic), 2% become symptomatic, and most present before the age of 2. The majority of symptomatic MD occur as painless hematochezia in children and therefore is often lower on the differential of an adult with a GI bleed. Even when MD is suspected as an etiology for GI bleeding in an adult, the evaluation can be challenging. Case Description/Methods: A 25-year-old male with no significant past medical history was admitted to the hospital for GI bleeding and then developed hemorrhagic shock requiring resuscitation with transfusion of large volumes of blood products. The etiology of his GI bleed remained elusive for several days despite evaluation with upper endoscopy, three colonoscopies, three CT angiograms of the abdomen and pelvis, and a video capsule endoscopy. Subsequently, he underwent two separate fluoroscopic angiograms with interventional radiology. While the first angiogram was unrevealing, the second angiogram demonstrated a tortuous ileal artery branch with active extravasation that was treated with embolization. Given IR findings, a Meckel’s scan was performed which was negative. A multi-disciplinary review of the case prompted further review of the patient’s abdominal CT angiogram and a potential finding of MD was seen at the distal ileum. Ultimately, the surgery team decided to take the patient to the operating room where they found and resected a segment of small bowel with tissue examination revealing the MD (Figure 1). Discussion: A Meckel’s scan is often considered the modality of choice for diagnosing MD in children, however, its diagnostic accuracy is considered to be much lower in adults. The typical approach to GI bleeding via upper endoscopy, colonoscopy, capsule endoscopy, CT and procedural angiography may be negative, as seen in our case. Balloon assisted enteroscopy, where available, may also be a potentially useful tool for diagnosing MD. This case highlights the importance of maintaining a broad differential diagnosis for GI bleeding and the challenges with current diagnostic modalities.Figure 1.: Meckel's diverticulum at the level of distal small bowel, approximately 60 cm from the ileocecal valve.

S3488 Symptomatic Meckel’s Diverticulum in an Adult Presenting With Recurrent Gastrointestinal Bleeding

Introduction: Meckel’s diverticulum is a gastrointestinal congenital malformation that results due to persistence of the vitelline duct, and is commonly diagnosed in children before the age of two. Rarely, symptomatic Meckel’s diverticulum can present in adults, as in this case with recurrent gastrointestinal bleeding. Case Description/Methods: A 51-year-old male with a history of iron deficiency anemia presented to the hospital with hematochezia associated with mild epigastric tenderness. He had a similar presentation one year ago with unrevealing EGD, colonoscopy, and video capsule endoscopy. Three months ago, repeat colonoscopy was notable for a single nonbleeding diverticulum in the terminal ileum and outpatient double balloon endoscopy was recommended, however not yet done due to current hospitalization. He presented with tachycardia and hypotension as well as a hemoglobin 10.6g/dL (previously 11.4g/dL few weeks prior) and mildly elevated BUN. CT abdomen and pelvis was negative for any active bleeding. Repeat EGD and colonoscopy was unremarkable except for blood-tinged fluid interspersed in the colon but again the source of bleeding remained obscure. Given the history of a previous finding of a terminal ileum diverticulum and persistence of hematochezia, a Meckel’s scan was performed revealing abnormal uptake in the right mid to lower abdomen suspicious for Meckel’s diverticulum containing ectopic gastric mucosa. Patient was taken to the operation room; a large Meckel’s diverticulum was noted at approximately two feet proximal to the ileo-cecal valve along with hemorrhagic inflammatory changes within the local mesentery. Patient underwent partial small bowel resection and appendectomy with pathology revealing a Meckel’s diverticulum of the ileum with gastric heterotopia. Patient had an uncomplicated recovery postoperatively along with resolution of hematochezia. Discussion: A finding of Meckel’s diverticulum is common in the pediatric population; however, it is a rare diagnosis in adults. This case highlights the importance of considering Meckel’s diverticulum for instances of recurrent gastrointestinal bleeding, especially in patients who are still symptomatic despite an extensive workup. It is also important to notice that Meckel's diverticulum can be missed on video capsule study.