Perforated Meckel's Diverticulum Research Articles

Perforation of Meckel’s diverticulum complicated with suspected acute appendicitis successfully treated by laparoscopic surgery

Some diseases have clinical symptoms similar to acute appendicitis, making preoperative diagnosis difficult, including Meckel’s diverticulum. We report a case with a preoperative diagnosis of suspected acute appendicitis, but a perforated Meckel diverticulum caused by a bamboo toothpick was discovered intraoperatively. A male patient, 32 years old, was admitted to the hospital for right iliac fossa pain 1 day before admission. Preoperative diagnosis of suspected acute appendicitis, emergency surgery indicated. During surgery, the appendix has no inflammation. Examining the entire abdomen, the ileum was found 50 cm from the ileocecal valve with a Meckel’s diverticulum perforated by a bamboo toothpick. The patient was successfully treated with laparoscopic surgery. Perforation of Meckel’s diverticulum is a rare complication. Preoperative diagnosing complications of Meckel’s diverticulum is challenging, especially in children. Most imaging investigations are unrecognizable, requiring laparoscopic exploration. Laparoscopic surgery is the preferred method of treatment. Taking a history of ingesting foreign bodies or having a habit of using toothpicks helps identify risk factors. During surgery, it is necessary to carefully examine the abdominal organs, especially when damage to the appendix is disproportionate to clinical symptoms.

Meckel’s diverticulum mimicking acute appendicitis in children: a retrospective cohort study

BackgroundThe aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children.Materials and methodsWe retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel’s diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded.ResultsA total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1–13 years). Perforated Meckel’s diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix.ConclusionsThe most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.

A Perforated Meckel's Diverticulum Simulating Appendicular Peritonitis : Case report

Meckel's diverticulum results from the partial persistence of the omphalomesenteric duct and its complications are rare. Diagnosis is often made intraoperatively. We present the case of a 46-year-old patient admitted to the emergency ward with symptoms suggestive of peritonitis. Clinical examination revealed tenderness in the right iliac fossa. Abdominal and pelvic ultrasound revealed a swollen appendix located laterocecally, measuring 9.2 mm in maximum thickness, with an associated oval collection containing finely echogenic contents measuring 32 × 14 mm, without evidence of effusion.During surgery, a perforated Meckel's diverticulum was discovered as the cause of the peritonitis. The patient underwent segmental bowel resection with ileostomy formation. Postoperative recovery was uneventful, and the patient was discharged on the third postoperative day. Anatomopathological examination of the surgical specimen showed inflammatory changes without signs of malignancy. One month after the operation, the patient underwent ileal continuity restoration.

Abdominal Peritonitis Secondary to a Perforated Meckel's Diverticulum: Case Report and Literature Review

Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. This is a true diverticulum as it contains all the layers of the intestinal wall. It is usually asymptomatic and discovered as an incidental finding during surgery for another cause. In adults, its complication is rare and clinically indistinguishable from an appendiceal condition. It has a risk of complications ranging from 2 to 40%, the most frequent being gastrointestinal bleeding, intestinal obstruction and acute abdomen (diverticulitis or diverticular perforation). We present the clinical case of a 21-year-old male with an initial diagnosis of perforated appendicitis who, upon undergoing exploratory laparoscopy, found diffuse peritonitis secondary to Meckel's diverticulum perforation. This patient underwent laparoscopic surgery for intestinal resection of the segment where the diverticulum was located and an end-to-end enteroanastomosis coupled with an appendectomy, due to presenting intense abdominal pain, cramping/oppressive in the lower hemiabdomen, evidence of peritoneal irritation, alteration of the formula white in laboratory studies and findings suggestive of appendicitis and perforation in the abdominal cavity in imaging studies. Therefore, it is concluded that in cases of acute abdomen, the differential diagnosis of Meckel's diverticulum should be taken into account in those patients who present symptoms related to its complications

Necrotizing fasciitis complicating perforated Meckel's diverticulum in a patient with acute lymphoblastic leukemia relapse

The occurrence of necrotizing fasciitis in children with acute lymphoblastic leukemia (ALL) has been reported with malignancies during granulocytopenic episodes from chemotherapy. Perforation of Meckel's diverticulum in children with leukemia is very rare. Only one case has been reported in the literature till now. A 10-year-old male presented with acute abdomen and was diagnosed with perforation peritonitis due to a perforated Meckel diverticulum receiving chemotherapy for relapse of B-cell ALL. In addition, the patient was a known case of celiac disease. Intraoperatively, due to the hemodynamic instability and thrombocytopenia, it was decided to perform a resection of the ileum bearing the pathology with a double-barrel ileostomy. He developed necrotizing fasciitis of the anterior abdominal wall due to Group A streptococci and overwhelming Gram-positive sepsis. The patient was managed comprehensively with multiple platelets concentrates, fasciotomy of the abdominal wall, and multiple debridements under the cover of broad-spectrum antibiotics. Histopathology of the resected Meckel's diverticulum showed ectopic gastric mucosa. Two months later, split-thickness skin grafting was performed. Early diagnosis and prompt surgical management may prevent mortality associated with both the delayed presentation of bowel perforation and necrotizing fasciitis in ALL patients.

Perforated Meckel's diverticulum

Acute abdominal pain with fever is a common presentation in the pediatric age group with a wide variety of differential diagnoses. We report a 9 year-old girl with abdominal pain, nausea, diarrhea and fever with exam findings of generalized abdominal tenderness. Her initial evaluation and imaging studies did not reveal the cause of her abdominal pain. Her worsening symptoms and change in physical examination prompted appropriate additional diagnostic workup which revealed a perforated Meckel's diverticulum with peritonitis as the etiology of her symptoms.

Perforated Meckel Diverticulum

Perforated Meckel Diverticulum

Perforated Meckel\u2019s diverticulum in neonates: a report of six cases and systematic review of the literature

BackgroundPerforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms “Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum.” All reports of perforated MD in the English literature were identified. Details of our 6 cases were analyzed in similar fashion.ResultsA total of 3027 manuscripts were screened and 59 cases including 6 of our own were identified. The vast majority (78%) were female. Fifty patients (84.7%) presented in the newborn period. Half of the cases (52.5%) had associated anomalies and 13 neonates (22%) required oxygen supplementation including CPAP or ventilatory support before surgery. In 73% of the cases, a resection of gut was undertaken. Histopathological assessment in 44 cases (74.6%) revealed no ectopic gastric mucosa. Three cases demised prior to treatment. The outcome in the vast majority was excellent with 84.7% surviving and discharged well.ConclusionPerforated MD is an unusual cause of a pneumoperitoneum in the newborns. Diagnosis is established at laparotomy and it rare to find ectopic mucosa histopathologically. The overall outcome is excellent.

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.

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.

Ruptured Meckel's diverticulum coexisting with a duplex appendix

Duplicate appendix is a rare anatomic variation of the vermiform appendix with an incidence rate of 0.004–0.009 %. A Meckel's diverticulum (MD) is a common congenital anomaly resulting from the persistence of the omphalomesenteric duct. It may present as lower gastrointestinal hemorrhage, intestinal obstruction, or inflammation. The co-existence of a MD and duplex appendix is rare and our literture search revealed only 2 previous reports. The objective of this article is to report a co-existing duplex appendix and symptomatic MD in a child, review the literature, and illustrate the challenges with the diagnostic process in a resource-limited setting. We present a 3-year-old male who was referred to our facility following a successful reduction of an incarcerated umbilical hernia at a peripheral facility. He presented 5 days later with signs of peritonitis and was optimized for surgery. Laparotomy was performed which revealed perforated MD with minimal peritoneal soiling. He also had an incidental duplex appendix consistent with Cave-Wallbridge type B1 and a 2 × 2cm umbilical defect. Segmental resection of the MD, double appendectomies, and peritoneal lavage was performed. A co-existing duplex appendix with MD is extremely rare. Complications of MD are challenging to diagnose. A duplex appendix has clinical and medicolegal implications. Surgeons should explore the cecum during appendectomy to avoid missed diagnosis.

Systematic review of Meckel's diverticulum in pregnancy.

Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future. The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed. Twenty-seven cases were included. Average age=26.9 years. Average gestation=25.1 weeks. Occurrence: first trimester=3.7%; second trimester=48.1% and third trimester=48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms=3.4 days. Diagnostic imaging modalities utilised: ultrasound=40.7%; CT=25.9%; MRI=14.8%; abdominal X-ray=11.1% and endoscopy=7.4%. All cases required definite surgical management: laparotomy=65.4%; laparoscopy=15.4%; C-section=19.2% and unreported=3.8%. Main intra-operative findings: perforated MD=40.7%; intussusception with MD as a lead point=11.1%; bleeding MD=11.1%, inflamed MD=11.1%; small bowel obstruction=11.1%; gangrenous MD=3.7%; volvulus=3.7% and unspecified=7.4%. Mean length from ileocolic junction=51.7cm. Average length of stay was 7.1 days. T-test (p-value=0.12) when comparing management strategy. Three maternal complications and two foetal mortalities. MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.

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.

Meckel's diverticulum perforation by a wooden toothpick in a child: A case report

Abstract Perforation of Meckel's diverticulum (MD) by ingested foreign body (FB) is an extremely uncommon cause of acute abdomen in children. We report on a 13-year-old boy who presented with right iliac fossa pain associated with anorexia, tenderness, guarding and rebound tenderness. Abdominal ultrasound showed findings of acute appendicitis. However, laparoscopy revealed a wooden toothpick perforating MD and a hyperemic appendix. The FB was removed and laparoscopic diverticulectomy and appendectomy performed. Perforation of MD by a FB is a diagnostic challenge and it should be included in the differential diagnosis of acute abdomen in children.

Ingested foreign bodies in children: Do they really pass spontaneously from the gastrointestinal tract? A single-centre experience with 1000 cases.

Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (1), Meckel's diverticulum perforation (1), and perforation due to rigid endoscopy (1). We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.

Meckel's Diverticulum Perforation Due to Strangulated Inguinal Hernia (Littre's Hernia): A Rare Case

Meckel's Diverticulum Perforation Due to Strangulated Inguinal Hernia (Littre's Hernia): A Rare Case

Perforated Meckel's diverticulum in a neonate

Meckel's diverticulum (MD) is a true diverticulum in the small intestine due to an incomplete obliteration of the vitelline duct. It is commonly located within two feet from the ileocecal valve and occurs in approximately two percent of the population before the age of two years. Meckel's diverticulum is often clinically silent but when symptomatic (4%), it could present with gastrointestinal bleeding, bowel obstruction, perforation or diverticulitis. A 1900g male infant was born at 31 weeks and six days. He was placed on CPAP for poor respiratory effort, and was transported to our intensive care unit immediately after delivery. By day of life three, he had failed to pass meconium and developed signs of intestinal perforation prompting surgical exploration. A perforated Meckel's diverticulum was discovered and he underwent a small bowel resection with primary anastomosis. Histopathology study of resected bowel showed a small intestine with focal mural necrosis and perforation, and marked serositis with abundant acute on chronic inflammation. We present a case of a neonatal symptomatic MD in a preterm infant with failure to pass meconium without obstruction on imaging, and an extensive literature review on this topic in the last 40 years. The literature review and our case show that it can be safe to perform primary anastomosis after resection for perforated MD in the neonatal population, even in those of low birth weight.

Multifaceted behavior of Meckel's diverticulum in children.

Meckel's diverticulum (MD) is one of the most common congenital malformations of gastrointestinal tract in children. However, the nonspecific clinical manifestations of MD often cause a diagnostic as well as therapeutic challenge to pediatric surgeon. This study aimed to review our experience in managing this disease while evaluating the management strategies. We retrospectively analyzed the clinical data of all patients diagnosed with MD admitted to our center between January 2010 and December 2015. Factors documented including demographic criteria, clinical manifestations, preoperative examinations, surgical methods, histopathological characteristics, postoperative complications, and outcomes. The patients included 210 males and 76 females, aged from 1day to 15years. In fifty three patients, the MD was an incidental finding at laparotomy or laparoscopy. The remaining 233 patients were symptomatic and presented with various clinical features. Ninety nine patients presented with episodes of bleeding per rectum or melena. Fifty six patients demonstrated symptoms of diverticulitis or perforated MD. Forty patients were diagnosed as intestinal obstruction, and 35 patients with intussusception requiring surgical reduction. Two cases of Littre hernia and one case of foreign body trapped in MD were also observed in this group. Six patients misdiagnosed as appendicitis at another institution were reoperated in our department. Among the 99 patients with bleeding per rectum, 78 underwent a Tc-99m scan that showed a positive tracer in 55 patients and negative in 23. All patients underwent resection of the diverticulum, except for 2 cases of postponed resection. Histology revealed ectopic gastric mucosa or ectopic pancreatic tissue in 154 patients; significant differences were observed between the symptomatic group and the accidentally found group. One patient died of peritonitis and sepsis postoperatively; one case of anastomotic leak and one case of adhesive intestinal obstruction were reoperated. Meckel's diverticulum has various clinical presentations and it is difficult to make a precise diagnosis preoperatively. It is necessary to maintain a high suspicion of MD in the pediatric age group with symptoms of abdominal pain, gastrointestinal hemorrhage or intestinal obstruction. Heterotopic tissue is the main cause of complicated diverticulum, and it is safe and feasible to remove the incidentally found MD. Laparoscopy should become the first choice of methods in diagnosis and treatment of MD. Treatment study. Level IV.

Clinical characteristics of Meckel diverticulum in children: A retrospective review of a 15-year single-center experience.

Meckel diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract in children. The aim of this study was to review and analyze clinical data on the diagnosis and management of Meckel diverticulum in pediatric patients. The records of 102 pediatric patients (<14 years old) who underwent surgery for Meckel diverticulum at our institute between 2001 and 2015 were reviewed. Clinical, imaging, laboratory, surgical, and pathological data were recorded. The series comprised 65 males and 37 females with a median age of 5.6 years. Lower gastrointestinal bleeding was the most frequently identified clinical manifestation of Meckel diverticulum, and this manifestation was observed in 41 patients. Intussusception secondary to Meckel diverticulum was identified in 32 patients. Twelve patients presented clinical features of peritonitis; of these patients, 8 had perforated Meckel diverticulum and 4 had Meckel diverticulitis. In 10 patients, Meckel diverticulum was incidentally diagnosed during other surgeries, including appendectomy and neonatal enterostomy. Seven patients were diagnosed with intestinal obstruction. Technetium-99m pertechnetate imaging offered high diagnostic yield. Open surgery was performed on 59 patients, while a laparoscopic approach was employed in 35 patients. The remaining 8 patients did not undergo resection of the Meckel diverticulum. Histology revealed ectopic gastric mucosa in 42 patients (44.7%), ectopic pancreatic tissue in 35 patients (37.2%), mucosa of the small intestine in 15 patients (16.0%), and both gastric and pancreatic ectopic tissue in 2 patients (2.1%). All patients recovered uneventfully except 2 patients in whom an intestinal adhesion obstruction was identified after discharge. Meckel diverticulum had various clinical manifestations in children. Technetium-99m pertechnetate imaging may be useful for diagnosing Meckel diverticulum. Surgical excision of the Meckel diverticulum may be safe and effective in symptomatic patients, and relatively better outcomes can be achieved using this approach.

Perforated Gastrointestinal Stromal Tumor of the Meckel’s Diverticulum: a Case Report and Review of Literature

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the GI tract, they have a wide spectrum of clinical manifestations, and a small proportion of them present as an acute abdomen due to obstruction, perforation, or hemoperitoneum. We present a case of a perforated GIST of the Meckel's diverticulum and review the current literature on perforated GISTs. We ran a search on Pubmed and Google Scholar with the following terms "perforated GIST," "perforated Meckel's diverticulum," "GIST with peritonitis," and "GIST in Meckel's diverticulum." After selecting the relevant articles, we tabulated our results and analyzed the data. Out of the 45 cases, 32 (71.1%) were male and 13 (28.8%) were female. Out of the 45 reported cases, 41 (91.1%) were from the small intestine, 2 (4.44%) cases from the stomach, and 2 (4.44%) from the small bowel. In 15 (33.33%) cases, the site of perforation was the Meckel's diverticulum (MD). Forty-year-old male, presented with features of peritonitis localized to the right iliac fossa, was diagnosed as acute appendicitis and subjected to a diagnostic laparoscopy. Intraoperatively, a perforated Meckel's diverticulum was found, which on histopathological examination contained a low-grade GIST. Our literature search revealed that in reported cases of perforated GISTs, there is a slight male preponderance. Small bowel appears to be the most common site for a perforated GIST, and a significant proportion (30.23%) arise from the Meckel's diverticulum. And most importantly, the commonest tumor to cause perforation of a Meckel's diverticulum is a GIST.