Symptomatic Diverticulum Research Articles

Repair of Kommerell's Diverticulum and Aberrant Subclavian Arteries: Classification of the Five Groups in Declining Frequency and Their Operative Approaches

Repair of Kommerell's Diverticulum and Aberrant Subclavian Arteries: Classification of the Five Groups in Declining Frequency and Their Operative Approaches

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.

Endoscopic laser diverticulotomy in Zenker's diverticulum: experiences with basal wound sealing using a collagen-fibrin patch.

Very few reports investigated techniques of closure of the basal wound area to reduce severe complications like mediastinitis after endoscopic laser diverticulotomy. In this study, we report our experiences after routine use of a collagen-fibrin sealant patch for basal wound covering after laser diverticulotomy in consideration of postoperative complications and recurrence rates. This retrospective study was conducted in a tertiary referral center and university hospital. Endoscopic laser diverticulotomies performed in our hospital between January 2006 and July 2018 were included. After complete transection of the laser septum of the diverticulum, we placed a collagen-fibrin patch onto the basal wound area to cover the opening to the mediastinum. Patient records were evaluated to assess the occurrence of perioperative complications, and the data were compared with those reported in the literature. A total of 127 endoscopic laser diverticulotomies were performed in 109 patients (71 men, 38 women) suffering from Zenker's diverticulum. Morality rate was 0%, in particular no mediastinitis was observed. Mediastinal emphysema was observed in two patients (1.6%), and temporary or persistent recurrent nerve palsy in one patient (0.8%) each. The mean follow-up period was 71.6±5.16months. Recurrent symptomatic diverticulum was observed in 19.3% of the patients. These findings suggest that use of a collagen-fibrin sealant patch in endoscopic laser diverticulotomy may contribute to the safety of endoscopic controlled laser diverticulotomy without comprising the success rates.

453 LAPAROSCOPIC RESECTION OF A GIANT EPIPHRENIC DIVERTICULUM

Abstract Epiphrenic diverticula are acquired mucosal out-pouchings of the distal third of the oesophagus; vastly undiagnosed due to their usual asymptomatic status, with limited number in all published series, and a still ongoing debate both in their surgical indication and technique. This video shows all steps we think that are necessary when operating an epiphrenic diverticulum, in order to illustrate them all and to show the feasibility of performing such operation with minimally invasive procedures. Methods A 52-year-old male was diagnosed of a symptomatic giant epiphrenic diverticulum after previous complaints of dysphagia and regurgitation of undigested food. Preoperative barium-swallow and upper endoscopy confirmed the diagnosis, excluding any other secondary aetiology, and conventional oesophageal manometry did not show any relevant findings. Results Surgery was indicated for symptomatic disease, and a laparoscopic procedure was performed, with pneumoperitoneum created through a Veress needle and trocars placed similar to those used for a hiatal hernia repair. After opening the hiatus, access was granted to the mediastinum and the diverticulum was identified and dissected, and when its neck was completely exposed, diverticulectomy was performed using endostapler loads reinforced with Peri-strips Dry®. Aferwards, both an oesphageal myotomy (from the oesophago-gastric junction to the distal point of the diveticulum’s neck) and a partial Dor fundoplication (despite the absence of relevant findings in the conventional manometry) were performed. Conclusion Surgical management of epiphrenic diverticula should entail both resection of the pouch (diverticulectomy, to avoid postoperative persistent symptoms) and treatment of the underlying motility disorder that has been demonstrated in other studies in nearly 100% of the patients using high-resolution manometry (myotomy and fundoplication, both to avoid recurrences and leakages of the staple line). The laparoscopic approach is feasible without video-assisted thoracoscopy in diverticula with their neck up to 10 cm from the oesophagogastric junction. Video https://www.dropbox.com/s/hugbemgi6wl55kp/EpiphrenicDiverticulumx2.mp4?dl=0

Current possibilities of minimally invasive therapy of oesophageal diverticula.

Oesophageal diverticula represent arelatively rare pathology of the oesophagus requiring aspecific diagnostic and therapeutic approach. Interventional therapy is indicated for symptomatic diverticula, diverticula with other pathologies (tumour in the diverticulum, gastroesophageal reflux disease, low-malignancy gastroesophageal junction tumours).The open surgical approach is being increasingly replaced by minimally invasive surgical, endoscopic and combined methods. Surgical mini-invasive methods use transaxillary, thoracoscopic or transhiatal laparoscopic approach, often with endoscopic assistance. Endoscopic and transoral surgical procedures include various diverticulotomy techniques and submucosal tunnelling techniques (variants of peroral endoscopic myotomy). The primary concern in therapy is the reduction of symptoms, improvement of the quality of life and the patient´ssafety. The resulting quality of life is affected by the frequent presence of functional diseases of the oesophagus (achalasia, hypercontractile oesophagus).Although surgical minimally invasive therapy using the laparoscopic or thoracoscopic approach is safe, it nevertheless does not exclude serious risk of complications. Randomized and observational studies comparing endoscopic and surgical methods are still missing. It is, therefore, necessary to extend the records in order to update the indication algorithm of intervention therapy, focusing mainly on safety with aclear imperative for patient centralization.

Diagnosis and surgical treatment of symptomic stomach diverticulum

Gastric diverticulum is a rather rare disease. This lesion is diagnosed in about 0.01% of cases during contrast-enhanced X-ray examination and in 0.04-0.11% of patients undergoing endoscopic examination. Symptomatic diverticulum is complicated by diverticulitis, bleeding, perforation and malignant transformation. Therefore, surgical resection is indicated. We report surgical treatment of a patient with diverticulum of the cardiac part of the stomach. Endoscopic and X-ray examination was valuable to establish the correct diagnosis. Laparoscopic approach minimized surgical trauma and reduced surgery time.

Clinical Effect of Single-Site Laparoscopy in the Treatment of Meckel's Diverticulum in Children

Purpose: To observe the clinical effect of laparoscopic surgery on Meckel's diverticulum in children with (MD). Method: The clinical data of 20 children were analyzed retrospectively. All children were treated with laparoscopic surgery at single part of the umbilical cord, and the operation, clinical effects and postoperative complications were observed. Result: All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusion: Umbilical laparoscopy is effective in the treatment of pediatric MD with less trauma, simple operation, short operation time and quick recovery after operation. Background Meckel's diverticulum is the most common congenital developmental malformation of the gastrointestinal tract, which is a mesenteric malformation caused by embryonic yolk tube degeneration. The incidence in the population is 2.0%, most patients have no clinical symptoms, occasionally found in autopsy, laparotomy, clinical diagnosis is more difficult. The clinical manifestations of its complications are easy to be confused with other diseases such as intussusception, colonic polyps, necrotizing enteritis and acute appendicitis perforation. Date sources Based on the progress in the treatment of Meckel's diverticulum in children at home and abroad, the clinical data of 20 children with Meckel's diverticulum treated in our hospital were analyzed retrospectively to observe the clinical effect of laparoscopy-assisted operation in the treatment of Meckel's diverticulum in children. Results All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusions Surgical resection is the first choice for symptomatic Meckel diverticulum in children, and laparoscopic surgery is the first choice. The operative method of laparoscopic treatment of Meckel diverticulum in children with single part of umbilical cord has the advantages of less trauma, simple operation, short operation time and quick recovery after operation, and the operative effect is good.

Epiphrenic diverticula: An added source of complexity in achalasia management

Epiphrenic (pulsion) esophageal diverticula can occur in the setting of underlying esophageal motility disorders such as achalasia and present a unique management challenge to the gastroenterologist. Asymptomatic diverticula do not require treatment, but symptomatic diverticula require therapy targeted to the underlying esophageal motility disorder, or else the diverticula will recur. Generally, laparoscopic or combined laparoscopic/thoracoscopic myotomy, diverticulectomy, and anterior fundoplication are required. However, therapeutic options for epiphrenic diverticula are evolving as peroral endoscopic myotomy (POEM) becomes more commonplace. We review two cases of achalasia complicated by epiphrenic diverticula at our institution. In the first case, type II achalasia was identified and the patient underwent laparoscopic myotomy. In the second case, type III achalasia was present and the patient underwent successful POEM. We discuss the presentation, pathophysiology, and management of epiphrenic diverticula as well as the expanding role for POEM in diverticula.

P31 SURGICAL MANAGEMENT OF ACQUIRED TRACHEOESOPHAGEAL FISTULA CAUSED BY ESOPHAGEAL DIVERTICULUM

Abstract Aim To assess the safety and feasibility of surgical treatment for acquired tracheoesophageal fistula caused by esophageal diverticulum. Background & Methods There are rare studies of the treatment for acquired tracheoesophageal fistulas (TEFs) or bronchoesophageal fistulas (BEFs) caused by traction esophageal diverticula. Between Jan. 2014 and Apr. 2019, twelve patients were admitted to our department for TEF/BEF combined with esophageal diverticula. Clinical characteristics of the twelve patients were retrospectively reviewed. Results Among the 12 orifices in the airway side, there were two at the carina, three at the right main bronchus and seven at the right intermediate bronchus. All orifices in the esophagus side opened at the diverticula wall. All TEF/BEFs received surgical treatment. Firstly, the fistula tunnels were dissected easily. Then, interrupted sutures repaired the fistula orifices in the airway membrane. A limited diverticulectomy with the fistula resection was done in the esophagus. Separate layers of repair were performed for the defect in the esophagus. The serratus anterior muscle flap interposition was performed in all 12 cases. There were no postoperative morbidity and mortality. No recurrence fistula and symptomatic diverticula occurred. The airway and esophagus were unobstructed during the follow-up period. Conclusion Acquired TEF/BEFs caused by esophageal diverticula can be treated successfully by surgery. A limitated diverticulectomy is sufficient to ensure esophagus remodeling.

VS02.01: FLEXIBLE ENDOSCOPIC CRICOPHARYNGEAL MYOTOMY WITH THULIUM LASER

Abstract Description Flexible endoscopic treatment of Zenker's diverticulum is feasible, but electrocautery and CO2 laser technology carry the risk of collateral thermal injury. Thulium laser septum incision may overcome this limitation. We describe for the first time the use of thulium laser through flexible endoscopy in a small cohort of patients with Zenker diverticulum. Methods Thulium laser septum division was performed via flexible endoscopy under general anesthesia in 11 consecutive symptomatic patients with primary or recurrent Zenker diverticulum. Primary study aims were feasibility and safety of the procedure. To improve exposure and stabilize the septum during the procedure, either a transparent cap or a bivalve soft overtube were used. The laser system used was Opera® (Quanta System SpA, Varese, Italy), emitting a 1.9 μm Thulium wavelength radiation. A continuous laser configuration and an emission power of 5 to 16 W were chosen to allow incision of the mucosa and cricopharyngeal myotomy. Using 272 and 365 μm optical fibres in a non-contact mode, laser incision was performed in the midline of the septum until cricopharyngeal muscle fibers were encountered and a V-shaped myotomy was completed under visual control. Results Between May and January 2018, 11 consecutive patients were treated. Four patients presented with recurrent symptomatic diverticulum after previous transoral septum stapling or endoscopic myotomy. Median dysphagia and regurgitation scores were 4.1 ± 0.7 and 3.3 ± 0.8 respectively. Complete division of the septum was achieved in all patients. There was no bleeding nor need of adjunctive electrocautery devices to complete the procedure. The post-operative course was uneventful in all patients; the chest film and gastrographin swallow study on post-operative day one were negative for pneumomediastinum or leaks. All patients were discharged within 48 hours on a soft diet. At the 2-month follow-up visit, all patients were satisfied with the procedure with a post-operative dysphagia score of 2.0 ± 0.6 and a regurgitation score of 1.5 ± 0.4. Conclusions Division of Zenker's septum with Thulium laser is feasible and safe through flexible endoscopy. Longer term follow-up is required to establish effectiveness and reproducibility of this novel procedure. Disclosure All authors have declared no conflicts of interest.

Cricopharyngeal myotomy with thulium laser through flexible endoscopy: proof-of-concept study.

Background and study aims Endoscopic treatment of Zenker’s diverticulum has proven feasible, but electrocautery and CO 2 laser technology carry the risk of collateral thermal injury. Thulium laser septum incision may overcome this limitation. We describe for the first time the use of thulium laser through flexible endoscopy in a small cohort of patients with Zenker diverticulum. Patients and methods Thulium laser septum division was performed via flexible endoscopy under general anesthesia in consecutive symptomatic patients with primary or recurrent Zenker diverticulum. Primary study outcomes were feasibility and safety of the procedure. A 1.9-μm laser fiber was used with an emission power of 10 – 16 W. Results Five patients were treated between May and June 2017. Two patients presented with recurrent symptomatic diverticulum after previous transoral septum stapling. Complete division of the septum was achieved in all patients. There was no bleeding nor need of adjunctive electrocautery devices to complete the procedure. The postoperative course was uneventful in all patients; the chest film and gastrographin swallow study on postoperative Day 1 were negative for pneumomediastinum, leaks or residual pouch. All patients were discharged within 48 hours on a soft diet. At the 1- and 3-month follow-up visits, all patients were satisfied with the procedure and reported improved swallowing and absence of regurgitation and cough. Conclusions Division of Zenker’s septum with thulium laser is feasible and safe through flexible endoscopy. Longer-term follow-up is required to establish efficacy and effectiveness of this novel procedure.

Recurrent Branchial Cleft Cyst with Symptomatic Cervical Oesophageal Diverticulum in Adult -An Interesting Presentation of Incomplete Branchial Cleft Cyst Excision

Recurrent Branchial Cleft Cyst with Symptomatic Cervical Oesophageal Diverticulum in Adult -An Interesting Presentation of Incomplete Branchial Cleft Cyst Excision

Naujas perforavusio dvylikapirštės žarnos divertikulo gydymas atliekant Roux-en-Y duodenojejunostomiją

Dvylikapirštės žarnos divertikulai yra dažniausia divertikuliozės vieta plonojoje žarnoje. Nuo 1 % iki 5 % tokių divertikulų yra simptominiai ir pasireiškia skausmu, kraujavimu, uždegimu, cholestaze, cholangitu, obstrukcija, perforacija, pankreatitu ar piktybine transformacija. Pati sudėtingiausia komplikacija yra perforacija, kuri sudaro 0,03 %. Diagnozavus dvylikapirštės žarnos divertikulo perforaciją, tradicinis gydymas buvo paprasta divertikulektomija ir dvylikapirštės žarnos užsiuvimas dviem sluoksniais su retroperitoninio tarpo drenavimu. Pastaruoju metu aprašoma vis daugiau sėkmingų konservatyvaus ir kitokio chirurginio gydymo atvejų. Mes aprašome savo patirtį, susijusią su dvylikapirštės žarnos divertikulito gydymu atliekant Roux-en-Y duodenojejunostomiją Shigeru Fujisaki metodu po nesėkmingo konservatyvaus gydymo.

Urethral diverticulectomy with Martius labial fat pad interposition improves symptom resolution and reduces recurrence.

To assess the presenting features and medium-term symptomatic outcomes in women having excision of urethral diverticulum with Martius labial fat pad (MLFP) interposition. We reviewed our prospective database of all female patients having excision of a symptomatic urethral diverticulum between 2007 and 2015. Data on demographics, presenting symptoms and clinical features were collected, as well as postoperative outcomes. In all, 70 women with a mean (range) age of 46.5 (24-77) years underwent excision of urethral diverticulum with MLFP interposition. The commonest presenting symptoms were a urethral mass (69%), urethral pain (61%), and dysuria (57%). Pre-existing stress urinary incontinence (SUI) was present in 41% (29) of the women. After surgery, at a mean (SD) of 18.9 (16.4) months follow-up (median 14 months), complete excision of urethral diverticulum was achieved in all the women, with resolution of urethral mass, dysuria and dyspareunia in all, and urethral pain in 81%. Immediately after surgery, 10 (24%) patients reported de novo SUI, which resolved with time and pelvic floor muscle training such that at 12 months only five (12%) reported continued SUI. There was one symptomatic diverticulum recurrence (1.4%). The commonest presenting symptom of a female urethral diverticulum is urethral pain followed by dysuria and dyspareunia. Surgical excision with MLFP interposition results in complete resolution of symptoms in most women. The incidence of persistent de novo SUI in an expert high-volume centre is 12%.

MR enterography for the diagnosis of symptomatic Meckel diverticulum in pediatric patients

Objective To retrospectively investigate the value of MR enterography(MRE) for detecting symptomatic Meckel diverticulum(MD) in pediatric patients. Methods We retrospectively selected 16 patients from our MR database patients who underwent MRE between June 2014 and September 2015. They were referred for MRE because of suspected MD after negative or inconclusive upper sonography or scintigraphy or for exclusion diagnosis. There were 13 males and 3 females, with a median age of 2.2 years of age ranging from 0.4 to 8.2 years old. The first symptom included unexplained gastrointestinal bleeding, abdominal pain, small-bowel obstruction, intussusception, vomiting and fever. Two experienced radiologists determined the diverticulum's location, shape, contents and peripheral structural abnormalities. Results MD were diagnosed by MRE in all children. A total of 13 MD and 3 intestinal duplication cysts were pathologically confirmed. The diverticulum's location included: the right lower quadrant in 2 cases, around the navel in 4 cases, the left lower quadrant in 4 cases, the middle quadrant in 2 cases and pelvic cavity in 1 case. The diverticulum's presented as a blind-ending fluid-filled or gas-filled structure in 11 cases and a solid-appearing mass in 2 cases. The wall of the diverticulum showed restricted diffusion, increased mural enhancement comparable with that of adjacent small bowel in 12 cases, and interruption of the wall continuity in 1 case. Hemorrhage in diverticulum appeared as hyperintensity on T1WI images and/or hypointensity on T2WI images in 2 cases. Extravasation of intravascular contrast medium into the gastrointestinal tract due to active bleeding from a Meckel diverticulum was detected in 2 cases. Peripheral structural abnormalities included soft-tissue stranding, adjacent mesenteric stranding and enhancement, free fluid, small-bowel obstruction and enlarged lymph nodes. Conclusion MRE may play an important role in the diagnosis of suspected symptomatic Meckel diverticula, particularly given its lack of ionizing radiation. Key words: Meckel diverticulum; Child; Magnetic resonance imaging

916 Two Staged Endoscopic Approach for the Management of a Large Symptomatic Epiphrenic Diverticulum in the Setting of Achalasia

916 Two Staged Endoscopic Approach for the Management of a Large Symptomatic Epiphrenic Diverticulum in the Setting of Achalasia

Simultaneous Transvesical Laparoendoscopic Single-Port Diverticulectomy and Cystolithotripsy

Introduction: Transvesical laparoendoscopic single-site surgery (T-LESS) is a novel minimally invasive approach that has been introduced to decrease the morbidity related to laparoscopic multiport placement and to improve cosmetic results. This technique was first used for foreign body removal from the bladder.1 We previously described a practical application of this method for bladder diverticulectomy.2 A potentially significant role of T-LESS has been noticed by other investigators.3 We present a video of the use of this approach for simultaneous bladder diverticulectomy and cystolithotripsy.4 Materials and Methods: A total of 10 patients underwent the T-LESS diverticulectomies. In two patients, additional procedures (ureteral reimplantation or cystolithotripsy) were carried out simultaneously, using the same access. In this video, we present the T-LESS diverticulectomy and cystolithotripsy in a 58-year-old male patient found to have a symptomatic diverticulum and intradiverticular multiple calculi, up to 2 cm in diameter. The following operative steps were employed: (1) introduction of the TriPort+ (Olympus) into the bladder; (2) establishing the pneumovesicum; (3) removal of the calculi either intact or after cystolithotripsy with the lithoclast probe; (4) dissection of the diverticulum with standard laparoscopic instruments; and (5) closure of the bladder wall defect with the V-Loc suture. An 18F Foley catheter was placed in the bladder for 7 days. Results: The procedure was completed effectively, without blood loss or any complications. No extra port was added. The operative time was 115 minutes, and the hospital stay was 2 days. In a 6-month follow-up, no bladder diverticulum or stones were observed, and the patient confirmed a significant reduction in preoperative symptoms. Conclusion: The T-LESS technique for the simultaneous removal of the bladder diverticulum and stones is a feasible and safe procedure. This combination of already existing techniques can be a valuable method for the treatment of more complex pathologies of the lower urinary tract. Nevertheless, further development of applicable instruments is needed. The authors have nothing to disclose. Runtime of video: 7 mins 48 secs

MP71-18 LOW-VOLUME PROSTATE IN BENIGN PROSTATIC HYPERPLASIA (BPH): A RISK FACTOR FOR SYMPTOMATIC BLADDER DIVERTICULA REQUIRING SURGICAL TREATMENT

INTRODUCTION AND OBJECTIVES: to evaluate the association between prostate volume, age, and occurrence of bladder diverticula requiring surgical treatment on patients with symptomatic BPH. METHODS: we performed a retrospective search on our prospectively collected database searching for patients with BPH managed surgically between Jan/10 and Oct/14. Analyzed data comprised age at, prostatic volume measured on abdominal ultrasound, type of prostatic surgery, and presence of bladder diverticula requiring surgical treatment ( 3cm and/or symptomatic). Patients were divided in regards to diverticula requiring surgical treatment. Groups were compared using Student T test and Chi-square/Fisher exact test. Logistic regression was performed to seek for associations between the presence of the symptomatic diverticula and preoperative parameters. Significance was set at p<0.05. RESULTS: A total of 1532 patients were surgically treated for BPH in the analyzed period and 41 (2.6%) had symptomatic bladder diverticula. Mean diverticula size was 6.8 2.9cm and mean number of diverticula per patient was 1.5 0.8 (1-5). Treatment of the diverticula was performed laparoscopically in 13 (31.8%) patients, by endoscopic incision in 14 (34.1%), and by open resection in 14 cases (34.1%). Patients with treated diverticula did not differ from the other cohort in regards to age (66.9 8.3 vs. 68.5 8.8 years, respectively; p1⁄40.16) and surgical technique (p1⁄40.11). Mean prostate volume was significantly lower in the treated diverticula group (53.6 45.0 vs. 80.7 51.9g, respectively; p<0.01). Prostate volume and age distributions among patients with and without diverticula are depicted in figures 1A and B. Logistic regression revealed only prostate volume to significantly impact the presence of symptomatic diverticula requiring surgical treatment (OR1⁄4-0.03; 95% CI 0.955 e 0.988; p1⁄40.01). Roc curve analysis revealed a significant association with an AUC of 0.73 (p<0.001)(fig.1c). CONCLUSIONS: In patients with BPH, there is a significant association between prostate volume and risk of symptomatic bladder diverticulum. Bladder diverticula requiring surgical treatment are more common in patients with low prostate volume.

English

Meckel&rsquo;s diverticulum occurs around the fifth to seventh week of the embryological development. It originates when the vitelline or omphalomesenteric duct which normally connects the primitive gut to the yolk sac fails to obliterate. Meckel&rsquo;s diverticulum may be symptomatic or remain silent throughout life time and incidentally discovered at autopsy. Symptoms primarily emanates from an array of complications which may include diverticulitis, haemorrhage, obstruction and intussusceptions. Diverticulitis predominately affects adults and remains exceedingly rare in infancy. However, Meckel&rsquo;s diverticulitis clinical symptoms are non-specific and frequently resemble other common acute surgical and inflammatory conditions of the abdomen. The infrequency and varied symptomatology make clear-cut pre-operative diagnosis of diverticulitis extremely challenging. We hereby, report a case of a six month old infant with acute diverticulitis who present with brief history of vomiting, abdominal distension and fever. Basically, our report is aimed at forewarning clinicians to consider meckel&rsquo;s diverticulitis as a differential diagnosis when assessing children present with acute abdominal pathologies. &nbsp; Key words: Meckel&rsquo;s diverticulum, diverticulitis, acute appendicitis, infants, children, asymptomatic diverticulum, symptomatic diverticulum, diagnosis, surgical resection.

Colitis Ulcerosa together with Meckel's diverticulum causing severe haemorrhage in children

Meckel diverticulum is a vertigal remnant of the omphalomesenteric(vitellointestinal) duct.As a congenitaly anomaly it is a true diverticulum,ranger from 1 – 12 cm in a lenghtand it found 45 – 90 cm proximal to the ileocecal valve.It is frequently heterotopic tissue(gastric mucosa accounts for 50%),occurs in about 2% of the general population.The cause of bleeding is mucosal ulceration,because the ectopic gastric mucosa produces hydrocholic acid.The male or female ratio of patients with symptomatic diverticulum is 3:1.The association between bleeding Meckel's diverticulum and bleeding ulcerative colitis is unknown in a hungarian pediatric literature.We describe the case of a 9 years old boy presented nausea,intermittal abdominal pain and rectal bleeding.He has not been earlier any illness.Total colonoscopy was done with biopsy. We diagnosed ulcerative colitis,the histological examination showed the presence of inflammation colonic mucosa (crypta abscess,signs of severe colitis).He had been transmitted in the intensive care unit with recurrence rectal bleeding.He received transfusion because of severe anaemia. Abdominal reultrasound examination was negativ.99mTc pertechnetate didn't localized bleeding place in the abdominal tract.After 5 days the new rectal bleeding indicated explorative laparatomy suspected Meckel's diverticulum despite of negative scintigraphy.Meanwhile of laparatomy we diagnosed Meckel's. diverticulum(10 cm lenght,45 cm from the ileocecal valve).The histology found ectopic gastric mucosa int he diverticulum.The diverticulum resection,appendectomy were made.The ulcerative colitis has been treated with medicament.The control blood test is negativ.He was descharged after 10 days laparatomy.The correct value of signs and new signs is very importent indicating conservative treatment or surgical intervention.