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Journal of Medical Case Reports May 2021Inverted Meckel's diverticulum refers to the condition in which the diverticulum inverts on itself. The reasons for such an inversion are poorly understood due to the...
BACKGROUND
Inverted Meckel's diverticulum refers to the condition in which the diverticulum inverts on itself. The reasons for such an inversion are poorly understood due to the rarity of the condition. We present a case of inverted Meckel's diverticulum, an uncommon finding, as a cause of recurrent intussusception.
CASE PRESENTATION
A 30-year old Indian woman presented with complaints of pain in the central abdomen for 3 days, accompanied with vomiting and loose stools. Computed tomography images were suggestive of intussusception with intestinal obstruction. Intra-operative findings were suggestive of an intussuscepted segment of ileum measuring 10 cm in length, proximal to ileocecal junction. Ileo-ileal anastomosis was performed after appropriate resection. Upon opening the specimen, we were surprised to find an inverted Meckel diverticulum with lipoma at one end causing the intussusception. The patient made an uneventful recovery and was discharged after 5 days.
CONCLUSION
The reasons for inversion include abnormal peristalsis around the diverticulum and non-fixity of the diverticulum itself. The inverted diverticulum itself can cause luminal compromise and acts as a lead point for intussusception leading to obstruction. Computed tomography remains the diagnostic tool of choice for identifying intestinal obstruction and intussusception. Although pathological signs, such as lipoma, can be identified, the identification of any inversion will require a proficient radiologist. Inverted Meckel's diverticulum is a rare condition which is difficult to diagnose preoperatively. Treatment is surgical, whether diagnosed pre-operatively or intra-operatively, and includes segmental resection and anastomosis. This uncommon condition should be noted as one-off differential diagnosis for intussusception and intestinal obstruction.
Topics: Adult; Anastomosis, Surgical; Female; Humans; Ileum; Intestinal Obstruction; Intussusception; Meckel Diverticulum
PubMed: 34020701
DOI: 10.1186/s13256-021-02736-2 -
Abdominal Radiology (New York) Feb 2023The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal... (Review)
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.
Topics: Humans; Adult; Child; Ileum; Diagnostic Imaging; Meckel Diverticulum; Intestinal Obstruction
PubMed: 36401130
DOI: 10.1007/s00261-022-03739-3 -
JSLS : Journal of the Society of... 2014Meckel diverticulum (MD) is the most common congenital gastrointestinal malformation found in approximately 2% of the general population. MD manifests in adults as... (Review)
Review
BACKGROUND
Meckel diverticulum (MD) is the most common congenital gastrointestinal malformation found in approximately 2% of the general population. MD manifests in adults as gastrointestinal bleeding, bowel obstruction, intussusception, or perforation in <5% of cases. There is no consensus on the ideal management strategy in symptomatic MD. Therefore, we searched the literature to highlight the role of laparoscopy in diagnosing and treating symptomatic MD.
METHOD
We used PubMed, Medline, Google Scholar, Ovid, and Cochrane data search engines looking for articles containing terms such as Meckel diverticulum, ectopic gastric mucosa, laparoscopic, technetium 99m pertechnetate, and acute management. We included articles reporting on case series in the English language on adult patients only and reporting on laparoscopic approach in the management of symptomatic MD.
RESULTS
A total of 5 articles reporting on 35 cases were found. We report on the pooled data from these series with emphasis on number of patients, age, male to female ratio, length of stay, conversion to open procedure, method of resection, complications, first presentation, and confirmation of diagnosis preoperatively. We also compare the results of laparoscopic versus open approaches mentioned in the literature.
CONCLUSIONS
The laparoscopic approach was found to be effective as a diagnostic and therapeutic modality in patients with symptomatic MD; however, its adoption as the gold standard still needs further studies with larger patient numbers.
Topics: Adult; Humans; Intestinal Obstruction; Laparoscopy; Meckel Diverticulum
PubMed: 25489221
DOI: 10.4293/JSLS.2014.00349 -
Andes Pediatrica : Revista Chilena de... Feb 2021Meckel's diverticulum (MD) is the remnant of the vitelline duct (VD) also called omphalomesente ric duct and it is considered the most frequent gastrointestinal...
INTRODUCTION
Meckel's diverticulum (MD) is the remnant of the vitelline duct (VD) also called omphalomesente ric duct and it is considered the most frequent gastrointestinal malformation. Most of the cases are asymptomatic and the diagnosis of this type is always a challenge.
OBJECTIVE
To describe 3 sympto matic presentations of MD and to discuss its symptoms, signs, and possible diagnostic-therapeutic tools.
CLINICAL CASES
Case 1: A six-month-old patient with obstructive bowel syndrome. In explo ratory laparotomy, an MD was identified with a mesodiverticular band causing an internal hernia. Case 2: A three-year-old patient presenting with digestive hemorrhage and severe anemia requiring blood transfusion. Upper gastrointestinal endoscopy did not show bleeding origin. Due to persis tent melena, the patient required a new blood transfusion. An Abdomen/pelvis tomography scan was performed, showing a suspicious image of MD which was confirmed by laparotomy. Case 3: A newborn with prenatal anencephaly and omphalocele diagnosis. In immediate care of the newborn, meconium evacuation from the umbilical defect was noticed. It was managed as ruptured omphalo cele, installing a bowel silo bag. In primary closure, the permeability of the omphalomesenteric duct was confirmed. An intestinal en bloc resection and anastomosis were performed in all 3 cases. The last one developed an anastomosis leakage resulting in a terminal ileostomy.
CONCLUSION
MD, frequently asymptomatic, is often overlooked as a differential diagnosis of abdominal emergencies in children. When suspecting DM with gastric ectopic mucosa, Tc-99m pertechnetate scintigraphy should be performed as a diagnostic procedure of choice, according to each case.
Topics: Blood Transfusion; Child, Preschool; Diagnosis, Differential; Gastrointestinal Hemorrhage; Hernia, Umbilical; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Meckel Diverticulum; Photography
PubMed: 34106190
DOI: 10.32641/andespediatr.v92i1.2470 -
AJR. American Journal of Roentgenology Aug 2015The objective of our study was to determine how often symptomatic Meckel diverticulum and asymptomatic Meckel diverticulum are detected on CT in patients with known...
OBJECTIVE
The objective of our study was to determine how often symptomatic Meckel diverticulum and asymptomatic Meckel diverticulum are detected on CT in patients with known Meckel diverticulum and to evaluate factors that influence detection.
MATERIALS AND METHODS
A total of 85 CT examinations of 40 patients (eight pediatric patients and 32 adult patients; 29 male patients and 11 female patients; average age, 46.2 ± 23.7 [SD] years) with a pathologic diagnosis of Meckel diverticulum were retrospectively evaluated. These patients included 26 adult patients with incidentally found asymptomatic Meckel diverticulum and 14 patients (eight pediatric and six adult patients) with symptomatic Meckel diverticulum. The CT technical factors and patients' morphologic factors were compared with the detection of Meckel diverticulum using mixed-effect logistic regression models.
RESULTS
Meckel diverticulum was detected on at least one CT examination in eight of 14 (57.1%) symptomatic patients (two of four patients with bleeding, two of six patients with small-bowel obstruction, two of two patients with acute diverticulitis, one of one patient with incisional hernia, and one of one patient with inverted Meckel diverticulum) and in 13 of 23 (56.5%) total CT examinations. Asymptomatic Meckel diverticulum was detected on at least one CT examination in 11 of 26 (42.3%) patients and in 16 of 62 (25.8%) total CT examinations. The amount of peritoneal fat was related to the detection of Meckel diverticula (p = 0.02). Although not statistically significant, the subjective quality of axial CT (p = 0.05) tended to be related to detection, whereas the use of IV (p = 0.59) or positive oral (p = 0.41) contrast material was unrelated to detection. In the original CT reports, none of the asymptomatic cases of Meckel diverticulum was prospectively detected, whereas Meckel diverticulum was detected or mentioned as a possibility in 64% of the symptomatic cases.
CONCLUSION
In patients with known Meckel diverticulum, CT can detect Meckel diverticulum in up to 47.5% of all patients. Meckel diverticulum is more commonly detected in symptomatic patients than in asymptomatic patients, and detection is related to the amount of peritoneal fat.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Incidental Findings; Infant; Male; Meckel Diverticulum; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 26204277
DOI: 10.2214/AJR.14.13898 -
Radiologic Clinics of North America Nov 2015Right lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important... (Review)
Review
Right lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel diseaseRight lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel disease.
Topics: Abdominal Pain; Appendicitis; Diagnosis, Differential; Diverticulitis; Gastrointestinal Diseases; Humans; Inflammatory Bowel Diseases; Meckel Diverticulum; Tomography, X-Ray Computed
PubMed: 26526431
DOI: 10.1016/j.rcl.2015.06.004 -
The American Surgeon Jun 2021Meckel's diverticulum is a congenital abnormality often associated with the pediatric population. When seen in the adult population, management is controversial. This... (Comparative Study)
Comparative Study
BACKGROUND
Meckel's diverticulum is a congenital abnormality often associated with the pediatric population. When seen in the adult population, management is controversial. This study sought to determine demographic and outcome differences between diverticulectomy and small bowel resection in adults diagnosed with Meckel's diverticulum.
METHODS
An analysis of the American College of Surgeons National Surgical Quality Improvement database (2015-2018) was performed, capturing patients with a postoperative diagnosis of Meckel's diverticulum. Inclusion criteria included diverticulectomy or small bowel resection, and exclusion criteria included other major procedures such as colectomy or concomitant diverticulectomy and a small bowel resection. Demographics and outcomes were analyzed between those receiving diverticulectomy or resection.
RESULTS
506 patients undergoing surgical treatment of Meckel's diverticulum were captured. The majority of these patients were white (79.05%), male (68.77%), and averaged 46 years old. The 2 populations were homogenous, with no significant differences in demographics or comorbidities between populations. Mean operative time was shorter in the diverticulectomy group than the resection group (68.92 ± 35.89 vs. 89.33 ± 40.16 minutes, < .0001). There were no deaths at 30 days. Length of stay, readmission rate, wound infection, and discharge destination were similar among both groups.
DISCUSSION
Our analysis of a national database reveals no difference in outcomes between patients receiving a diverticulectomy or resection for Meckel's diverticulum. Operating time may be slightly increased for resection. However, decision to excise the diverticulum vs. the segment of small bowel should be individualized to each patient, their pathology, and clinical picture.
Topics: Databases, Factual; Digestive System Surgical Procedures; Female; Humans; Intestine, Small; Male; Meckel Diverticulum; Middle Aged; Operative Time; Quality Improvement; United States
PubMed: 33284028
DOI: 10.1177/0003134820954820 -
Journal of Investigative Medicine : the... Mar 2021Meckel's diverticulum (MD) is a well-defined diagnosis in children presenting with either bleeding or obstruction. Although anecdotally adult patients may present with...
Meckel's diverticulum (MD) is a well-defined diagnosis in children presenting with either bleeding or obstruction. Although anecdotally adult patients may present with complications from MD, their presentation seems to be different, with a reported predominance of non-bleed-related presentations. Reports in this population, however, are limited, and little is known of the epidemiology of MD in older patients. We performed a retrospective analysis of the Agency of Healthcare Research and Quality National Inpatient Sample of all US hospital discharges from 2012 to 2016. We identified patients with a primary discharge diagnosis of MD. Data were abstracted as raw numbers and population weighted rates of discharge with age group, income level, length of stay (LOS) and hospital charges as additional information. On average, 2030 individuals were discharged annually; most (71.1%) were adults (>18 years). Although MD was predominant in males in all age groups, the gender ratio decreased with older age categories from 3.5:1.0 (1-17 years) to 1.6:1.0 (65-84 years). LOS averaged 5.3 days with no clear relationship to other parameters. Median income category, however, closely correlated (R=0.9996) with diagnosis in older age categories. MD may be significantly more prevalent in adult patients than was previously understood. Differences in gender preponderance suggest that gender may influence the pattern of presentation. Diagnosis in older individuals is closely associated with income or socioeconomic status but not hospital charges or LOS.
Topics: Adolescent; Aged; Aged, 80 and over; Child; Child, Preschool; Gastrointestinal Hemorrhage; Humans; Infant; Laparoscopy; Length of Stay; Male; Meckel Diverticulum; Retrospective Studies
PubMed: 33443055
DOI: 10.1136/jim-2020-001581 -
Current Gastroenterology Reports Apr 2016The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most... (Review)
Review
The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most commonly in infancy; however, some may not present until adulthood. Most congenital anomalies of the small intestine will present with obstructive symptoms while some may present with vomiting, abdominal pain, and/or gastrointestinal bleeding. Various radiologic procedures can aid in the diagnosis of these lesions that vary depending on the particular anomaly. Definitive therapy for these congenial anomalies is surgical, and in some cases, surgery needs to be performed urgently. The overall prognosis of congenital anomalies of the small intestine is very good and has improved with improved medical management and the advent of newer surgical modalities. The congenital anomalies of the small intestine reviewed in this article include malrotation, Meckel's diverticulum, duodenal web, duodenal atresia, jejunoileal atresia, and duplications.
Topics: Digestive System Abnormalities; Duodenal Obstruction; Humans; Intestinal Atresia; Intestinal Volvulus; Intestine, Small; Meckel Diverticulum
PubMed: 26951229
DOI: 10.1007/s11894-016-0490-4 -
Journal of Pediatric Surgery Sep 2021Meckel diverticulum (MD) is present in 2% of the population. Many practitioner feel the diagnosis relies upon technetium-99 m pertechnetate scintigraphy. When negative,...
BACKGROUND/PURPOSE
Meckel diverticulum (MD) is present in 2% of the population. Many practitioner feel the diagnosis relies upon technetium-99 m pertechnetate scintigraphy. When negative, patients undergo additional invasive procedures delaying definitive therapy. This study aims to identify features of bleeding MD and generate a risk score, which could preclude unnecessary testing and facilitate earlier operation.
METHODS
All patients <18-years-old who presented with hematochezia from 2005 to 2015 were identified. MD diagnosis was based on histopathology of operative tissue. Controls were patients with hematochezia undergoing colonoscopy. A points system was used generate a risk score.
RESULTS
A total of 215 patients presented with hematochezia out of which 42 patients with MD were identified. Predictive variables included infant (OR 7, 95%CI 2-29) and toddler (OR 20, 95%CI 8-50) age groups, duration <6 days (OR 18, 95%CI 8-43), presence of large blood volume (OR 16, 95% CI 7-36), hemoglobin <7 g/dL (OR 6, 95% CI 3-15) and transfusion requirement (OR 16, 95% CI 7-38). A score of 6 or higher is highly suggestive of MD.
CONCLUSIONS
This scoring system identifies children with bleeding MD who may benefit from exploratory surgery without undergoing endoscopy. This novel scoring system can be applied to provide accurate clinical diagnosis, reduce unnecessary tests and allow prompt surgical management.
Topics: Adolescent; Colonoscopy; Gastrointestinal Hemorrhage; Hemoglobins; Humans; Infant; Meckel Diverticulum; Radionuclide Imaging
PubMed: 33422327
DOI: 10.1016/j.jpedsurg.2020.12.013