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Asian Journal of Surgery May 2024
PubMed: 38772826
DOI: 10.1016/j.asjsur.2024.05.108 -
Journal of Indian Association of... 2023Choledochal cysts (CCs) are abnormal dilatations of the biliary system. Usually, CCs are classified into five types. The sixth type (Type VI) is an emerging and rare... (Review)
Review
Choledochal cysts (CCs) are abnormal dilatations of the biliary system. Usually, CCs are classified into five types. The sixth type (Type VI) is an emerging and rare type, reported the first case in 1991. We report this rare CC, Type VI seen in our experience for the first time. We have also reviewed the literature; only 26 cases of Type VI were found, including adults and children, ever since the first case has been reported in 1991. To the best of our knowledge, this is the 11 pediatric case report of a Type VI choledochal cyst.
PubMed: 38173633
DOI: 10.4103/jiaps.jiaps_144_23 -
World Journal of Clinical Cases Feb 2024Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and...
BACKGROUND
Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding.
CASE SUMMARY
This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided.
CONCLUSION
Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.
PubMed: 38322683
DOI: 10.12998/wjcc.v12.i4.865 -
Turkish Archives of Pediatrics Nov 2023Foreign body (FB) ingestion is a common problem in children and is an important public health problem in terms of causing serious complications. This study aims to...
OBJECTIVE
Foreign body (FB) ingestion is a common problem in children and is an important public health problem in terms of causing serious complications. This study aims to evaluate the complication management and intervention rates of FBs crossing the gastroesophageal junction.
MATERIALS AND METHODS
The hospital records of all children who presented to our clinic because of ingestion of FB between August 2019 and August 2021 were retrospectively reviewed. Patients who had an FB crossing the esophagogastric junction on plain radiographs showing the entire gastrointestinal tract taken at the time of admission were included in this study. Patients who had an FB removed from the esophagus by endoscopy were excluded from this study.
RESULTS
Of the 127 patients included in this study, 66 (52%) were male and 61 (48%) were female, with a mean age of 4.94 ± 3.15 years (3 months-17 years), and 59% (n = 75) of the patients were under 5 years of age. The most common type of FB was a coin (47%). The first pediatric cases in the literature were a clothespin discovered in the stomach and a Meckel's diverticulum perforated by a sunflower seed shell. Management included spontaneous passing (89%), endoscopy (7%), and open surgery (4%).
CONCLUSION
Although FBs passing through the esophagogastric junction may be asymptomatic in most cases, the need for close monitoring and surgical intervention should be kept in mind in these patients.
PubMed: 37850664
DOI: 10.5152/TurkArchPediatr.2023.23023 -
Journal of Surgical Case Reports Aug 2023Although Meckel's diverticulum is the most common congenital anomaly of the small bowel (2% prevalence worldwide), it rarely causes symptoms, with only 4% of those with...
Although Meckel's diverticulum is the most common congenital anomaly of the small bowel (2% prevalence worldwide), it rarely causes symptoms, with only 4% of those with the anomaly developing any complications, including Meckel's diverticulitis. In contrast to this, appendicitis is the most common general surgical emergency, with a lifetime incidence of 6.7-8.6%. Therefore, the case of a man presenting with right-sided abdominal pain to an Emergency Department with both Meckel's diverticulitis and appendicitis is rare. This case study illustrates the importance of careful assessment of the entire abdomen when operating on patients with right-sided abdominal pain, so as not to miss Meckel's diverticulitis even when appendicitis has already been found.
PubMed: 37593191
DOI: 10.1093/jscr/rjad465 -
International Journal of Surgery Case... Dec 2023Littre's hernia (LH) is a rare condition involving Meckel's diverticulum within a hernia sac, with an incidence of <0.1 % of all complicated hernias. To this day, only...
INTRODUCTION
Littre's hernia (LH) is a rare condition involving Meckel's diverticulum within a hernia sac, with an incidence of <0.1 % of all complicated hernias. To this day, only a few case reports have been published concerning this entity.
CASE PRESENTATION
A 48-year-old patient with a history of four midline C sections and an incarcerated incisional midline hernia was admitted to the emergency department for small bowel obstruction evolving for 12 h. Examination revealed an incarcerated midline incisional hernia. An abdominal CT scan was performed, showing a multi-orifice incisional hernia with a small bowel loop and a 3 cm abscess. The patient underwent an urgent midline laparotomy. During surgery, we found a small bowel loop with a perforated Meckel's diverticulum, located 50 cm from the ileocaecal valve, associated with a 3 cm abscess. Surgical drainage of the abscess, resection of 20 cm of small bowel, including the diverticulum, and an appendicectomy were performed. The incisional midline hernia was managed by herniorrhaphy. The post-operative course was uneventful.
CLINICAL DISCUSSION
Surgeons need to keep in mind the possibility of discovering Meckel's diverticulum in a hernia sac in every incarcerated hernia. Complete history intake and careful physical examination are important to uncover signs prompting clinical suspicion. Littre's hernia is rare and difficult to diagnose, with no distinguishing clinical features or physical signs.
CONCLUSION
Managing LH involves treating the symptomatic Meckel's diverticulum with various resection methods and the hernia itself, with mesh application being a controversial topic. Prophylactic resection remains debatable among experts.
PubMed: 37979554
DOI: 10.1016/j.ijscr.2023.109066 -
Radiology Case Reports Oct 2023Meckel's diverticulum is a common congenital gastrointestinal malformation affecting 2% of the general population. Most affected patients are asymptomatic, and excessive...
Meckel's diverticulum is a common congenital gastrointestinal malformation affecting 2% of the general population. Most affected patients are asymptomatic, and excessive bleeding causing a significant drop in hemoglobin count is an uncommon complication of Meckel's diverticulum, especially in adult patients. Herein, we present an adult case of Meckel's diverticulum that nearly led to hemodynamic instability. Laparotomy and segmental small bowel resection were critical in treating the patient.
PubMed: 37577078
DOI: 10.1016/j.radcr.2023.07.041 -
JNMA; Journal of the Nepal Medical... Feb 2024Littre's hernia is an extremely rare type of hernia which has Meckel's diverticulum as its content. A 63-year-old male, presented to the emergency department with chief...
UNLABELLED
Littre's hernia is an extremely rare type of hernia which has Meckel's diverticulum as its content. A 63-year-old male, presented to the emergency department with chief complaints of swelling and pain around the umbilicus. The patient was diagnosed with an incarcerated umbilical hernia. Following the emergency laparotomy, the intraoperative finding depicted an umbilical Littre's hernia. The patient underwent open Meckel's diverticulectomy with mesh repair. Preoperative diagnosis of Littre's hernia is unlikely due to its low incidence and lack of specific radiological and clinical findings, but the role of computed tomography scan and ultrasound are important in differentiating between strangulated or incarcerated bowel and omentum and in guiding the urgency of operative management.
KEYWORDS
case reports; hernia; Meckel diverticulum.
Topics: Male; Humans; Middle Aged; Hernia, Umbilical; Meckel Diverticulum; Ultrasonography; Radiography; Tomography, X-Ray Computed
PubMed: 38409995
DOI: 10.31729/jnma.8443 -
International Journal of Surgery Case... Aug 2023Meckel's diverticulum (MD) is a common congenital malformation of the digestive tract, often asymptomatic but occasionally leading to complications such as bowel...
INTRODUCTION AND IMPORTANCE
Meckel's diverticulum (MD) is a common congenital malformation of the digestive tract, often asymptomatic but occasionally leading to complications such as bowel obstruction and ischemia. Timely recognition and treatment of these complications are crucial.
PRESENTATION OF CASE
We report the case of a 27-year-old male patient presenting with complete intestinal obstruction and ischemia of the ileum due to a fibrous band associated with MD. The patient presented with severe abdominal pain lasting for 10 h. Physical examination revealed a distended abdomen, antalgic position, and positive decompression. Laboratory tests showed leukocytosis and elevated lactic acid levels. Computed tomography revealed dilated small bowel loops with signs of intestinal ischemia. Emergency exploratory laparoscopy confirmed a complete ileum with ischemia and identified a fibrous band originating from the mesentery, strangulating the affected loop. The fibrous band was dissected and sectioned, confirming its association with the MD, which was resected with subsequent recovery of peristalsis and vascularization of the compromised segment. The patient had a favorable postoperative recovery without complications.
DISCUSSION
MD is a rare cause of bowel obstruction, requiring a high index of suspicion for diagnosis. Despite the challenges in preoperative identification, early surgical intervention is crucial to prevent adverse outcomes. This case emphasizes the importance of promptly recognizing and managing MD-related complications to optimize patient outcomes.
CONCLUSION
MD should be considered in cases of acute occlusive abdomen, despite its infrequent occurrence. Early diagnosis and timely surgical intervention are essential to minimize morbidity and mortality associated with MD-related complications.
PubMed: 37557036
DOI: 10.1016/j.ijscr.2023.108614 -
Cureus Dec 2023Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or...
Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or bleeding is relatively high, small bowel obstruction induced by axial torsion of the MD is rare. Therefore, we herein report such a case along with a review of the literature. A 34-year-old female with right lower quadrant pain, nausea, and vomiting was admitted to our hospital with the diagnosis of adhesive small bowel obstruction due to a cesarean section performed five years previously. A long intestinal tube was placed, and the patient's clinical symptoms and X-ray findings showed relief of the small bowel obstruction. However, she developed severe right lower quadrant pain after contrast examination through the long intestinal tube despite the fact that the contrast agent had smoothly reached the terminal ileum. Blood tests and enhanced computed tomography (CT) showed a remarkable elevation of inflammatory markers, the appearance of ascites, and closed-loop-like and abscess-like appearances near the site of the caliber change. With a diagnosis of internal hernia, the patient underwent emergency laparotomy by means of a midline incision. Purulent ascites was observed within the abdominal cavity. Small bowel obstruction caused by a single band was observed in the right lower quadrant. Further exploration revealed an inflammatory MD with neck torsion and a mesodiverticular band (MDB). Simple mesodiverticular band resection by electrocautery and diverticulectomy by linear stapler were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. In the case of juvenile-onset small bowel obstruction, axial torsion of the MD should be considered as a differential diagnosis. Herein, we report such a difficult diagnostic case and the first English literature review of small bowel obstruction due to axial torsion of the MD.
PubMed: 38249182
DOI: 10.7759/cureus.50934