-
Cirugia Espanola Feb 2024
Topics: Humans; Meckel Diverticulum; Diverticulitis; Gastrointestinal Hemorrhage
PubMed: 37769709
DOI: 10.1016/j.cireng.2023.09.003 -
Current Gastroenterology Reports Jan 2020Meckel's diverticulum may be detected incidentally or present with symptoms from infancy and to old age. The presentation may be acute, with several complications... (Review)
Review
PURPOSE OF REVIEW
Meckel's diverticulum may be detected incidentally or present with symptoms from infancy and to old age. The presentation may be acute, with several complications associated with the condition. We aim to review the many faces with which a Meckel's diverticulum may present, either symptomatically or as an incidental finding.
RECENT FINDINGS
Due to its rarity, recent studies mainly include small retrospective series or case reports. Emphasis in the recent literature is on clinical presentation, the pathology of symptomatic cases, management options and risks of neoplasia. Symptoms are mainly caused by obstruction, bleeding or diverticulitis. Cross-sectional imaging is unspecific, although capsule endoscopy is reported of use in case series. Meckel's diverticulum presents with clinical features that are age-specific. Complicated Meckel's diverticulum is treated by resection. Optimal treatment of incidental cases remains debated. Meckel's diverticulum usually stays asymptomatic, and decision-making for management should be based on patient-specific factors. Use of minimal invasive techniques mandates refinement of the optimal treatment.
Topics: Humans; Incidental Findings; Meckel Diverticulum; Retrospective Studies
PubMed: 31930430
DOI: 10.1007/s11894-019-0742-1 -
ANZ Journal of Surgery Sep 2021Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy....
INTRODUCTION
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.
MATERIALS AND METHODS
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.
RESULTS
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 = 51.7 cm. 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.
CONCLUSION
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.
Topics: Adult; Female; Humans; Intestinal Perforation; Intussusception; Laparoscopy; Laparotomy; Meckel Diverticulum; Pregnancy
PubMed: 34152674
DOI: 10.1111/ans.17014 -
The Pan African Medical Journal 2023
Topics: Humans; Abdomen, Acute; Meckel Diverticulum
PubMed: 37637406
DOI: 10.11604/pamj.2023.45.54.39639 -
European Journal of Radiology Dec 2022Inverted Meckel's diverticulum (IMD) is a well-established but rare disease. This study aimed to summarize the radiological and clinical characteristics of IMD, and...
PURPOSE
Inverted Meckel's diverticulum (IMD) is a well-established but rare disease. This study aimed to summarize the radiological and clinical characteristics of IMD, and correlates its radiological and surgical findings to obtain an accurate early preoperative diagnosis.
METHOD
This is a retrospective study included IMD patients from a large children's medical center in China, between January 2009 and March 2022. We reviewed demographic data, clinical manifestations, preoperative examinations, surgical findings, histopathological results, and outcomes.
RESULTS
Twenty-three cases with IMD (14 male patients [60.9%]; median age, 6.7 years; age range, 9 months to 13 years) were retrospectively reviewed over a period of 13 years. The typical clinical manifestations of IMD included abdominal pain, vomiting, and abdominal tenderness. The most commonly used imaging modalities were abdominal ultrasound and computed tomography. This is the first case series on pediatric IMD, that describes the clinical process of IMD, proposes clinical phases of IMD, and first summarizes the radiological findings characteristic of each clinical phase.
CONCLUSIONS
The clinical process of IMD can be divided into four phases (intussuscepted Meckel's diverticulum [MD], inverting MD, inverted MD, intussusception secondary to IMD). Patients in different clinical phases present with various radiological features. Mastering the radiological and clinical characteristics of each phase of IMD can aid in its early diagnosis and timely operative intervention, thus avoiding unnecessary intestinal necrosis and resection.
Topics: Child; Humans; Infant; Male; Abdominal Pain; Meckel Diverticulum; Radiography; Radiology; Research; Retrospective Studies
PubMed: 36402103
DOI: 10.1016/j.ejrad.2022.110611 -
Journal of Clinical Medicine Mar 2024: The complications associated with Meckel's diverticulum (MD) are well-known. However, blunt injuries regarding MD have not been widely described in the literature....
: The complications associated with Meckel's diverticulum (MD) are well-known. However, blunt injuries regarding MD have not been widely described in the literature. This was the reason for undertaking research on MD lesions. : The materials consisted of 28 cases of damage to MD after blunt trauma published during the years 1921-2022. The collected data were subjected to statistical analysis. : The following MD injuries have been identified, starting with the most common isolated perforation of MD, bleeding from the area of MD, perforation of MD with concomitant tearing of the mesentery intestines and bleeding, intussusception of MD, and intramural hematoma of MD with adjacent mesenteric hematoma. Most injuries were caused by a traffic accident, followed by sports, accidents at work, and then violence. Almost all the cases (27) involved men. Several possible mechanisms may contribute to post-traumatic damage to MD. First of all, they are associated with abdominal compression and a secondary increase in intra-abdominal pressure as well as with the action of shearing forces during deceleration. : Traumatic MD injuries are differentiated and very rare. They can coexist with other serious injuries to the abdominal organs.
PubMed: 38541840
DOI: 10.3390/jcm13061614 -
Journal of Indian Association of... 2023Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2...
CONTEXT
Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2 years of life.
AIMS
To present our experience with GI duplication (cysts) at a pediatric surgery tertiary care teaching institute.
SETTINGS AND DESIGN
It is a retrospective observational study undertaken in the department of pediatric surgery at our center between 2012 and 2022 for GI duplications.
MATERIALS AND METHODS
All children were analyzed for their age, sex, presentation, radiological evaluation, operative management, and outcomes.
RESULTS
Thirty-two patients were diagnosed with GI duplication. Slight male predominance was present in the series (M: F ≈ 4:3). Fifteen (46.88%) patients presented in the neonatal age group; 26 (81.25%) patients were under 2 years. In the majority of cases ( = 23, 71.88%), the presentation was acute onset. Double duplication cysts on opposite sides of the diaphragm were present in one case. The most common location was ileum ( = 17), followed by gallbladder ( = 6), appendix ( = 3), gastric ( = 1), jejunum ( = 1), esophagus ( = 1), ileocecal junction ( = 1), duodenum ( = 1), sigmoid ( = 1), and anal canal ( = 1). Multiple associations (malformations/surgical pathologies) were present. Intussusception ( = 6) was the most common, followed by intestinal atresia ( = 5), anorectal malformation ( = 3), abdominal wall defect ( = 3), hemorrhagic cyst ( = 1), Meckel's diverticulum ( = 1), and sacrococcygeal teratoma ( = 1). Four cases were associated with intestinal volvulus, three cases with intestinal adhesions, and two with intestinal perforation. Favorable outcomes were present in 75% of cases.
CONCLUSION
GI duplications have varied presentations depending on site, size, type, local mass effect, mucosal pattern, and associated complications. The importance of clinical suspicion and radiology cannot be underrated. Early diagnosis is required to prevent postoperative complications. Management is individualized as per the type of duplication anomaly and its relation with the involved GI tract.
PubMed: 37197242
DOI: 10.4103/jiaps.jiaps_108_22 -
Polski Przeglad Chirurgiczny Aug 2019Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract, with its incidence estimated at 1-4% in the general population. In most... (Review)
Review
Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract, with its incidence estimated at 1-4% in the general population. In most cases Meckel's diverticulum is a latent, asymptomatic anomaly, but in some cases, it may lead to complications such as intestinal obstruction, bleeding and inflammation. The literature provides no precise recommendations for the management of accidentally diagnosed, unaffected Meckel's diverticulum. The aim of this study was to review the literature on the subject to determine the current state of knowledge. Based on an analysis of 17 papers, the following criteria (risk factors) were identified justifying 'preventive' resection of an accidentally found, unaffected Meckel's diverticulum: age <50 years, male gender, length >2 cm, macroscopic abnormalities suggesting the presence of ectopic gastric mucosa as well as narrow neck of the diverticulum. When the criteria are not met, there is a minimal lifetime risk of complications. Leaving diverticulum intact is recommended in cases of peritonitis, major abdominal trauma and at older age. Nevertheless, indications or contraindications for resection are relative, and surgeons are safe to make their decision depending on individual patient's situation.
Topics: Gastrointestinal Hemorrhage; Humans; Intestinal Obstruction; Meckel Diverticulum; Risk Factors
PubMed: 31849359
DOI: 10.5604/01.3001.0013.3400 -
ANZ Journal of Surgery Jan 2022
Topics: Humans; Meckel Diverticulum; Neuroendocrine Tumors
PubMed: 34143513
DOI: 10.1111/ans.17022 -
Clinical Imaging Nov 2022To determine the most common presentations of Meckel diverticulum (MD) in children and the performance of imaging modalities in prospective diagnosis.
PURPOSE
To determine the most common presentations of Meckel diverticulum (MD) in children and the performance of imaging modalities in prospective diagnosis.
MATERIALS AND METHODS
A 28-year retrospective review was performed of children under 18 years of age with MD listed as a diagnosis on pathology and/or surgical reports. The medical record was reviewed to determine presenting clinical scenarios. All imaging performed for each case was reviewed.
RESULTS
Seventy-six patients met inclusion criteria. Of the surgically removed MD, most presented with abdominal symptoms (n = 31, 41%); gastrointestinal (GI) bleeding (n = 15, 20%), or both abdominal symptoms and GI bleeding (n = 7, 9%). Twenty-nine percent of MD were discovered incidentally at surgery performed for other reasons. Of the symptomatic MD, only 31% were prospectively diagnosed. For patients with abdominal symptoms, CT had a sensitivity of 13% (3/24) while nuclear medicine (NM) scan had a sensitivity of 0% (0/2). For patients with GI bleed, CT had a sensitivity of 29% (2/7) and NM scan had a sensitivity of 71% (10/14). For patients with both abdominal symptoms and GI bleed, CT was 0% (0/2) and NM scan 75% (3/4) sensitive.
CONCLUSION
MD as a cause of abdominal symptoms and gastrointestinal bleeding may be difficult to diagnose due to nonspecific presentations and nonspecific findings. Most prospectively diagnosed MD are on NM scan in patients with GI bleed with abdominal pain (sensitivity of >70%). CT is relatively insensitive for MD in all symptomatology groups (0 to 29%).
Topics: Abdominal Pain; Adolescent; Child; Diagnostic Imaging; Gastrointestinal Hemorrhage; Humans; Meckel Diverticulum; Prospective Studies
PubMed: 35986976
DOI: 10.1016/j.clinimag.2022.07.008