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Indian Journal of Nuclear Medicine :... 2022A 13-year-old adolescent male presented with an episode of rectal bleed. He has had five such episodes in the past year where he witnessed black tarry stools mixed with...
A 13-year-old adolescent male presented with an episode of rectal bleed. He has had five such episodes in the past year where he witnessed black tarry stools mixed with fresh blood, painless, not associated with fever or hematemesis. Clinical examination revealed pallor and a soft, non-tender abdomen. Vitals were stable. Blood investigations revealed haemoglobin of 102g/L, WBC count of 10 X 109/L and platelet count of 165 × 109/L. The clotting screen was normal. Upper GI endoscopy and colonoscopy revealed no abnormality. The patient underwent Tc-99m pertechnetate scintigraphy to look for Meckel's Diverticulum in view of painless lower GI bleed.
PubMed: 36817191
DOI: 10.4103/ijnm.ijnm_127_22 -
Cureus Jun 2023The presence of a Meckel's diverticulum in the hernial sac is called a Littre's hernia. It is a rare complication of Meckel's diverticulum. We present a 56-year-old male...
The presence of a Meckel's diverticulum in the hernial sac is called a Littre's hernia. It is a rare complication of Meckel's diverticulum. We present a 56-year-old male patient who complained of swelling in the umbilical region. After the clinical examination and imaging studies, we diagnosed the patient with a partially reducible umbilical hernia. The patient underwent exploration and was found to have omentum, Meckel's diverticulum, and part of the ileum within the sac. The patient underwent segmental resection of the bowel, primary repair of the hernial defect, and onlay meshplasty. Postoperatively, the patient did not develop any complications.
PubMed: 37519505
DOI: 10.7759/cureus.41115 -
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 -
Cureus Jan 2023Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Histologically, it is a true diverticulum comprising all four layers of...
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Histologically, it is a true diverticulum comprising all four layers of the intestinal tract. The complications associated with Meckel's diverticulum include bleeding, bowel obstruction, and intussusception. Torsions are an extremely rare complication. The patient was a 15-year-old boy who presented to the emergency department with acute-onset lower abdominal pain and was admitted to the hospital for a follow-up of abdominal pain due to nonspecific imaging findings. The symptoms of the patient worsened 12 hours after admission, and he underwent emergency laparoscopic surgery. A large Meckel's diverticulum with torsion and necrosis was observed 30 cm proximal to the ileocecal valve. The diverticulum was twisted around the base of the neck. Subsequently, wedge resection of the small intestine, including the diverticulum, was performed. Stem torsion is a rare complication of Meckel's diverticulum. As definitive preoperative diagnosis was difficult to obtain through imaging studies, early laparoscopic surgery was considered effective.
PubMed: 36819440
DOI: 10.7759/cureus.33850 -
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 -
Radiology Case Reports May 2022Intussusception secondary to Meckel's diverticulum is a rare entity in adults and hence, can be a challenging to accurately diagnose preoperatively. This case...
Intussusception secondary to Meckel's diverticulum is a rare entity in adults and hence, can be a challenging to accurately diagnose preoperatively. This case illustrates the clinical, imaging, operative, and histologic manifestations of a Meckel's diverticulum leading to a long segment ileo-ileal intussusception in an adult female patient presenting with symptoms of small bowel obstruction.
PubMed: 35309378
DOI: 10.1016/j.radcr.2022.02.039 -
The Quarterly Journal of Nuclear... Mar 2024Pediatric gastrointestinal imaging plays a crucial role in evaluating and managing digestive system disorders in children. This comprehensive review dives into the... (Review)
Review
Pediatric gastrointestinal imaging plays a crucial role in evaluating and managing digestive system disorders in children. This comprehensive review dives into the nuances of pediatric gastrointestinal imaging techniques, focusing on three specific modalities: gastric emptying scintigraphy (GES), intestinal transit scintigraphy (ITS), and gastrointestinal bleeding scintigraphy. GES involves real-time monitoring of stomach emptying using radiotracers and gamma camera technology. While challenges exist in standardizing protocols due to age-specific meal compositions, GES remains pivotal in diagnosing motility disorders, gastroesophageal reflux, and abdominal pain in children. ITS, utilizing [Ga], provides insights into gastrointestinal motility disorders such as Hirschsprung disease. It aids in whole-gut transit evaluation, guiding surgical interventions and improving long-term clinical outcomes. Gastrointestinal bleeding scintigraphy, employing [mTc], assists in diagnosing conditions like Meckel's diverticulum and occult bleeding, offering continuous monitoring to pinpoint the bleeding site along the entire gastrointestinal tract. SPECT-CT improves the accuracy and the standards of care. Each technique's protocol details, clinical indications, and diagnostic capabilities are thoroughly discussed, highlighting the importance of these non-invasive, functional imaging modalities in pediatric gastroenterology.
Topics: Humans; Child; Radionuclide Imaging; Gastric Emptying; Radioisotopes; Gastrointestinal Hemorrhage
PubMed: 38587360
DOI: 10.23736/S1824-4785.24.03548-9 -
ANZ Journal of Surgery May 2023Meckels diverticulum (MD) causes a number of acute surgical pathologies and can contain ectopic tissue with the surgical aim to resect all ectopic mucosa. This has...
BACKGROUND
Meckels diverticulum (MD) causes a number of acute surgical pathologies and can contain ectopic tissue with the surgical aim to resect all ectopic mucosa. This has traditionally implied a small bowel resection (BR); though contemporary literature has demonstrated Meckel's diverticulectomy to be safe. The aim of this study was to determine optimal resection strategy, and assess MD histopathological features and their relationship to outcomes.
METHODS
A 19-year retrospective review of patient medical records across seven hospitals was conducted with demographic, clinical and pathological data collected. Analysis was conducted using a student's t-test for continuous variables and chi-squared test for categorical variables. Univariate regression was performed to identify risk factors. P < 0.05 was considered statistically significant.
RESULTS
One hundred and sixty patients underwent resection of MD, 70 (44%) had Meckel's diverticulectomy and 90 (56%) had BR. No significant difference in length (P = 0.486), width (P = 0.238), or ratio (P = 0.188) of diverticulectomy compared to BR, with fewer complications in diverticulectomy. In all, 24 (15.3%) MD were perforated, of whom 5 had gastric mucosa, 2 had mixed ectopic mucosa and 1 carcinoid tissue. There were no cases of ectopic mucosa in the resection margin requiring re-operation, or causing base perforation. MD specimen with greater length: width ratio was a risk factor for perforation OR 1.437 P = 0.042 but not for malignancy P = 0.813 or ectopic tissue P = 0.185.
CONCLUSION
Meckel's diverticulectomy is safe via laparoscopic or open approach compared with BR. Despite higher perforation rates in MD with greater length: width ratio, no malignancy or ectopic risk was identified, supporting diverticulectomy as a safe operative approach.
Topics: Humans; Retrospective Studies; Choristoma; Digestive System Surgical Procedures; Meckel Diverticulum; Laparoscopy
PubMed: 36821518
DOI: 10.1111/ans.18351 -
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 -
The British Journal of Surgery Dec 2020
Topics: Aged; Humans; Intestinal Obstruction; Intestine, Small; Male; Meckel Diverticulum; Tomography, X-Ray Computed
PubMed: 33179806
DOI: 10.1002/bjs.12036