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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 -
The Pan African Medical Journal 2023
Topics: Humans; Abdomen, Acute; Meckel Diverticulum
PubMed: 37637406
DOI: 10.11604/pamj.2023.45.54.39639 -
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 -
Annals of Medicine and Surgery (2012) Jul 2019An up to date published literature has shown that Meckel's Diverticulum (MD) are discovered incidentally and are benign, malignant transformation is unusual with... (Review)
Review
An up to date published literature has shown that Meckel's Diverticulum (MD) are discovered incidentally and are benign, malignant transformation is unusual with reported incidence to be only 0.5%-3.2%. The research available on this rare tumour remains scanty, mainly consisting of case reports and case series with many researchers reporting on their own clinical experience and often disagree on not only its epidemiology, but also more so on its surgical indications. In addition to the above there is no agreed standard formal grading and staging classification for primary MD tumour that can not only help assess the tumour in a systematic way, but also advise on a standard treatment plan that is to be followed after emergency surgery. Hence, the aim of this article is to systematically review the latest evidence on these rare types of malignant neoplasm originating from MD, and conclude the best management options when encountered with such situations.
PubMed: 31245001
DOI: 10.1016/j.amsu.2019.05.017 -
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 -
Cureus Aug 2022Meckel's diverticulum (MD), the most common congenital disease of the small bowel, commonly presents with symptoms of painless rectal bleeding and intestinal...
Meckel's diverticulum (MD), the most common congenital disease of the small bowel, commonly presents with symptoms of painless rectal bleeding and intestinal obstruction. The treatment of symptomatic MD involves resection of the lesion regardless of patient age; however, the excision of asymptomatic and incidentally identified MDs in adults remain controversial. On one hand, the complications arising from MDs decrease with age, leading to a lower benefit than risk ratio with prophylactic resection. On the other hand, malignancies, such as neuroendocrine tumors, may arise over time from untreated MDs. This can lead to poor prognostic complications, such as liver or lymph node metastases. In this case report, we describe an incidental Meckel's diverticulum discovered during an exploratory laparotomy for acute sigmoid diverticulitis in an adult male. Later biopsy findings discovered the lesion to contain a grade 1 neuroendocrine tumor. Based on our literature review findings, resection of the incidental Meckel's diverticulum was a reasonable approach given the low complication risks of the procedure and the possibility of malignant transformation and progression.
PubMed: 36072199
DOI: 10.7759/cureus.27625 -
International Journal of Surgery Case... Jun 2024Paraduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature.
INTRODUCTION AND IMPORTANCE
Paraduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature.
CASE PRESENTATION
Four male and one female child complained of paraduodenal hernias, two on the right side and three on the left side. The intestinal part that herniated inside the hernia sac was also malrotated in four patients. One patient had Meckel's diverticulum with a herniated intestine. One infant had extrahepatic biliary disease, a single atrium, polysplenia, intestinal malrotation, and a left paraduodenal hernia. Exploratory labarotomy was done for reduction of the intestine, reorientation, and repair of hernia orifices.
CLINICAL DISCUSSION
Paraduodenal hernia is a component of malrotation. Cautious dissection of the hernia orifice is required to keep away from injuries to the inferior mesenteric vein or left colic artery in the course of the restoration of the left paraduodenal hernia. Also, the superior mesenteric vessels may be injured in the course of the restoration of the right paraduodenal hernia.
CONCLUSION
There is a correlation between the occurrence of PDH with malrotation. The diagnosis of malrotation can be made with an ultrasound abdomen; however, it is true that ultrasound cannot make a confirmed diagnosis in all patients. Once the diagnosis of a mesocolic hernia has occurred, surgical repair is mandatory by closure of the defect.
PubMed: 38714067
DOI: 10.1016/j.ijscr.2024.109696 -
Journal of Indian Association of... 2022The purpose of this study was to study the presentation of patients who underwent Meckel's diverticulectomy (MD) and utility of pertechnetate Meckel's scan in the...
PURPOSE
The purpose of this study was to study the presentation of patients who underwent Meckel's diverticulectomy (MD) and utility of pertechnetate Meckel's scan in the diagnosis of MD.
METHODS
The clinical presentation of a retrospective cohort of patients who underwent MD from January 2007 to December 2019 was studied. The modes of presentation, treatment, and the diagnostic utility of pertechnetate Meckel's scans were evaluated. False-positive and false-negative scans were reviewed. The presence of gastric mucosa on histology of Meckel's was correlated with presentation as gastrointestinal bleeding and positive scan results.
RESULTS
Ninety-nine patients underwent MD. Thirty-five out of 263 (13.3%) Meckel's scans done were positive. There was a male preponderance (86.9%). The peak age of presentation was 0-4 years (rectal bleeding or intestinal obstruction). Only a third of the patients with Meckel's diverticulum Meckel's had a preoperative diagnosis of Meckel's. The sensitivity/specificity of Meckel's scan was higher in patients presenting with painless rectal bleeding. Seven patients were false positive (weak tracer uptake or ectopic uptake) and five were false negative. Two patients with false-negative Meckel's scan, having gastrointestinal bleeding had gastric mucosa on histology of Meckel's.
CONCLUSION
Meckel's diverticulum has a male predominance. Meckel's scan has a high sensitivity in the children presenting with fresh painless rectal bleeding but is of limited use in the diagnosis of Meckel's diverticulum in other forms of presentations. False-positive scans can be anticipated in the presence of weak or ectopic uptake. False-negative scans can occur even in the presence of bleeding and in spite of the presence of gastric mucosa in the Meckel's diverticulum. Laparoscopy is a useful tool in diagnosis and treatment.
PubMed: 35733589
DOI: 10.4103/jiaps.JIAPS_392_20 -
Surgical Case Reports Jun 2023Adenocarcinoma in an inverted Meckel's diverticulum with intussusception has not been reported to date. We discuss the clinical issues concerning this rare condition and...
BACKGROUND
Adenocarcinoma in an inverted Meckel's diverticulum with intussusception has not been reported to date. We discuss the clinical issues concerning this rare condition and review the relevant literature.
CASE PRESENTATION
A 71-year-old Japanese female was referred to our hospital for further investigation of severe anemia. Computed tomography revealed a tumorous lesion in the terminal ileum. Capsule endoscopy did not provide detailed images. Exploratory laparoscopy revealed intussusception in the terminal ileum. An intraluminal tumor 70 cm proximal to the ileocecal valve was observed to be the lead point. Partial resection including the tumor was performed. Macroscopically, a polypoid tumor at the tip of an inverted diverticulum-like structure was observed. The tumor was histologically composed of adenocarcinoma accompanied by gastric and pyloric gland metaplasia in the background mucosa, which was confirmed by immunohistochemical staining. Based on these characteristics, this tumor is considered to have developed from the ectopic gastric mucosa in a Meckel's diverticulum.
CONCLUSIONS
When we encounter patients with unfamiliar lesions in the small bowel, we need to differentiate Meckel's diverticulum related disease. Meckel's diverticulum can invert into the lumen of the small bowel and cause an intussusception, and has potential of malignant transformation.
PubMed: 37271767
DOI: 10.1186/s40792-023-01680-1