-
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 -
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 -
Children (Basel, Switzerland) Jan 2022Vitelline duct anomalies (VDA, including Meckel's diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic...
Vitelline duct anomalies (VDA, including Meckel's diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic versus asymptomatic VDA, analyzing clinico-laboratory data from 73 children, aged 1 day to 17 years, treated at a tertiary Pediatric Surgery Institution from 2002-2017. A male preponderance was obtained (ratio 3.6:1). MD accounted for 85% of VDA. Incidence of symptomatic VDA decreased with older age. Leading symptoms were intestinal obstruction and hemorrhage. Mucosal heterotopia (present in 39% of symptomatic MD) was associated with anemia and lowered CRP-levels. On ROC-analysis, hemoglobin < 8.6 g/dL, CRP < 0.6 mg/dL and MD distance to ileocecal valve >40 cm were predictors of ectopic tissue in symptomatic MD. Our data confirmed known characteristics as male preponderance, declined incidence of symptomatic cases with age and predominance of gastric ectopia in symptomatic MD. Moreover, anemia and prolonged distance of MD to ileocecal valve were predictors of ectopic mucosa in symptomatic MD.
PubMed: 35053658
DOI: 10.3390/children9010035 -
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 -
Diagnostics (Basel, Switzerland) May 2024Meckel's diverticulum is a developmental GI anomaly. It is a remnant of the omphalomesenteric duct (vitelline duct) and the most common congenital anomaly found in the...
Meckel's diverticulum is a developmental GI anomaly. It is a remnant of the omphalomesenteric duct (vitelline duct) and the most common congenital anomaly found in the small intestine. It contains ectopic/heterotopic gastric mucosa in half of the cases. Imaging investigations for diagnosing Meckel's diverticulum may include a plain radiography; however, this has a very limited diagnostic value. A blind-ending fluid-filled structure can sometimes be seen with sonography, but again, this technique's diagnostic value is limited due to multiple factors. A CT scan may be helpful in localizing the bleeding diverticulum, which can be better visualized with CT enterography. Diverticula containing gastric mucosa can be diagnosed with a higher sensitivity with Tc-99 scintigraphy. The typical location of Meckel's diverticulum is within two feet of the ileocecal valve; thus, ectopic gastric mucosal uptake is typically seen in the lower right quadrant in scintigraphy. We present a rare case of Tc-99 pertechnetate scintigraphy showing ectopic gastric mucosa in the upper mid abdomen, which was surgically proven to be at the mid ileum. To our knowledge, there is no ectopic Meckel's diverticulum case published in the literature. Familiarity with this atypical imaging presentation of relatively common ectopic gastric mucosa may help the radiologists in the timely diagnosis and management of the patient.
PubMed: 38893687
DOI: 10.3390/diagnostics14111162 -
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 -
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 -
International Journal of Surgery Case... Aug 2022Though Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is uncommon in the general population and rare in adults. Its...
INTRODUCTION
Though Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is uncommon in the general population and rare in adults. Its preoperative diagnosis is challenging. While obstruction is the commonest complication, its occurrence with gangrenous Meckel's diverticulum is rare. The aim of this presentation is to report this combination and to create awareness among surgeons and radiologists to increase preoperative diagnosis of Meckel's diverticulum preventing morbidity and mortality from delay in intervention.
PRESENTATION OF THE CASE
A twenty-years-old male presented with periumblical pain that later shifted to lower abdomen, vomiting and fever of 10 h durations. He has no history of smoking or diabetes. Physical examination showed tachycardia, fever, and lower abdominal tenderness. Exploratory laparotomy revealed gangrenous Meckel's diverticulum and ileal obstruction by a band arising from the tip of diverticulum to ileal mesentery. We did segmental resection of the ileum containing Meckel's diverticulum and end-to-end anastomosis with the excellent outcome.
DISCUSSION
Preoperative diagnosis of Meckel's diverticulum is challenging because of non-specific clinical presentations and less sensitivity and specificity of imaging investigations. A high index of suspicion can improve its diagnosis. Axial torsion with gangrenous Meckel's diverticulum is the rarest complication. Management of symptomatic Meckel's diverticulum is surgery. Treatment of silent Meckel's diverticulum is controversial with no strong evidence to treat or not to treat.
CONCLUSION
Gangrenous Meckel's diverticulum causing small bowel obstruction is rare. Surgeons must have a high index of suspicion to increase preoperative diagnosis of complicated Meckel's diverticulum.
PubMed: 35863288
DOI: 10.1016/j.ijscr.2022.107419 -
Frontiers in Surgery 2023Meckel's diverticulum is a rare congenital pathology among newborns. Nevertheless, it is an uncommon abdominal pathology in the adult population. Therefore, we aim to...
BACKGROUND
Meckel's diverticulum is a rare congenital pathology among newborns. Nevertheless, it is an uncommon abdominal pathology in the adult population. Therefore, we aim to provide a detailed account of our surgical approach in treating 27 cases of Meckel's diverticulum.
METHODS
This study is a cross-sectional analysis that utilized a database with prospectively collected data from 2004 to 2022. All patients under the age of 18 were excluded from the population. We described the population's demographic characteristics, symptoms, anatomopathological study, surgical technique, complications, morbidity, and mortality. A subgroup analysis was performed between the symptomatic and asymptomatic patients.
RESULTS
A total of 27 patients who underwent surgical resection for a posteriorly diagnosed Meckel's diverticulum were included. The male population accounted for 81.4% ( = 22) of the sample size. The symptomatic group consisted of 18 male and four female patients. Abdominal pain was the predominant symptom in 85% of the patients. Out of the 22 symptomatic patients, only 9% had a positive perioperative diagnosis of Meckel's diverticulum. All 27 patients with diverticulum diagnosis received the resection through diverticulectomy ( = 6), small bowel resection with end-to-end anastomosis ( = 6), and small bowel resection with lateral to lateral anastomosis ( = 15). The mean distance between the diverticulum and the ileocecal valve was 63.4 cm. The symptomatic group had an average diverticulum length of 3.54 cm, with an average base width of 2.47 cm. In the other group, the values were 2.75 and 1.61 cm. The average length of hospital stay in the symptomatic group was 7.3 days.
CONCLUSIONS
Meckel's diverticulum is a rare pathology in the adult population. Its presentation varies from asymptomatic to symptomatic patients, and surgery is the cornerstone treatment for this pathology.
PubMed: 38179318
DOI: 10.3389/fsurg.2023.1327545