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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 -
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 -
JSLS : Journal of the Society of... 2014Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the...
BACKGROUND AND OBJECTIVES
Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy.
METHODS
A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum.
RESULTS
Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications.
CONCLUSIONS
Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.
Topics: Adolescent; Child; Child, Preschool; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Obstruction; Intestine, Small; Laparoscopy; Male; Meckel Diverticulum; Retrospective Studies
PubMed: 25392652
DOI: 10.4293/JSLS.2014.00015 -
JSLS : Journal of the Society of... 2014Meckel diverticulum (MD) is the most common congenital gastrointestinal malformation found in approximately 2% of the general population. MD manifests in adults as... (Review)
Review
BACKGROUND
Meckel diverticulum (MD) is the most common congenital gastrointestinal malformation found in approximately 2% of the general population. MD manifests in adults as gastrointestinal bleeding, bowel obstruction, intussusception, or perforation in <5% of cases. There is no consensus on the ideal management strategy in symptomatic MD. Therefore, we searched the literature to highlight the role of laparoscopy in diagnosing and treating symptomatic MD.
METHOD
We used PubMed, Medline, Google Scholar, Ovid, and Cochrane data search engines looking for articles containing terms such as Meckel diverticulum, ectopic gastric mucosa, laparoscopic, technetium 99m pertechnetate, and acute management. We included articles reporting on case series in the English language on adult patients only and reporting on laparoscopic approach in the management of symptomatic MD.
RESULTS
A total of 5 articles reporting on 35 cases were found. We report on the pooled data from these series with emphasis on number of patients, age, male to female ratio, length of stay, conversion to open procedure, method of resection, complications, first presentation, and confirmation of diagnosis preoperatively. We also compare the results of laparoscopic versus open approaches mentioned in the literature.
CONCLUSIONS
The laparoscopic approach was found to be effective as a diagnostic and therapeutic modality in patients with symptomatic MD; however, its adoption as the gold standard still needs further studies with larger patient numbers.
Topics: Adult; Humans; Intestinal Obstruction; Laparoscopy; Meckel Diverticulum
PubMed: 25489221
DOI: 10.4293/JSLS.2014.00349 -
Journal of the Royal Society of Medicine Oct 2006Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. It can cause complications in the form of ulceration, haemorrhage,... (Review)
Review
Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours. These complications, especially bleeding, are more common in the paediatric age group than in adults; however it is not uncommon to miss the diagnosis of Meckel's diverticulum in adults. Here, we reviewed the literature regarding the complications of this forgotten clinical entity in adults with potential diagnostic difficulties and management strategies.
Topics: Child; Child, Preschool; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m
PubMed: 17021300
DOI: 10.1177/014107680609901011 -
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 -
The Pan African Medical Journal 2018
Topics: Adult; Female; Hernia, Abdominal; Humans; Intestinal Obstruction; Meckel Diverticulum
PubMed: 31448000
DOI: 10.11604/pamj.2018.31.243.10740 -
The Pan African Medical Journal 2023
Topics: Humans; Abdomen, Acute; Meckel Diverticulum
PubMed: 37637406
DOI: 10.11604/pamj.2023.45.54.39639 -
In Vivo (Athens, Greece) 2022Cancer of the Meckel's diverticulum (MD) is extremely rare. It is often advanced at the time of operation and the prognosis is poor. An effective treatment for this...
BACKGROUND
Cancer of the Meckel's diverticulum (MD) is extremely rare. It is often advanced at the time of operation and the prognosis is poor. An effective treatment for this cancer has not yet been developed and there is no MD-carcinoma mouse model.
MATERIALS AND METHODS
MD carcinoma was established as a patient-derived xenograft (PDX) in 5-week-old male nude mice by subcutaneous transplantation of surgical specimens together with surrounding normal tissue. Hematoxylin and eosin (H&E) staining was performed on paraffin-embedded tissue sections of the original tumor resected from patients and transplanted tumors grown in nude mice.
RESULTS
Three of five mice implanted with MD tumor fragments grew. MD-carcinoma histopathology, observed with H&E-stained tissue sections of the tumors grown in the mice and tumor from the original patient, was concordant. Both showed the luminal structures characteristic of MD carcinoma, and the lumens were filled with serous fluid.
CONCLUSION
The first PDX mouse model of MD carcinoma has been established. The PDX model maintained MD-carcinoma histology of the tumor in the patient. The MD carcinoma mouse model will enable basic research on MD carcinoma, as well as the testing of novel therapeutic agents.
Topics: Animals; Carcinoma; Disease Models, Animal; Humans; Male; Meckel Diverticulum; Mice; Mice, Nude; Prognosis; Treatment Outcome
PubMed: 35738609
DOI: 10.21873/invivo.12870 -
The Pan African Medical Journal 2015Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of... (Review)
Review
Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.
Topics: Abdomen, Acute; Abdominal Pain; Adult; Diagnosis, Differential; Humans; Ileostomy; Intestinal Perforation; Laparotomy; Male; Meckel Diverticulum; Peritonitis
PubMed: 26175810
DOI: 10.11604/pamj.2015.20.319.5980