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JPMA. the Journal of the Pakistan... Nov 2022Meckel's diverticulum is the most common gastrointestinal tract's congenital abnormality. Spontaneous perforation of Meckel's diverticulum is very rare and can mimic...
Meckel's diverticulum is the most common gastrointestinal tract's congenital abnormality. Spontaneous perforation of Meckel's diverticulum is very rare and can mimic acute appendicitis. Here we report the case of an 11-year-old male patient, who was presented to the Surgical A unit of Ayub Teaching Hospital, Abbottabad on 21st January, 2021 with one-day history of abdominal pain, predominantly in the periumbilical area and right iliac fossa, associated with nausea. On physical examination his abdomen was tense, tender with guarding and generalized rigidity. A provisional diagnosis of perforated appendix or enteric perforation of a hollow viscus was made. The patient had an emergency laparotomy, where a perforated Meckel's diverticulum was discovered. Resection of the portion of gut containing Meckel's diverticulum was done along with primary anastomosis. Heterotopic gastric mucosa of diverticulitis, associated with perforation was confirmed on histopathology. The patient made an uneventful recovery during postoperative period. This case report is an interesting and an unusual case of Meckel's diverticulum complication. It highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen in this age group.
Topics: Male; Humans; Child; Meckel Diverticulum; Spontaneous Perforation; Abdominal Pain; Abdomen, Acute; Laparotomy; Intestinal Perforation; Appendicitis
PubMed: 37013310
DOI: 10.47391/JPMA.4202 -
World Journal of Gastroenterology Jul 2014To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers.
AIM
To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers.
METHODS
Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted (TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years (range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was established based on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients' demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed.
RESULTS
MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min (range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d (range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years (range 10 mo-10 years).
CONCLUSION
Trans-umbilical laparoscopic-assisted Meckel's diverticulectomy is safe and effective in the treatment of MD, with excellent results.
Topics: Abdominal Pain; Adolescent; Child; Child, Preschool; Female; Gastrointestinal Hemorrhage; Humans; Infant; Italy; Laparoscopy; Length of Stay; Male; Meckel Diverticulum; Operative Time; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 25009390
DOI: 10.3748/wjg.v20.i25.8173 -
Journal of Nuclear Medicine : Official... Feb 2016Gastrointestinal bleeding scintigraphy performed with (99m)Tc-labeled autologous erythrocytes or historically with (99m)Tc-sulfur colloid has been a clinically useful... (Review)
Review
Gastrointestinal bleeding scintigraphy performed with (99m)Tc-labeled autologous erythrocytes or historically with (99m)Tc-sulfur colloid has been a clinically useful tool since the 1970s. This article reviews the history of the techniques, the different methods of radiolabeling erythrocytes, the procedure, useful indications, diagnostic accuracy, the use of SPECT/CT and CT angiography to evaluate gastrointestinal bleeding, and Meckel diverticulum imaging. The causes of pediatric bleeding are discussed by age.
Topics: Aging; Child; Erythrocytes; Gastrointestinal Hemorrhage; History, 20th Century; History, 21st Century; Humans; Meckel Diverticulum; Nuclear Medicine; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon
PubMed: 26678616
DOI: 10.2967/jnumed.115.157289 -
Journal of Medical Case Reports May 2015Heterotopic pancreas is defined as pancreatic tissue without a real anatomical or vascular connection to the pancreas. It can be found in the stomach, duodenum, jejunum,... (Review)
Review
INTRODUCTION
Heterotopic pancreas is defined as pancreatic tissue without a real anatomical or vascular connection to the pancreas. It can be found in the stomach, duodenum, jejunum, ileum, Meckel's diverticulum, colon gall bladder, umbilicus, fallopian tube, mediastinum, spleen and liver. Complications of heterotopic pancreas are inflammation, bleeding, obstruction, malignant transformation, carcinoid syndrome, jejunojejunal intussusception and ileus, but it is usually asymptomatic and diagnosed only during examinations for other diseases.
CASE PRESENTATION
An 81-year-old Lithuanian woman was diagnosed with caecal cancer and had undergone elective surgery. A right hemicolectomy was performed and a Meckel's diverticulum was observed and excised. Histological results showed a poorly differentiated G3 adenocarcinoma of her large intestine and heterotopic pancreas tissue in the Meckel's diverticulum and mesenteric adipose tissue.
CONCLUSIONS
Asymptomatic heterotopic pancreas is rarely diagnosed, and usually found incidentally during surgical or diagnostic interventions. Although it has no symptoms, heterotopic pancreas found during surgical procedures should be excised.
Topics: Aged, 80 and over; Asymptomatic Diseases; Cecal Neoplasms; Choristoma; Colonoscopy; Female; Humans; Meckel Diverticulum; Pancreas
PubMed: 25956067
DOI: 10.1186/s13256-015-0576-x -
In Vivo (Athens, Greece) 2023Meckel's diverticulum carcinoma (MDCa) is extremely rare. It is often advanced when found, and the prognosis is poor. Effective treatment for this cancer has not yet...
Meckel's Diverticulum Carcinoma Is Arrested by Oxaliplatinum and Eradicated by 5-Fluorouracil in a PDX Mouse Model Indicating Candidate First-line Treatment for a Rare Cancer.
BACKGROUND/AIM
Meckel's diverticulum carcinoma (MDCa) is extremely rare. It is often advanced when found, and the prognosis is poor. Effective treatment for this cancer has not yet been developed. We previously established a patient-derived xenograft (PDX) nude-mouse model of MDCa. In the present study, we investigated the efficacy of oxaliplatinum (L-OHP) and 5-fluorouracil (5-FU) on an MDCa PDX nude-mouse model.
MATERIALS AND METHODS
PDX mouse models of MDCa were divided into three groups (five mice per group): untreated control; L-OHP-treated; and 5-FU-treated. Tumor volumes of the three groups were compared after 2 weeks.
RESULTS
L-OHP arrested tumor growth (p=0.038) and 5-FU apparently eradicated the tumor (p=0.007).
CONCLUSION
L-OHP and 5-FU are candidates for clinical first-line therapy of MDCa.
Topics: Humans; Mice; Animals; Fluorouracil; Meckel Diverticulum; Oxaliplatin; Treatment Outcome; Carcinoma
PubMed: 37369464
DOI: 10.21873/invivo.13232 -
World Journal of Gastroenterology Sep 2021Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly. However, its presentation as an inverted Meckel's diverticulum is a rare...
BACKGROUND
Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly. However, its presentation as an inverted Meckel's diverticulum is a rare complication, of which few cases have been reported in the literature.
CASE SUMMARY
Here, we report the case of a 33-year-old man with iron deficiency anemia without manifestation of gastrointestinal bleeding. An upper gastrointestinal endoscopy and total colonoscopy were performed, but no abnormalities were found within the observed area. Finally, a capsule endoscopy was performed and offered us a clue to subsequently confirm the diagnosis of inverted Meckel's diverticulum computed tomography scan. Laparoscopic intestinal resection surgery was performed. The final pathology report described a Meckel's diverticulum.
CONCLUSION
Since inverted Meckel's diverticulum is an uncommon disease and its clinical presentation is not specific, it may go undetected by capsule endoscopy. Successful diagnosis and treatment of this disease requires a high index of clinical suspicion.
Topics: Adult; Anemia, Iron-Deficiency; Capsule Endoscopy; Double-Balloon Enteroscopy; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum
PubMed: 34629826
DOI: 10.3748/wjg.v27.i36.6154 -
Journal of Cancer Research and... 2017Tumors arising from Meckel's diverticulum (MD) reported in the literature are mainly carcinoid and gastrointestinal stromal tumors. We herein report a rare case of... (Review)
Review
Tumors arising from Meckel's diverticulum (MD) reported in the literature are mainly carcinoid and gastrointestinal stromal tumors. We herein report a rare case of adenocarcinoma arising from intestinal mucosa in an MD with multiple liver metastases at the onset of symptoms. A 57-year-old female complaining of bloody stool for 2 weeks was admitted to our hospital. Colonoscopy revealed massive bloody fluids but did not find any neoplasm. Computed tomography (CT) found a heterogeneous mass at the distal ileum and multiple liver metastases. A segmental ileal resection with local mesentery excision was performed to control the bleeding. During surgery, a tumor arising from a diverticulum in the antimesenteric border of ileum was observed. Histologic examination revealed moderate to poorly differentiated adenocarcinoma. Majority of the MD remain asymptomatic and are diagnosed incidentally during small bowel contrast study, laparoscopy or laparotomy done for unrelated conditions, or until complications arise from the diverticulum. Malignancies are reported to account for only 0.5%-3.2% of the complications. The occurrence of adenocarcinoma in an MD is exceedingly rare. In the few cases described so far, the prognosis of adenocarcinoma within an MD has been poor due to the advanced stage as seen at the time of surgery. Despite the availability of many publications, there is a little consensus concerning the management of an incidental finding of MD. Adenocarcinoma in an MD is extremely sporadic and prognosis has been reported as very poor. However, early diagnosis is challenging. When found incidentally during laparotomy, MD should be carefully examined and best treated with prophylactic resection.
Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Colonoscopy; Female; Fluorouracil; Gastrointestinal Hemorrhage; Humans; Ileum; Incidental Findings; Intestinal Mucosa; Leucovorin; Meckel Diverticulum; Middle Aged; Organoplatinum Compounds; Tomography, X-Ray Computed; Ultrasonography
PubMed: 29237920
DOI: 10.4103/jcrt.JCRT_124_17 -
Frontiers in Surgery 2021Meckel diverticulum (MD) is the most common congenital anomaly of the intestines, with an incidence of 2% of the general population. It can present as various clinical...
Meckel diverticulum (MD) is the most common congenital anomaly of the intestines, with an incidence of 2% of the general population. It can present as various clinical features with complications and be life threatening if diagnosis is delayed and treatment late. We report three pediatric cases with complicated MD: one female presented with small-bowel obstruction, one male with peritonitis, and one female with severe iron-deficiency anemia, without gross gastrointestinal bleeding nor any ectopic gastric mucosa. All patients underwent exploratory laparotomy, segmental small-bowel resection, and primary anastomosis. They successfully recovered and were uneventfully discharged on the fourth, seventh, and 10th postoperative days, respectively. MD can present with various complication spectrums, including small-bowel obstruction, peritonitis, and severe iron-deficiency anemia, which may cause difficulty in definitive diagnosis, particularly in children. Segmental small-bowel resection and primary anastomosis are effective surgical approaches and show good outcomes for MD patients.
PubMed: 34113646
DOI: 10.3389/fsurg.2021.674382 -
The Turkish Journal of Gastroenterology... Apr 2014Meckel's diverticulum is a common anomaly of the small intestine and occasionally presents as obscure gastrointestinal hemorrhage. Before operation, it is difficult to... (Review)
Review
Meckel's diverticulum is a common anomaly of the small intestine and occasionally presents as obscure gastrointestinal hemorrhage. Before operation, it is difficult to diagnose by imaging, especially in adults. Conventional abdominal computed tomography and endoscopy have limitations for the diagnosis of Meckel's diverticulum. Diagnostic methods in patients with small bowel lesions include enteroclysis, angiography, push enteroscopy, and capsule endoscopy; however, all of these techniques have low diagnostic yields to detect Meckel's diverticulum. Recently, computed tomographic enterography has been reliable in assessing small bowel disease. We present 3 cases of Meckel's diverticulum with bleeding in adults who were diagnosed by computed tomographic enterography. The bleeding source was not found in the total colonoscopy, and Tc-99m pertechnetate scans were negative in these patients. However, outpouching structures of the distal ileum with enhancement were detected by computed tomographic enterography. All patients underwent small bowel segmental resection. Meckel's diverticulum was confirmed by histopathology of the resected ileum segment, and the type of heterotopic tissue was gastric mucosa.
Topics: Adolescent; Adult; Gastrointestinal Hemorrhage; Humans; Male; Meckel Diverticulum; Radiology, Interventional; Tomography, X-Ray Computed
PubMed: 25003685
DOI: 10.5152/tjg.2014.6044 -
The Journal of International Medical... Sep 2020Meckel's diverticulum (MD) is a relatively common true congenital diverticulum on the ileum. Bleeding caused by polypoid hyperplasia of ectopic gastric mucosa in MD is...
Meckel's diverticulum with polypoid hyperplasia of ectopic gastric mucosa diagnosed by double-balloon enteroscopy and single-photon emission computed tomography/computed tomography.
Meckel's diverticulum (MD) is a relatively common true congenital diverticulum on the ileum. Bleeding caused by polypoid hyperplasia of ectopic gastric mucosa in MD is rare. A 14-year-old Chinese boy presented with intermittent melena and haematochezia for 1 month. Laboratory data showed normocytic anaemia. Gastroscopic findings were normal. The patient underwent exploratory laparotomy without bowel preparation on day 2 because of sudden haematochezia and decreased haemoglobin. Intraoperative colonoscopy revealed inflammatory changes in the terminal ileal mucosa with diffuse haemorrhage. Melena with decreased haemoglobin recurred 20 days after the first operation. Computed tomography (CT) and angiography revealed a tubular lesion that was localised in the right lower abdominal quadrant. Single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging with 99m-technetium pertechnetate confirmed moderately increased uptake in the distal ileum. Retrograde double-balloon enteroscopy (DBE) showed a diverticulum with prominent mucosal polypoid hyperplasia at an insertion depth of 100 cm from the anastomotic stoma. Diverticulectomy and end-to-end anastomosis were performed, and MD was confirmed by a histopathological examination. The patient's postoperative recovery was uneventful during the 2-month follow-up. MD with polypoid hyperplasia of ectopic gastric mucosa is rare. Complementary use of DBE and SPECT/CT can accurately diagnose MD by providing anatomical and functional information.
Topics: Adolescent; Double-Balloon Enteroscopy; Gastric Mucosa; Humans; Hyperplasia; Male; Meckel Diverticulum; Tomography, Emission-Computed
PubMed: 32954882
DOI: 10.1177/0300060520955055