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Hansen LØ, Thorndal C, Agache A, Koulaouzidis A. Meckel's diverticulum discovered by capsule endoscopy: a systematic review of case reports. Scand J Gastroenterol 2025; 60:414-420. [PMID: 40202427 DOI: 10.1080/00365521.2025.2487536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 01/30/2025] [Accepted: 03/27/2025] [Indexed: 04/10/2025]
Abstract
OBJECTIVES Capsule endoscopy has achieved its place as a diagnostic tool in a clinical setting, especially in the small bowel. The most frequent malformation of the gastrointestinal tract (Meckel's Diverticulum) has therefore been discovered incidentally by capsule endoscopies multiple times. However, it is still not a regular diagnostic modality when the pathology is suspected. In this review of case reports, we aim to evaluate the knowledge and rationales of using capsule endoscopy as a diagnostic tool for Meckel's diverticulum. METHODS We performed a search through Pubmed and Embase to find all publications describing cases of Meckel's diverticulum diagnosed by capsule endoscopy. All data was collected, and a stratification based on age group (adult versus pediatric patients) was performed. RESULTS The search resulted in 43 cases of Meckel's diverticulum diagnosed with capsule endoscopy, reported in 33 publications. The majority of the patients were male, with a median age of 20 years, and had an average of three negative investigations performed prior to capsule endoscopy. The three most commonly used investigations were upper and lower endoscopy and Meckel's scan. The most frequent finding on capsule endoscopy was the double lumen sign. CONCLUSION The case reports indicate that capsule endoscopy can and has been used as a diagnostic tool for Meckel Diverticulum going back as far as 2002, with the most common finding being the double lumen sign. But it also highlights that patients too often go through multiple negative investigations before having a capsule endoscopy performed.
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Affiliation(s)
- Lea Østergaard Hansen
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Thorndal
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alexandra Agache
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anastasios Koulaouzidis
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Bowman S, Wysong M, Marzec S. Abdominal Pain and Vomiting in a 2-Year-Old Boy: A Case of Intussusception and Perforated Meckel's Diverticulum. JOURNAL OF BROWN HOSPITAL MEDICINE 2025; 4:54-58. [PMID: 40191707 PMCID: PMC11966758 DOI: 10.56305/001c.129038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/24/2025] [Indexed: 04/09/2025]
Abstract
Meckel's diverticulum is a congenital anomaly that can lead to complications such as gastrointestinal bleeding, intussusception, and perforation. We present a case of a healthy 2-year-old boy who initially presented with abdominal pain, vomiting, and diarrhea, which was misdiagnosed as acute gastritis. Despite symptomatic treatment, his condition worsened with the development of intermittent abdominal pain and non-bloody diarrhea. Initial imaging, including abdominal X-ray and ultrasound, did not reveal significant findings, and the patient was discharged after rehydration. However, he returned to the hospital with worsening pain and new reddish-brown stool, prompting further evaluation. A targeted ultrasound revealed ileo-ileal intussusception, and surgical exploration confirmed a perforated Meckel's diverticulum. Histopathology confirmed acute Meckel's diverticulitis with serosal inflammation and perforation. This case underscores the rarity of complications from Meckel's diverticulum, which typically presents with painless bloody stool, but in this patient, led to both intussusception and perforation.
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Affiliation(s)
- Sara Bowman
- Department of Pediatric Hematology-Oncology Nationwide Children's Hospital
| | - Matthew Wysong
- Department of Hospital Pediatrics Nationwide Children's Hospital
| | - Sarah Marzec
- Department of Hospital Pediatrics Nationwide Children's Hospital
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Kapseu SK, Tchokonte-Nana V. Meckel's Diverticulum Mimicking a Postoperative Flange with Acute Intestinal Obstruction and Midgut Volvulus: A Case Report. Surg Case Rep 2025; 11:24-0079. [PMID: 40026839 PMCID: PMC11868803 DOI: 10.70352/scrj.cr.24-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 12/25/2024] [Indexed: 03/05/2025] Open
Abstract
INTRODUCTION The interest of this case lies in the exceptional and rare character of the observed association.: Meckel's diverticulum (MD) mimicking a postoperative flange complicated by acute intestinal obstruction and malrotation by midgut volvulus. CASE PRESENTATION A 17-year-old black male student, with a body mass index of 28 kg/m2 was admitted to the emergency department of a 4th category rural hospital, with paroxystic abdominal pain and vomiting. Medical history revealed an abdominal surgery for an umbilical hernia 3 years earlier. There was no malformation such as imperforate anus, Hirschsprung's disease, esophageal tracheal fistula, or cardiac anomaly in the medical history. An abdominal X-ray confirmed an acute intestinal obstruction showing hydroaeric levels. The diagnosis of acute intestinal obstruction on a flange was retained. A median laparotomy was performed; a solid mass-like lengthy structure mimicking postoperative flange was seen associated with midgut volvulus, while a malposition of the intestine was observed with a mesenteric band, as well as a hyperemic appendix. A 90° rotation stop of the midgut also called a complete common mesentery was in place; we then carried out a Ladd procedure. Morpho-pathological examination of the surgical specimens revealed the following: richly vascularized fibro-adipose tissues with no evidence of malignancy in the diverticular specimen, and acute pan-appendicitis with no evidence of malignancy in the appendicular specimen. The patient started to ingest food orally on the third postoperative day, and he was discharged uneventfully on the fifth day. CONCLUSION MD, although generally a tubular structure, may sometimes appear as a non-tubular mass during clinical examination. Intestinal obstruction due to MD associated with midgut volvulus is exceptional. Management of this association should be based on accurate knowledge of the morpho-embryological specificities during gut development.
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Affiliation(s)
- Stéphane Kohpe Kapseu
- Cliniques Universitaires des Montagnes, Bangangté, West, Cameroon
- Faculty of Health Sciences, Comparative Anatomy and Experimental Histopathology and Surgery, Université des Montagnes, Bangangté, West, Cameroon
| | - Venant Tchokonte-Nana
- Faculty of Health Sciences, Comparative Anatomy and Experimental Histopathology and Surgery, Université des Montagnes, Bangangté, West, Cameroon
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Mao YH, Huang LB, Jia Q, Li SJ, Zeng Q, Yang J, Yang CJ, Pu Q, Liu XP. Rare "ileum-ileum-colon type" adult intussusception caused by Meckel's diverticulum inversion: A case report. Medicine (Baltimore) 2025; 104:e41237. [PMID: 40184087 PMCID: PMC11709155 DOI: 10.1097/md.0000000000041237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 12/19/2024] [Indexed: 04/05/2025] Open
Abstract
RATIONALE Ileum-ileum-colon intussusception constitutes a small proportion of the classification of intussusception. Both adult intussusception and Meckel's diverticulum are rare clinical entities, with few reports documenting Meckel's diverticulum inversion leading to ileum-ileum-colon intussusception in adults. PATIENT CONCERNS A 33-year-old Chinese male presented with intermittent abdominal pain persisting for 1 month, that had intensified over the preceding day. DIAGNOSES Abdominal computed tomography revealed intussusception, suspected to be secondary to a small intestinal lipoma. INTERVENTIONS Emergency laparotomy was performed, during which the ileum, located approximately 70 cm from the ileocecal region, was found to be invaginated into the terminal ileum and subsequently into the ascending colon, reaching the hepatic flexure. An inverted Meckel's diverticulum was at the forefront of the intussusception. Surgical resection of the diverticulum, terminal ileum, and cecum was performed, followed by an end-to-side anastomosis of the ileum and colon. OUTCOMES The patient was discharged on postoperative day 7 without complications. During a 1-month follow-up, the patient reported no discomfort and exhibited normal bowel movements. LESSONS Adult intussusception of the "ileum-ileum-colon type" resulting from inverted Meckel's diverticulum is exceedingly rare and poses challenges for preoperative diagnosis. Prompt surgical intervention can lead to favorable outcomes in patients. During surgery, the initial step should involve attempting reduction of the intussusception while ensuring that the intestine is preserved as much as possible to maintain intestinal function.
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Affiliation(s)
- Yi-Hu Mao
- Department of Gastrointestinal Surgery, The People’s Hospital of Lezhi, Lezhi, China
| | - Li-Bin Huang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, Sichuan Province, China
| | - Qi Jia
- Department of Gastrointestinal Surgery, The People’s Hospital of Lezhi, Lezhi, China
| | - Shu-Jun Li
- Department of Gastrointestinal Surgery, The People’s Hospital of Lezhi, Lezhi, China
| | - Qian Zeng
- Department of Gastrointestinal Surgery, The People’s Hospital of Lezhi, Lezhi, China
| | - Jian Yang
- Department of Gastrointestinal Surgery, The People’s Hospital of Lezhi, Lezhi, China
| | - Cai-Jun Yang
- Department of Gastrointestinal Surgery, The People’s Hospital of Lezhi, Lezhi, China
| | - Qi Pu
- Department of Gastrointestinal Surgery, The People’s Hospital of Lezhi, Lezhi, China
| | - Xue-Ping Liu
- Department of Pathology, The People’s Hospital of Lezhi, Lezhi, China
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Moreno-Alfonso JC, Hernández Martín S, Molina Caballero A, Pérez Martínez A, Yárnoz Irazábal MC. The "rule of two" in Meckel's diverticulum - Does it truly apply to the pediatric population in our area? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 39364705 DOI: 10.17235/reed.2024.10798/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Meckel's Diverticulum (MD) originates from the incomplete obliteration of the omphalomesenteric duct during the seventh week of gestation. The classic clinical description of MD follows the "rule of two: 2% of the population, 2 inches in length, 2 feet from the ileocecal valve, a 2:1 ratio between males and females, and presentation at two years of age. This study evaluates to what extent the "rule of two" applies to a Spanish pediatric cohort.
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O'Doherty C, Yan A, O'Doherty M, Gilman D. Emergent Laparotomy Reveals Possible Meckel's Diverticulum: A Case Report. Cureus 2024; 16:e71498. [PMID: 39544566 PMCID: PMC11561334 DOI: 10.7759/cureus.71498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2024] [Indexed: 11/17/2024] Open
Abstract
Small bowel obstruction (SBO) remains the most common diagnosis encountered by general surgeons, with 70% of cases related to adhesions from previous abdominal surgeries. Less common etiologies include Crohn's disease, gallstone ileus, and Meckel's diverticulum (MD). While MD is the most common congenital anomaly of the gastrointestinal tract, it is less frequently considered as a cause in adults. Nonetheless, it remains crucial to consider MD as a potential cause of SBO in adults, especially when evaluating patients with unexplained SBO and recurrent idiopathic abdominal pain, especially in those without a history of abdominal surgery. We present a case of a 74-year-old male presenting with right upper quadrant abdominal pain, constipation, and bilious vomiting, with a presumed diagnosis of SBO and perforation, potentially attributed to MD. This case highlights the differential challenges posed by small bowel diverticula and their complications, underscoring the need for vigilance in recognizing these complications and optimizing clinical management.
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Affiliation(s)
- Casey O'Doherty
- Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Audrey Yan
- Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Missy O'Doherty
- Emergency Medicine/Paramedics, Institute of Applied Technology, San Diego, USA
| | - Denise Gilman
- General Surgery, Trinity West Medical Center, Steubenville, USA
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Alkhlaifat AM, Qsous RS, Bani Khaled SH, Arekat KA, Almabroom MS. A Giant Perforated Meckel's Diverticulum With Fecalith Obstruction: A Case Report. Cureus 2024; 16:e71943. [PMID: 39564051 PMCID: PMC11576067 DOI: 10.7759/cureus.71943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2024] [Indexed: 11/21/2024] Open
Abstract
Meckel's diverticulum is a common congenital malformation of the small intestines. This true diverticulum can lead to complications such as intestinal obstruction, bleeding, and rarely perforation, particularly in adults where the diagnosis is uncommon and often complicated by overlapping symptoms with conditions such as acute appendicitis. Giant Meckel's diverticulum (>5 cm) cases are extremely rare and pose significant clinical challenges due to severe complications. A 44-year-old male patient presented with a two-day history of diffuse, colicky abdominal pain, nausea, and diarrhea. Initial evaluations, including lab tests and imaging, were inconclusive. However, on the following day, the patient exhibited worsening pain, mild tachycardia, and elevated white blood cell count. A computed tomography scan revealed a tubular structure with significant enhancement and surrounding fat stranding, suggestive of an inflamed Meckel's diverticulum with micro-perforation. Exploratory laparotomy confirmed a giant (>5 cm) perforated Meckel's diverticulum with a large fecalith and extensive adhesions. Surgical intervention included adhesiolysis, bowel resection, and anastomosis. Postoperatively, the patient's condition improved, and he was discharged on the third day. Histopathology confirmed acute suppurative inflammation and perforation without evidence of malignancy or ectopic tissue. This case highlights the diagnostic challenges and severe complications of giant Meckel's diverticulum in adults. Timely surgery is critical, especially for rare presentations like giant perforated diverticulum with fecalith obstruction. Awareness of Meckel's diverticulum in adult acute abdomen cases is essential to avoid delays and reduce morbidity and mortality.
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Affiliation(s)
- Ali M Alkhlaifat
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Ra'ad S Qsous
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | | | - Khaled A Arekat
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
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Ahmed M, Saeed R, Allawi A, Zajicek J. Meckel's Diverticulum With Perforation. Cureus 2024; 16:e67026. [PMID: 39280390 PMCID: PMC11402473 DOI: 10.7759/cureus.67026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 09/18/2024] Open
Abstract
Meckel's diverticulum (MD) is a common congenital defect of the small intestinal tract resulting from incomplete obliteration of the vitellointestinal duct. It presents with unexplained gastrointestinal bleeding, bowel obstruction, and inflammation. In rare instances, the presentation is with perforation similar to acute appendicitis with perforation. The symptoms, clinical exam, and radiological findings of our patient, a 38-year-old male, were consistent with perforated acute appendicitis; he was found to have a perforated Meckel's diverticulum intraoperatively.
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Affiliation(s)
- Mohamed Ahmed
- Surgery, University of California, Riverside, Riverside, USA
| | - Rasha Saeed
- Occupational Medicine/Environmental Medicine, University of California, Irvine, Irvine, USA
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Saab MA, Jacobson E, Hanson K, Kruciak B, Miramontes D, Harper S. Prehospital Whole Blood Administration for Pediatric Gastrointestinal Hemorrhage: A Case Report. PREHOSP EMERG CARE 2024; 29:89-92. [PMID: 38940756 DOI: 10.1080/10903127.2024.2372808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
The management of gastrointestinal (GI) hemorrhage in a prehospital setting presents significant challenges, particularly in arresting the hemorrhage and initiating resuscitation. This case report introduces a novel instance of prehospital whole blood transfusion to an 8-year-old male with severe lower GI hemorrhage, marking a shift in prehospital pediatric care. The patient, with no previous significant medical history, presented with acute rectal bleeding, severe hypotension (systolic/diastolic blood pressure [BP] 50/30 mmHg), and tachycardia (148 bpm). Early intervention by Emergency Medical Services (EMS), including the administration of 500 mL (16 mL/kg) of whole blood, led to marked improvement in vital signs (BP 97/64 mmHg and heart rate 93 bpm), physiology, and physical appearance, underscoring the potential effectiveness of prehospital whole blood transfusion in pediatric GI hemorrhage. Upon hospital admission, a Meckel's diverticulum was identified as the bleeding source, and it was successfully surgically resected. The patient's recovery was ultimately favorable, highlighting the importance of rapid, prehospital intervention and the potential role of whole blood transfusion in managing acute pediatric GI hemorrhage. This case supports the notion of advancing EMS protocols to include interventions historically reserved for the hospital setting that may significantly impact patient outcomes from the field.
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Affiliation(s)
- Mathew A Saab
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Eric Jacobson
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Kip Hanson
- San Antonio Fire Department, San Antonio, Texas
| | | | - David Miramontes
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Stephen Harper
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
- Department of Emergency Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas
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Sekarsari D, Saptari EP, Amal MY, Handoyono QF, Siswoyo AD, Sastiono, Oswari H, Krisnuhoni E. The significance of Meckel's scan in pediatric gastrointestinal bleeding cases: A case report. Radiol Case Rep 2024; 19:2767-2772. [PMID: 38680747 PMCID: PMC11046046 DOI: 10.1016/j.radcr.2024.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Meckel's diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, identified in 2% of the population according to autopsy studies. Most patients remain asymptomatic throughout their lives and are typically diagnosed when complications arise. The diagnosis can be challenging, but imaging is crucial for promptly identifying and distinguishing it from other conditions that have similar clinical manifestations. A 13-year-old male was admitted with a 5-day history of rectal bleeding. The patient continued to experience painless gastrointestinal bleeding, indicating the performance of a Tc-99m pertechnetate scintigraphy or Meckel's scan. Planar images revealed focal uptake within the right hemiabdomen, suggestive of the presence of a Meckel's diverticulum. Subsequent laparotomy surgery confirmed the presence of a Meckel's diverticulum located 50 cm from the ileocecal valve. Histopathological examination of the resected specimen confirmed Meckel's diverticulum with ectopic gastric mucosa. This patient with Meckel's diverticulum exhibited minimal abdominal symptoms, and there were no other complications such as intussusception, which could lead to bowel obstruction. Technetium-99m pertechnetate scintigraphy is a common method for evaluating children with unexplained gastrointestinal tract bleeding. SPECT/CT fusion imaging enables the simultaneous fusion of functional and anatomical information, preventing false-negative scintigraphy examinations. Its capability to precisely localize activity in abnormal structures contributes to accurate scan interpretation. Complications of Meckel's diverticulum are uncommon and pose a diagnostic challenge. Through comprehensive history-taking, physical examination, and nuclear imaging, the diagnosis can be identified, and surgical intervention can be performed to achieve the best possible outcome for the patient.
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Affiliation(s)
- Damayanti Sekarsari
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
| | - Ella Putri Saptari
- Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
| | - Mohamad Yanuar Amal
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
| | - Quinta Febryani Handoyono
- Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
| | - Alvita Dewi Siswoyo
- Department of Nuclear Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
| | - Sastiono
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
| | - Hanifah Oswari
- Division of Gastrohepatology, Department of Pediatrics, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
| | - Ening Krisnuhoni
- Department of Anatomic Pathology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Salemba Raya No. 4, Kenari, Senen, Central Jakarta, DKI Jakarta, Indonesia
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Haq A, Haghighat Jahromi A. Ectopic "Ectopic" Gastric Mucosa. Diagnostics (Basel) 2024; 14:1162. [PMID: 38893687 PMCID: PMC11172280 DOI: 10.3390/diagnostics14111162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
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.
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Affiliation(s)
- Adeel Haq
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA;
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12
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Yagnik VD, Garg P, Dawka S. Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review. Clin Exp Gastroenterol 2024; 17:147-155. [PMID: 38736719 PMCID: PMC11088382 DOI: 10.2147/ceg.s460053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, poses a dilemma when incidentally encountered during surgery. Despite historical descriptions and known complications of symptomatic MD, the decision to resect an incidental MD (IMD) lacks clear guidelines. This study aims to assess whether resecting IMDs is justified by synthesizing evidence from studies published between 2000 and 2023. Factors influencing this decision, such as demographic risks, surgical advancements and complications, are systematically examined. METHODS AND MATERIAL Following the PRISMA 2020 guidelines, this review incorporates 42 eligible studies with data on outcomes of asymptomatic MD management. Studies, both favoring and opposing resection, were analyzed. RESULTS Considering complications, malignancy potential, and operative safety, the risk-benefit analysis presents a nuanced picture. Some authors propose conditional resection based on specific criteria, emphasizing patient-specific factors. Of 2934 cases analyzed for short- and long-term complications, the morbidity rate was 5.69%. Of 571 cases where mortality data were available, all 5 fatalities were attributed to the primary disease rather than IMD resection. CONCLUSION The sporadic, unpredictable presentation of IMD and the variability of both the primary disease and the patient make formulation of definitive guidelines challenging. The non-uniformity of complications reporting underscores the need for standardized categorization. While the balance of evidence leans towards resection of IMDs, this study acknowledges the individualized nature of this decision. Increased safety in surgery and anesthesia, along with better understanding and management of complications favor a judicious preference for resection, while taking into account patient characteristics and the primary disease.
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Affiliation(s)
- Vipul D Yagnik
- Department of Surgery, Banas Medical College and Research Institute, Palanpur, GJ, India
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, GJ, India
| | - Pankaj Garg
- Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, HR, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
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Carlaw KR, Liyanage C. A rare case of perforated Meckle's diverticulitis: a case report. J Surg Case Rep 2024; 2024:rjae315. [PMID: 38764737 PMCID: PMC11102781 DOI: 10.1093/jscr/rjae315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024] Open
Abstract
Meckle's diverticulum is the most common embryological anomaly of the small bowel that is rarely seen in adults. It is caused by the incomplete closure of the vitelline or omphalomesenteric duct. Those who are symptomatic from Meckle's diverticulum have varied clinical presentations, which raise significant challenges with diagnostic and management options. We report a case of a 47-year-old male who presented to the hospital with clinical signs of appendicitis but was found to have perforated Meckle's diverticulitis with faecoliths on computed tomography imaging and laparoscopy. Furthermore, histopathology revealed an ectopic gastric tissue cell type, which is a rare finding. This was definitively managed surgically with laparoscopic resection of Meckle's diverticulum and appendicectomy.
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Affiliation(s)
- Kirsten R Carlaw
- General Surgery Department, Dubbo Base Hospital, Myall Street, Dubbo, NSW 2830, Australia
| | - Chandika Liyanage
- General Surgery Department, Dubbo Base Hospital, Myall Street, Dubbo, NSW 2830, Australia
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14
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Zhou J, Zhang H, Xiang Q, Dong F, Sun L. Heterotopic pancreas in Meckel's diverticulum causing perforation in an infant: a case report. J Surg Case Rep 2024; 2024:rjae375. [PMID: 38826858 PMCID: PMC11141289 DOI: 10.1093/jscr/rjae375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024] Open
Abstract
Perforation of Meckel's diverticulum caused by heterotopic pancreas is a rare condition. Despite recent improvements in imaging studies, Meckel"'s diverticulitis and heterotopic pancreas are difficult to diagnose preoperatively and are often diagnosed during autopsy or laparotomy. Symptomatic patients are typically >1 year, and cases of infants displaying symptoms are rarely reported. We report a rare case of heterotopic pancreas in Meckel's diverticulum causing perforation in an infant. In cases of infants presenting with unexplained acute abdominal pain, there should be a high index of suspicion for congenital gastrointestinal malformations. Prompt action in the form of exploratory laparotomy or laparoscopy is crucial to prevent the escalation of complications and to definitively confirm the diagnosis.
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Affiliation(s)
- Junjie Zhou
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Hongbin Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Qianming Xiang
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Fabiao Dong
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
| | - Luyun Sun
- Department of Pediatric Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
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15
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Salman Roghani R, Jamali A, Ajumobi A. Occult Gastrointestinal Hemorrhage From a Meckel's Adenocarcinoma: A Diagnostic Dilemma. Cureus 2024; 16:e59685. [PMID: 38836148 PMCID: PMC11150015 DOI: 10.7759/cureus.59685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/06/2024] Open
Abstract
Gastrointestinal bleeding from Meckel's diverticulum can be challenging to diagnose. We present a case of a 78-year-old man with painless hematochezia. Despite undergoing standard investigations, the source of bleeding remained elusive until arteriography localized bleeding from Meckel's diverticulum. Prompt management involved embolization followed by laparoscopic resection. This case underscores the need to consider Meckel's diverticulum as a source of obscure gastrointestinal bleeding even in the elderly, as well as the need to use non-conventional diagnostic approaches when standard methods fail. The successful management of the case through embolization and laparoscopic resection highlights the crucial role interventional radiologists and surgeons play in the management of Meckel's diverticulum-related complications.
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Affiliation(s)
| | - Arsia Jamali
- Internal Medicine, Eisenhower Health, Rancho Mirage, USA
| | - Adewale Ajumobi
- Gastroenterology, Eisenhower Health, Rancho Mirage, USA
- Medicine, University of California Riverside, Riverside, USA
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16
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Sun YM, Xin W, Liu YF, Guan ZM, Du HW, Sun NN, Liu YD. Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case reports. World J Clin Cases 2024; 12:865-871. [PMID: 38322683 PMCID: PMC10841135 DOI: 10.12998/wjcc.v12.i4.865] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding. CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided. CONCLUSION Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.
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Affiliation(s)
- Yi-Meng Sun
- School of Clinical Medicine, Weifang Medical University, Weifang 261000, Shandong Province, China
| | - Wang Xin
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yu-Fang Liu
- Department of Burn Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Zhe-Ming Guan
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Hao-Wen Du
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Ning-Ning Sun
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yong-Dong Liu
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
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17
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Gambardella M, Smaldone M, Iazzetta F, Corbisiero MC, Graviero G, Coppola GM. Preoperative CT diagnosis of perforated Meckel's diverticulitis in a young patient: a case report. J Basic Clin Physiol Pharmacol 2024; 35:93-97. [PMID: 38015811 DOI: 10.1515/jbcpp-2023-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Meckel's diverticulum (MD) is a common asymptomatic congenital intestinal anomaly. Clinical manifestations of MD can occur in about 4 % of cases by the presentation of its complications, generally intestinal occlusion, bleeding, and diverticular inflammation. MD's complications are challenging preoperative diagnoses, as manifest with clinical symptoms that overlap with those of other acute non-traumatic abdominal diseases. Thus, in the emergency setting, abdominal computed tomography (CT) represents an essential tool for the correct diagnosis of complicated MD. CASE PRESENTATION We present a case of a preoperative CT diagnosis of perforated Meckel's diverticulitis in a young patient admitted to our Emergency Department complaining of acute abdominal pain. CONCLUSIONS The case highlights the importance of evaluating Meckel's diverticulum complications among the differential diagnoses of acute non-traumatic abdominal pain and the high sensitivity of CT in assessing their presence in the proper clinical setting.
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18
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Konstantakis C, Mantzios P, Sotiropoulos C, Anesidis S, Thomopoulos KC. Intussuscepted Polypoid Meckel's Diverticulum Presenting With Gastrointestinal Bleeding in a Young Adult. Cureus 2024; 16:e51744. [PMID: 38318558 PMCID: PMC10840443 DOI: 10.7759/cureus.51744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
A 22-year-old female patient with a recent hospitalization for gastrointestinal bleeding presented with recurrent hematochezia and a positive shock index. Previous investigations, including endoscopy and wireless small bowel capsule, were non-diagnostic. CT angiography revealed extravasation in the ileum. Initial tests like technetium-99m scintigraphy and ileocolonoscopy were negative. Repeat wireless small bowel capsule identified a partially ulcerated polypoid mass in the distal ileum. At surgical exploration, an intussuscepted Meckel's diverticulum was identified and resected. A histopathologic examination confirmed the diagnosis. Meckel's diverticulum is a rare cause of gastrointestinal bleeding in adults. Preoperative diagnosis can be challenging. Reports of a polypoid morphology are very scarce in indexed literature and mostly derive from investigation with device-assisted enteroscopy. We report this extremely rare finding at capsule endoscopy to raise clinician awareness and to discuss diagnostic difficulties associated with similar cases, such as the negative scintigraphy result and the optimal timing of repeat capsule endoscopy.
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Affiliation(s)
| | - Petros Mantzios
- Gastroenterology Department, University General Hospital of Patras, Patras, GRC
| | | | - Stathis Anesidis
- General Surgery Department, University General Hospital of Patras, Patras, GRC
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19
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Zanchetta M, Inversini D, Pappalardo V, Grappolini N, Morabito M, Gianazza S, Carcano G, Ietto G. Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD. Life (Basel) 2023; 13:1996. [PMID: 37895380 PMCID: PMC10608533 DOI: 10.3390/life13101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
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Affiliation(s)
- Matteo Zanchetta
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Davide Inversini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Vincenzo Pappalardo
- Department of Surgery, Cittiglio-Angera Hospital-ASST Settelaghi, 21100 Varese, Italy
| | - Niccolo Grappolini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Marika Morabito
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Simone Gianazza
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Giulio Carcano
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
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20
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McKellar Stewart K, Lee J, De Robles MS. Double trouble: concomitant Meckel's diverticulitis and acute appendicitis. J Surg Case Rep 2023; 2023:rjad465. [PMID: 37593191 PMCID: PMC10431297 DOI: 10.1093/jscr/rjad465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023] Open
Abstract
Although Meckel's diverticulum is the most common congenital anomaly of the small bowel (2% prevalence worldwide), it rarely causes symptoms, with only 4% of those with the anomaly developing any complications, including Meckel's diverticulitis. In contrast to this, appendicitis is the most common general surgical emergency, with a lifetime incidence of 6.7-8.6%. Therefore, the case of a man presenting with right-sided abdominal pain to an Emergency Department with both Meckel's diverticulitis and appendicitis is rare. This case study illustrates the importance of careful assessment of the entire abdomen when operating on patients with right-sided abdominal pain, so as not to miss Meckel's diverticulitis even when appendicitis has already been found.
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Affiliation(s)
| | - Jessica Lee
- Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia
| | - Marie Shella De Robles
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
- Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia
- Graduate School of Medicine, University of Wollongong, Keiraville, New South Wales, Australia
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21
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Hariharan A, Amin S, Munankami S, Shrestha M, Altomare J. Symptomatic Meckel's Diverticulum Presenting As Recurrent Gastrointestinal Bleeding in an Adult. Cureus 2023; 15:e41723. [PMID: 37575711 PMCID: PMC10414796 DOI: 10.7759/cureus.41723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
A 51-year-old male presented to the hospital with recurrent gastrointestinal bleeding. Prior work up with an esophagogastroduodenoscopy (EGD), colonoscopy, and video capsule endoscopy failed to reveal a bleeding source. Given a history of a terminal ileum diverticulum noted on previous colonoscopy and persistence of hematochezia, a Meckel's scan was performed, which revealed abnormal uptake suspicious for a Meckel's diverticulum containing ectopic gastric mucosa. After surgical resection, pathology confirmed a Meckel's diverticulum with gastric heterotopia. This case highlights the importance of considering Meckel's diverticulum for instances of recurrent gastrointestinal bleeding, especially in patients who are still symptomatic despite an extensive workup. Moreover, it is important to note that a Meckel's diverticulum can be missed on video capsule endoscopy.
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Affiliation(s)
| | - Shefali Amin
- Internal Medicine, Tower Health Medical Group, West Reading, USA
| | | | - Manish Shrestha
- Internal Medicine, Tower Health Medical Group, West Reading, USA
| | - John Altomare
- Gastroenterology, Tower Health Medical Group, West Reading, USA
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22
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Ng DYL, Wilkie B, Chubb DP. Small bowel obstruction secondary to Meckel's diverticulum impacted with phytobezoar. ANZ J Surg 2023; 93:2036-2037. [PMID: 37272241 DOI: 10.1111/ans.18548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Daniel Yee Lee Ng
- Department of General Surgery, Albury Wodonga Health, Albury, New South Wales, Australia
| | - Bruce Wilkie
- Department of General Surgery, Albury Wodonga Health, Albury, New South Wales, Australia
| | - Daniel Peter Chubb
- Department of General Surgery, Albury Wodonga Health, Albury, New South Wales, Australia
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23
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Hutchinson S, Awadalla A, Pereira N. Recurrent Intussusception in the Setting of Meckel's Diverticulum in an Infant. Cureus 2023; 15:e40325. [PMID: 37448419 PMCID: PMC10338048 DOI: 10.7759/cureus.40325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Intussusception is a condition consisting of a proximal portion of the bowel contracting into a more distal bowel portion. The recurring act of intussusception is typically caused by a pathological lead point persisting within the bowel. The most common lead point for intussusception is a Meckel's diverticulum, which arises due to the incomplete obliteration of the omphalomesenteric canal causing a true diverticulum in the small bowel. This report outlines a case of a 10-month-old male infant who experienced three intussusception episodes, eventually requiring surgical intervention. A clinician's awareness of this phenomenon aids in implementing adequate treatment.
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Affiliation(s)
| | - Abanoub Awadalla
- College of Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | - Nicholas Pereira
- Department of Pediatrics, South Texas Health System Children's, Edinburg, USA
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24
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Li C, Zhang XW, Zhao CA, Liu M. Abdominal bronchogenic cyst: A rare case report. World J Clin Cases 2022; 10:12671-12677. [PMID: 36579087 PMCID: PMC9791524 DOI: 10.12998/wjcc.v10.i34.12671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/29/2022] [Accepted: 10/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Bronchogenic cysts are cystic masses caused by congenital abnormal development of the respiratory system, and usually occur in the pulmonary parenchyma or mediastinum.
CASE SUMMARY A rare case of a bronchogenic cyst discovered in the abdominal cavity of a 35-year-old man is reported. Physical examination found a space-occupying lesion in the patient’s abdomen for 4 d. Laparoscopic exploration found the cyst tightly adhered to the stomach and its peripheral blood vessels; therefore, intraoperative laparotomy was performed. The cystic mass was resected en bloc with an Endo-GIA stapler. The final postoperative pathological diagnosis confirmed an abdominal bronchogenic cyst.
CONCLUSION This is a rare case of a bronchogenic cyst that was discovered within the abdominal cavity of a male patient. The cyst is easily confused with or misdiagnosed as other lesions. Therefore, it is necessary to distinguish abdominal bronchogenic cyst from gastrointestinal stromal tumor, Meckel’s diverticulum, enteric duplication cyst, or lymphangioma. Although computer tomography and magnetic resonance imaging were the primary diagnostic approaches, endoscopic ultrasound-guided fine-needle aspiration could assist with clarification of the cytological or histopathological diagnosis before surgery.
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Affiliation(s)
- Chao Li
- School of Public Health, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of General Surgery, Xi’an Gaoxin Hospital, Xi'an 710075, Shaanxi Province, China
| | - Xin-Wei Zhang
- Department of Thoracic Surgery, Shaanxi Provincial Cancer Hospital, Xi’an 710061, Shaanxi Province, China
| | - Chang-An Zhao
- Department of Pathology, School of Basic Medical Science, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Min Liu
- Department of General Surgery, Xi’an Gaoxin Hospital, Xi'an 710075, Shaanxi Province, China
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25
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Dos Santos Villalaz E, Rios Rodriguez JE, Rodrigues Seixas Nunes Z, de Souza Bivaqua VB, Moreira Printes TR, Façanha Neto CD. Obstructive acute abdomen due to Meckel's diverticulum in adult: Case report. Int J Surg Case Rep 2022; 99:107717. [PMID: 36261951 PMCID: PMC9568863 DOI: 10.1016/j.ijscr.2022.107717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum is anatomically considered as a true diverticulum, with its embryological origins arising from a persistent omphalomesenteric duct. In adults, the disease is usually asymptomatic, often being accidentally diagnosed during imaging tests or surgery to treat other diseases, or due to further complications. PRESENTATION OF THE CASE We report the case of a 26-year-old female patient was admitted to the emergency room complaining of pain and abdominal distension for 3 days, progressing to cessation of the elimination of gas for 1 day together with nausea and vomiting. Since the cause of the obstruction was not clearly identified, the patient's clinical status did not improve with non-operative measures and laparoscopy was not available, an exploratory laparotomy was conducted. In the cavity inventory, an approximately 20 cm wide MD was found in the terminal ileum adhered to the distal portion of the anterior abdominal wall. DISCUSSION MD is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of between 0.3 % and 2.9 % in the general population. The clinical picture is usually asymptomatic, with the diagnosis made either via imaging tests performed to investigate other diseases, or during surgery to treat complications. CONCLUSION MD is the most common anomaly of the digestive tract, despite its low prevalence. It presents even rarer complications, including obstruction, digestive bleeding, or diverticulitis. It is important to consider the diverticulum as a diagnostic hypothesis in cases of obstruction without apparent causes, but it does not alter the initial management of the patient.
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26
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Halabi M, Abid G, Zenilman ME, Moussa H. Treatment of an unusual case of Meckel's diverticulum with a new robotic platform. Int J Surg Case Rep 2022; 99:107613. [PMID: 36103757 PMCID: PMC9568712 DOI: 10.1016/j.ijscr.2022.107613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Meckel's diverticulum (MD) is a common congenital anomaly of the digestive tract that affects around 4 % of the population. Although it is relatively common, diagnosis still remains very challenging; it requires an astute clinician with a high clinical index of suspicion to achieve the diagnosis. Once a diagnosis is reached, treatment is almost always surgical. This case report provides evidence of the effectiveness of a new robotic surgical system for resection of MD in the elderly. Case presentation 61 year old male presented to the emergency room with recurrent hematochezia. After multiple diagnostic techniques, he was finally diagnosed with MD using Meckel's scan. After diagnosis, surgical resection using the Cambridge Medical Robotics (CMR) Versius robotic system was performed, which yielded good results. Clinical discussion This case highlights the use of a new robotic system for the treatment of Meckel's Diverticulum. Conclusion Our initial experience with the CMR Versius surgical system in small bowel resection was successful; however, further studies are needed to demonstrate the safety and efficacy of such a system.
Meckel's diverticulum can persist in the elderly, thus ruling out the disease based on age is not reasonable. Many diagnostic techniques can be used to investigate Meckel's diverticulum, however the most reliable is the Meckel's scan. Once Meckel's is diagnosed surgical treatment is usually curative. Small bowel resection can be done with this new robotic platform.
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Affiliation(s)
- Mouhammad Halabi
- The Department of Surgery, American Hospital in Dubai, United Arab Emirates; School of Medicine, Royal College of Surgeons in Ireland - Bahrain, Kingdom of Bahrain
| | - Ghita Abid
- Mohammed VI University of Health Sciences, Morocco
| | - Michael E Zenilman
- Department of Surgery, Weill Cornell Medicine, New York, United States of America
| | - Hatem Moussa
- The Department of Surgery, American Hospital in Dubai, United Arab Emirates.
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27
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Bejiga G, Ahmed Z. Gangrenous Meckel's diverticulum with small bowel obstruction mimicking complicated appendicitis: 'Case report'. Int J Surg Case Rep 2022; 97:107419. [PMID: 35863288 PMCID: PMC9403201 DOI: 10.1016/j.ijscr.2022.107419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Gosa Bejiga
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia.
| | - Zubeyri Ahmed
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia
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28
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Zhang H, Yang Z, Wang YH, Yang SM, Liu L, Bai JY, Fan CQ. Typical gastric mucosa with ulcer found by endoscopy in Meckel's diverticulum. Endoscopy 2022; 54:E154-E155. [PMID: 33910256 DOI: 10.1055/a-1471-1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hong Zhang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhen Yang
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan-Hong Wang
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shi-Ming Yang
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Lu Liu
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jian-Ying Bai
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chao-Qiang Fan
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
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Educational Case: Diverticulosis. Acad Pathol 2022; 9:100014. [PMID: 35600744 PMCID: PMC9115725 DOI: 10.1016/j.acpath.2022.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/12/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
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Camacho Baca P, Caballero-Alvarado J, Centurión-Jáuregui G, Del Castillo Soberón G, Lozano KP, Corvera CZ. [Perforation of Meckel's diverticulum by a fishbone]. Khirurgiia (Mosk) 2022:78-80. [PMID: 36562677 DOI: 10.17116/hirurgia202212278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.
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Affiliation(s)
| | | | | | | | - K P Lozano
- Antenor Orrego Private University, Piura, Peru
| | - C Z Corvera
- Antenor Orrego Private University, Piura, Peru
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Bleeding Meckel's Diverticulum in a 33-Year-Old Female Diagnosed with Video Capsule Endoscopy and a Technetium-99 m Pertechnetate Scan with a Favorable Response to H 2 Blocker and PPI. Case Rep Gastrointest Med 2021; 2021:1381395. [PMID: 34925925 PMCID: PMC8677379 DOI: 10.1155/2021/1381395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/27/2021] [Indexed: 11/22/2022] Open
Abstract
Meckel's diverticulum is a true diverticulum consisting of all three layers of the small intestine resulting from incomplete regression of the vitelline duct. While it is often benign, it can present with serious complications such as intussusception, ulceration, torsion, hemorrhage, obstruction, inflammation, and fistula formation. Although it typically presents in infancy and early childhood, it can also manifest much later into adulthood. We report a case of Meckel's diverticulum complicated by significant bleeding in a 33-year-old female patient. Diagnosis was accomplished with video capsule endoscopy and a technetium-99 m pertechnetate scan. The patient responded well to acid suppression, initially with an H2 blocker and later with a PPI (proton pump inhibitor), and remained asymptomatic for nearly four months in the interim to definitive surgical treatment. Microscopic examination of the resected diverticulum confirmed the presence of ectopic gastric mucosa. A PubMed literature search revealed several similar cases of Meckel's diverticulum complicated by hemorrhage with a favorable response to H2 blockers and PPIs. While surgical resection remains the mainstay of definitive treatment, medications aimed at acid suppression can delay the need for urgent surgery, allow for diagnostic assessment, and optimize conditions for elective surgical treatment.
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32
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Dirim AB, Ozyazici S. Giant Meckel's Diverticulitis Perforation Due to Necrosis. Cureus 2021; 13:e17997. [PMID: 34667673 PMCID: PMC8519317 DOI: 10.7759/cureus.17997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/05/2022] Open
Abstract
Although Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, its prevalence is approximately 2% in the general population. Most diverticula remain asymptomatic and can be diagnosed with obstruction, perforation, inflammation, and gastrointestinal hemorrhage. The treatment of complicated MD is surgery, but there is no clear treatment recommendation yet for incidentally detected cases. As in the case we present here, the development of perforation due to Giant Meckel's diverticulitis in an adult female patient is a very rare complication of a disease that can be diagnosed very rarely.
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Affiliation(s)
- Ahmet Baris Dirim
- Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, TUR
| | - Sefa Ozyazici
- Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, TUR
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Gawrieh B, Shater W, Deeb MA, Ghuzlan A, Kassab H, Salhab N. Litrre's hernia: partially reduced inguinal hernia in a 3-year-old boy. J Surg Case Rep 2021; 2021:rjab421. [PMID: 34611490 PMCID: PMC8485683 DOI: 10.1093/jscr/rjab421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
This report examines the case of a 3-year-old child presenting with a 1-month history of swelling in the right groin. The boy had no associated nausea or vomiting, was afebrile and had had normal bowel movements. Attempts to reduce the swelling were only partially successful. Ultrasonography indicated the presence of turbid hydrocele and a hernia sac containing an intestinal loop. Accordingly, the patient underwent an urgent herniotomy. Exposing the hernia sac revealed 5 cm Meckel's diverticulum, and the base of the diverticulum was resected from the inside of the hernia sac. The boy was discharged 4 days after the operation in good clinical condition. The presented case highlights the need to consider Littre's hernia when dealing with partially reduced inguinal hernias in children with no general signs or evidence of intestinal obstruction.
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Affiliation(s)
- Bardisan Gawrieh
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Waseem Shater
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Mohammad Ali Deeb
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Alaa Ghuzlan
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Hanna Kassab
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - Nabila Salhab
- Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria
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Jha SK, Ghimire S, Koirala DP. Torsed gangrenous Meckel's diverticulum causing gangrenous ileal segment: A rare case report of small bowel obstruction in children. Ann Med Surg (Lond) 2021; 69:102723. [PMID: 34457256 PMCID: PMC8379479 DOI: 10.1016/j.amsu.2021.102723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system. It is caused by an incomplete obliteration of the vitelline duct. Rarely, it can present with complications like torsion and gangrene formation. CASE PRESENTATION A 13-year previously healthy girl presented with sudden onset periumbilical pain and bilious vomiting who was subsequently diagnosed with Meckel's diverticulum. Intraoperatively, torsed gangrenous diverticulum forming band adhesion was found. Resection of Meckel's diverticulum along with gangrenous ileal segment followed by ileoileal anastomosis was done. DISCUSSION Axial torsion of Meckel's diverticulum with gangrene formation is a rare occurrence. Mesodiverticular band adhesion along with herniation of small bowel segments under it endangers viability of herniating segments. Preoperative diagnosis of complicated MD is difficult as it mimics other common acute abdominal conditions. CT scan and enteroclysis are imaging modalities of choice. Surgical resection of MD along with resection and anastomosis of gangrenous bowel segment results in complete cure. CONCLUSION Meckel's diverticulum with complications should be kept in the differential of acute abdominal conditions presenting with atypical symptoms. Surgical resection ensures complete cure.
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Affiliation(s)
- Saroj Kumar Jha
- Maharajgunj Medical Campus, Institute of Medicine, 44600, Kathmandu, Nepal
| | - Sharmila Ghimire
- Maharajgunj Medical Campus, Institute of Medicine, 44600, Kathmandu, Nepal
| | - Dinesh Prasad Koirala
- Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, 44600, Kathmandu, Nepal
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Evola G, Piazzese E, Bonanno S, Di Stefano C, Di Fede GF, Piazza L. Complicated Littre's umbilical hernia with normal Meckel's diverticulum: A case report and review of the literature. Int J Surg Case Rep 2021; 84:106126. [PMID: 34186459 PMCID: PMC8250448 DOI: 10.1016/j.ijscr.2021.106126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE A Littre's hernia (LH) is defined by the presence of Meckel's diverticulum (MD) in any kind of hernia sac. Preoperative diagnosis of LH is a challenge because of its rarity and the absence of specific radiological findings and clinical presentation. Surgery is the appropriate treatment of complicated LH that is an extremely rare condition with approximately 50 cases reported in the literature over the past 300 years. CASE PRESENTATION A 46-year-old Caucasian female was admitted to the Emergency Department with a two-day history of abdominal pain. Physical examination revealed an irreducible and painfull mass in umbilical region. Abdominal computed tomography scan showed the protrusion of greater omentum and small bowel loop through the umbilical ring. Laboratory tests were unremarkable. After diagnosis of strangulated umbilical hernia, the patient underwent exploratory laparotomy: the irreducible umbilical hernial sac was opened with presence of incarcerated and strangulated omentum and uncomplicated MD. Resection of incarcerated and ischemic greater omentum alone was performed. The postoperative course of patient was uneventful. CLINICAL DISCUSSION Meckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Preoperative diagnosis of LH is very difficult and surgery represents the correct treatment of complicated LH. CONCLUSION LH represents an extremely rare complication of MD difficult to diagnose and suspect because of the lack of specific radiological findings and clinical presentation. Surgery represents the appropriate treatment of abdominal wall hernias and complicated MD.
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Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.
| | - Enrico Piazzese
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy
| | - Santo Bonanno
- Department of Emergency Medicine, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy
| | - Carla Di Stefano
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy
| | - Giovanni Francesco Di Fede
- Department of Diagnostic Radiology, Santa Marta e Santa Venera Hospital, Via Caronia, 95024 Acireale, CT, Italy
| | - Luigi Piazza
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy
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De la Cruz Ku G, Nelson E, Calderon R, Hemmati P, Kim B. Meckel's Enterolith Causing Small Bowel Obstruction: A Useful Solution to a Unique Problem. Cureus 2021; 13:e15934. [PMID: 34336435 PMCID: PMC8312179 DOI: 10.7759/cureus.15934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 11/05/2022] Open
Abstract
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its course is usually benign but may also result in complications requiring surgical intervention. A diverticulum may also permit the removal of intraluminal objects without bowel resection and anastomosis. A woman in her 50s was found to have a mechanical small bowel obstruction secondary to an intraluminal mass within the terminal ileum. On exploration, an MD was encountered proximal to the mass. A diverticulectomy was performed after maneuvering the enterolith into the diverticulum. Meckel’s diverticulum with an associated enterolith is a rare cause of small bowel obstruction. Historic imaging may show long-standing stones in the bowel lumen and provide a diagnostic clue. Diverticulectomy may be performed to reduce the risks of small bowel resection and anastomosis. This technique can be used for other intraluminal objects requiring removal in the presence of an MD.
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Affiliation(s)
| | - Erek Nelson
- General Surgery, Mayo Clinic, Rochester, USA
| | | | | | - Brian Kim
- Trauma and Acute Care Surgery, Mayo Clinic, Rochester, USA
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Ahmed M, Elkahly M, Gorski T, Mahmoud A, Essien F. Meckel's Diverticulum Strangulation. Cureus 2021; 13:e14817. [PMID: 34094771 PMCID: PMC8171988 DOI: 10.7759/cureus.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/05/2022] Open
Abstract
Meckel's diverticulum is the most common congenital anomaly of the small intestine. It is a true diverticulum containing all layers of the intestinal wall and results from the incomplete resolution of the omphalomesenteric duct. The majority of the cases are asymptomatic; however, diagnostic challenges arise when it becomes inflamed, causes gastrointestinal hemorrhage, intestinal obstruction, or when it protrudes through a potential abdominal opening (Littre's hernia). We present a rare case of strangulated Meckel's diverticulum as a result of axial torsion presenting with right lower quadrant abdominal pain.
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Affiliation(s)
| | | | - Tito Gorski
- Surgery, Southwest Healthcare System, Murrieta, USA
| | - Ahmed Mahmoud
- Surgery, Riverside Community Hospital, Riverside, USA
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Internal Hernia and Volvulus in an Adult Male Caused by Meckel's Diverticulum: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57050443. [PMID: 34063707 PMCID: PMC8147769 DOI: 10.3390/medicina57050443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Meckel’s diverticulum is a common congenital abnormality of the gastrointestinal tract encountered in about 1–3% of the general population. Although most patients remain asymptomatic, a minority will experience serious complications such as acute abdomen, haemorrhage or obstructive ileus. Of all patients presenting with symptoms of obstruction due to Meckel’s diverticulum 7–18% is due to volvulus. Case Report: A 39-year-old male with multiple previous episodes of obstructive ileus presented with an acute abdomen. An exploratory laparotomy was performed in order to reveal the cause of the obstruction. An internal hernia with ileal volvulus and a Meckel’s diverticulum was found, which was later confirmed by histopathological examination. Conclusion: Meckel’s diverticulum is a rare cause of acute abdomen and obstructive ileus which should be considered when the symptoms date back to childhood. The difficulty of preoperative diagnosis dictates the need for exploratory laparoscopy or laparotomy as diagnostic tools.
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Rhodes E, Stone T, Spruill L, Hardie AD. A case report of inverted Meckel's diverticulum. Radiol Case Rep 2021; 16:1118-1122. [PMID: 33732404 PMCID: PMC7937938 DOI: 10.1016/j.radcr.2021.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
Inverted Meckel's diverticulum is an entity often discovered incidentally or through a clinical evaluation for gastrointestinal bleeding. While rare, inverted Meckel's diverticulum should be considered in the evaluation of a patient presenting with gastrointestinal bleeding, intestinal obstruction, or intussusception. In this case, a 67-year-old female with a remote history of surgically treated breast cancer presents to an urgent care facility with weakness and fatigue. She was found to be anemic with hemoglobin of 4. Imaging revealed a blind-ending pouch in the mid to distal ileum consistent with an inverted Meckel's diverticulum. Inverted Meckel's diverticulum is identified on computerized tomography as an intraluminal, blind-ending structure in the mid to distal ileum. The possibility of a lead point should be investigated and surgical resection is indicated to prevent intestinal obstruction.
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Affiliation(s)
- Elizabeth Rhodes
- College of Medicine, Medical University of South Carolina University Medical Center, Charleston, South Carolina
| | - Trevor Stone
- Department of Radiology, Medical University of South Carolina University Medical Center, 25 Courtenay St., Charleston, SC, 29412 USA
| | - Laura Spruill
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina University Medical Center, Charleston, South Carolina
| | - Andrew D Hardie
- Department of Radiology, Medical University of South Carolina University Medical Center, 25 Courtenay St., Charleston, SC, 29412 USA
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Usman A, Rashid MH, Ghaffar U, Farooque U, Shabbir A. Littré's Hernia: A Rare Intraoperative Finding. Cureus 2020; 12:e11065. [PMID: 33224659 PMCID: PMC7676821 DOI: 10.7759/cureus.11065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Littré’s hernia (LH) is a rare clinical entity defined by the presence of Meckel’s diverticulum (MD) within a hernial sac. Although MD is the most common congenital abnormality of the intestinal tract, most of its cases remain asymptomatic. It may, however, manifest itself in the form of multiple complications. One of its rare complications is LH, which is reported occurring in a mere 1% of all MD cases. The anamneses of LH are like any other hernia containing the gut, making its preoperative diagnosis unlikely. We present herein a case of a 16-year-old boy with an incarcerated LH at the inguinal region, which was successfully treated by wedge resection of the diverticulum followed by hernia repair.
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Affiliation(s)
- Ahmad Usman
- General Surgery, Nishtar Medical University and Hospital, Multan, PAK
| | - Muhammad Humayoun Rashid
- Cardiology, Ch. Pervaiz Elahi Institute of Cardiology, Multan, PAK.,Internal Medicine, Nishtar Medical University and Hospital, Multan, PAK
| | - Umar Ghaffar
- Internal Medicine, Nishtar Medical University and Hospital, Multan, PAK
| | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Ayesha Shabbir
- General Surgery, Nishtar Medical University and Hospital, Multan, PAK
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Ajmal HB, Majid Z, Tahir F, Sagheer S. Axial Torsion and Gangrene: An Unusual Complication of Meckel's Diverticulum. Cureus 2020; 12:e6702. [PMID: 32117653 PMCID: PMC7029826 DOI: 10.7759/cureus.6702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Meckel’s diverticulum (MD), a congenital abnormality of the gastrointestinal tract, is usually found in the pediatric population younger than two years of age; hence, its incidence in adults is rare. Although MD is mostly clinically silent, in adults, it may present with intestinal obstruction and diverticulitis. The complications of MD include hemorrhage, perforation, enterolith formation, torsion, Littre’s hernia, ulceration and neoplasm. Among these, torsion is one of the rarely reported complications of MD. MD being attached to the ileal mesentery or umbilicus, presence of mesodiverticular band, and the length, breadth and base diameter of the diverticulum contribute as a risk factor for torsion. A similar clinical picture of acute appendicitis must be excluded. We report a case of a 25-year-old male who presented with signs of intestinal obstruction in whom intraoperative finding of a torted MD with necrotic and twisted base was found upon emergency exploratory laparotomy.
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Affiliation(s)
- Hassan Bin Ajmal
- General Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Zainab Majid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Faryal Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Saima Sagheer
- Breast and General Surgery, Civil Hospital, Dow University of Health Sciences, Karachi, PAK
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Gómez Sánchez J, Zurita Saavedra M, Moreno Cortés C. Intestinal perforation in unusual location. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:971. [PMID: 31696721 DOI: 10.17235/reed.2019.6352/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Meckel's diverticulum is the most frequent congenital gastrointestinal malformation and the clinical presentation varies from the absence of symptoms to intestinal obstruction or secondary perforation due to a foreign body. When reviewing the literature we found an interesting article by Fonseca et al., which describes the perforation of a Meckel's diverticulum by a fishbone. In this case, no imaging tests were used for diagnosis as there was a high clinical suspicion of a Meckel's diverticulitis. Recently, we had a similar patient to the one described by Fonseca et al.
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Dávila Arias C, Guirado Isla L, González Ortega J. Meckel's diverticulum perforated by a foreign body: a rare cause of abdominal pain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:891-892. [PMID: 31657602 DOI: 10.17235/reed.2019.6547/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We present the case of a male with generalized abdominal pain of sudden onset in the right hemiabdomen, associated with defense and leukocytosis. The study of contrast CT identified a foreign body with a linear and sharp morphology that crossed the wall of a small bowel loop (Fig. 1). The patient underwent a segmental resection of the ileum, which showed a Meckel's diverticulum perforated by a chicken bone.
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