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Yan L, Zhou B, Wu P, Tian Y, Lou Y. Meckel's diverticulum mimicking acute appendicitis in children: a retrospective cohort study. BMC Surg 2024; 24:40. [PMID: 38291433 PMCID: PMC10829168 DOI: 10.1186/s12893-024-02323-4] [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: 10/09/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children. MATERIALS AND METHODS We retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel's diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded. RESULTS A total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1-13 years). Perforated Meckel's diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix. CONCLUSIONS The most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.
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Affiliation(s)
- Ling Yan
- Department of Pediatrics, Hangzhou Normal University, Hangzhou, China
| | - Bi Zhou
- Department of Pediatrics, Suzhou Hospital of Anhui Medical University, Suzhou, Anhui, China
| | - Peng Wu
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi, China
| | - You Tian
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, 310014, Zhejiang, China
| | - Yi Lou
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, 310014, Zhejiang, China.
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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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Somashekar Karanth KK, Mijar M, Shetty KB, Sultanpuri CS. Tummy pain is not often what we think - Imaging findings in uncommon causes of abdominal pain in children and adolescents - A case series. Afr J Paediatr Surg 2023; 20:147-151. [PMID: 36960512 DOI: 10.4103/ajps.ajps_161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acute abdominal pain is a common complaint in children. We came across several unusual causes of acute abdomen including jejunal haematoma, perforation and abdominal abscess following hydrostatic intussusception reduction, twisting of mesenteric cyst, perforation of sigmoid colon and Meckel's diverticulum presenting with intussusception. In this article, we aim to present imaging features of these entities so that paediatric surgeons, radiologists and other health-care providers are aware of these unusual manifestations of acute abdomen.
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Affiliation(s)
| | - Mahesh Mijar
- Department of Radiodiagnosis, Father Muller Medical College, Mangalore, Karnataka, India
| | - Kishan B Shetty
- Department of Pediatric Surgery, Father Muller Medical College, Mangalore, Karnataka, India
| | - Chetana S Sultanpuri
- Department of Radiodiagnosis, Father Muller Medical College, Mangalore, Karnataka, India
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Morris G, Kennedy A. Small Bowel Congenital Anomalies. Surg Clin North Am 2022; 102:821-835. [DOI: 10.1016/j.suc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ludwig K, De Bartolo D, Salerno A, Ingravallo G, Cazzato G, Giacometti C, Dall’Igna P. Congenital anomalies of the tubular gastrointestinal tract. Pathologica 2022; 114:40-54. [PMID: 35212315 PMCID: PMC9040549 DOI: 10.32074/1591-951x-553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 02/08/2023] Open
Abstract
Congenital anomalies of the tubular gastrointestinal tract are an important cause of morbidity not only in infants, but also in children and adults. The gastrointestinal (GI) tract, composed of all three primitive germ layers, develops early during embryogenesis. Two major steps in its development are the formation of the gut tube (giving rise to the foregut, the midgut and the hindgut), and the formation of individual organs with specialized cell types. Formation of an intact and functioning GI tract is under strict control from various molecular pathways. Disruption of any of these crucial mechanisms involved in the cell-fate decision along the dorsoventral, anteroposterior, left-right and radial axes, can lead to numerous congenital anomalies, most of which occur and present in infancy. However, they may run undetected during childhood. Therapy is surgical, which in some cases must be performed urgently, and prognosis depends on early diagnosis and suitable treatment. A precise pathologic macroscopic or microscopic diagnosis is important, not only for the immediate treatment and management of affected individuals, but also for future counselling of the affected individual and their family. This is even more true in cases of multiple anomalies or syndromic patterns. We discuss some of the more frequent or clinically important congenital anomalies of the tubular GI, including atresia's, duplications, intestinal malrotation, Meckel's diverticulum and Hirschsprung's Disease.
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Affiliation(s)
- Katrhin Ludwig
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Debora De Bartolo
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angela Salerno
- Department of Oncology, Anatomic and Histologic Pathology and Cytodiagnostics, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ingravallo
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Gerardo Cazzato
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Cinzia Giacometti
- Department of Services, Pathology Unit, ULSS 6 “Euganea”, Camposampiero, Italy
| | - Patrizia Dall’Igna
- Department of Emergencies and Organ Transplantation, Pediatric Surgery, University of Bari, Bari, Italy
- Correspondence Patrizia Dall’Igna Department of Emergencies and Organ Transplantation, Azienda Ospedaliero-Universitaria Consorziale, Ospedale Pediatrico Giovanni XXIII, via Giovanni Amendola 207, 70126 Bari, Italy E-mail:
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Nissen M, Sander V, Rogge P, Alrefai M, Tröbs RB. Meckel’s Diverticulum in Children: A Monocentric Experience and Mini-Review of Literature. CHILDREN 2022; 9:children9010035. [PMID: 35053658 PMCID: PMC8774297 DOI: 10.3390/children9010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
Vitelline duct anomalies (VDA, including Meckel’s diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic versus asymptomatic VDA, analyzing clinico-laboratory data from 73 children, aged 1 day to 17 years, treated at a tertiary Pediatric Surgery Institution from 2002–2017. A male preponderance was obtained (ratio 3.6:1). MD accounted for 85% of VDA. Incidence of symptomatic VDA decreased with older age. Leading symptoms were intestinal obstruction and hemorrhage. Mucosal heterotopia (present in 39% of symptomatic MD) was associated with anemia and lowered CRP-levels. On ROC-analysis, hemoglobin < 8.6 g/dL, CRP < 0.6 mg/dL and MD distance to ileocecal valve >40 cm were predictors of ectopic tissue in symptomatic MD. Our data confirmed known characteristics as male preponderance, declined incidence of symptomatic cases with age and predominance of gastric ectopia in symptomatic MD. Moreover, anemia and prolonged distance of MD to ileocecal valve were predictors of ectopic mucosa in symptomatic MD.
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Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
- Correspondence: ; Tel.: +49-23021733709; Fax: +49-23021731699
| | - Volker Sander
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
| | - Phillip Rogge
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
| | - Mohamad Alrefai
- Department of Pediatric Surgery, Marien Hospital Witten, St. Elisabeth Gruppe, Ruhr-University of Bochum, Marienplatz 2, D-58452 Witten, Germany; (V.S.); (P.R.); (M.A.)
| | - Ralf-Bodo Tröbs
- Department of Pediatric Surgery, St. Johannes Hospital, Helios Group, An der Abtei 7 bis 11, D-47166 Duisburg, Germany;
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Kang A, Kim SH, Cho YH, Kim HY. Surgical perspectives of symptomatic omphalomesenteric duct remnants: Differences between infancy and beyond. World J Clin Cases 2021; 9:11228-11236. [PMID: 35071553 PMCID: PMC8717527 DOI: 10.12998/wjcc.v9.i36.11228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical manifestations of omphalomesenteric duct remnant (OMDR) can vary with the age at diagnosis, from asymptomatic incidental findings to symptoms related to gastrointestinal complications. The lifelong complication rates are reported as 4%-34%, and complications are more common in patients younger than 2 years of age. The authors attempted to identify different clinical features and management for the various pediatric age groups.
AIM To find surgical perspectives for the pediatric age-related variants of OMDR and make recommendations for optimal management.
METHODS The medical records of pediatric patients diagnosed with OMDR were reviewed retrospectively. Fifteen patients diagnosed based on incidental findings during other surgeries were excluded. The patients were divided into two groups based on age: < 12 mo (infants) and > 12 mo (beyond infancy). We analyzed the demographic characteristics, clinical manifestations, diagnostic tools, surgical procedures, and clinical outcomes of the patients and compared them for the age groups. Chi-squared and Fisher's exact tests were used for nominal scales and a Mann-Whitney test was used for ratio scales.
RESULTS A total of 35 patients (7 infants, 28 children beyond infancy) were finally included. In both groups, Meckel's diverticulum (MD) was the most common type of OMDR, while umbilical lesions were more common in the infant group (P = 0.006). Hematochezia and abdominal pain were common in the beyond infancy group, while umbilical lesions were the most frequent symptoms in the infant group. Several diagnostic tools were used, but Meckel's scan was most useful in diagnosing OMDR in patients with painless rectal bleeding. Minimally invasive surgery was more commonly performed for children than for infants (P = 0.016). Single-incision laparoscopic surgery (SILS) was performed for fifteen patients who underwent laparoscopic surgery. There were only three cases of postoperative complications, and all patients survived in good condition.
CONCLUSION The clinical type of OMDR varies with age, umbilical lesions in infants, and MD beyond infancy. SILS is effective for managing children with MD regardless of age.
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Affiliation(s)
- Ayoung Kang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Soo-Hong Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Yong-Hoon Cho
- Department of Surgery, Pusan National University School of Medicine, Yangsan 50612, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Hae-Young Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
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Ghritlaharey RK. Management of Symptomatic Meckel's Diverticulum in Infants and Children. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2021. [DOI: 10.1055/s-0041-1739190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objectives The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome.
Materials and Methods This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum. This study was conducted at the author's department of pediatric surgery, and it was performed for 21 years from January 1, 2000 to December 31, 2020.
Results Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period of 21 years. The ratio for males to females was 3:1. This study consisted of infants, (n = 22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n = 43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n = 59, 70.23%), (2) perforation peritonitis (n = 17, 20.23%), (3) lower gastrointestinal bleeding (n = 4, 4.76%), and (4) incidental finding (n = 4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n = 17) of Meckel's diverticulum was responsible for the secondary intussusception. In children (n = 84), for Meckel's diverticulum, surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n = 36, 42.85%); (2) Meckel's diverticulectomy (n = 32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n = 12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n = 4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period.
Conclusion Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.
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Affiliation(s)
- Rajendra K. Ghritlaharey
- Department of Paediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India
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Khoury V, Taishori N, Abdo A, Omran A. Idiopathic Meckel's diverticulum perforation presenting at birth. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Triple presentation of acute appendicitis, Meckel's diverticulum, and hemorrhagic ovarian cyst: A rare case report and literature review. Int J Surg Case Rep 2021; 87:106462. [PMID: 34607264 PMCID: PMC8497848 DOI: 10.1016/j.ijscr.2021.106462] [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: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance With 2% prevalence worldwide, Meckel's diverticulum is the most common congenital anomaly of the small intestine, which anatomically results from incomplete obliteration of the vitelline duct. It is usually difficult to differentiate clinically between acute appendicitis and Meckel's diverticulitis, thus in most clinical situations, it is asymptomatic and usually incidentally discovered intraoperatively. On the other hand, Acute appendicitis is one of the most common presentations in a surgical emergency with an 8.6% incidence in males and 6.7% in females. Triple presentation of acute appendicitis, Meckel's diverticulum, and a hemorrhagic ovarian cyst is a rare incidence in literature. Case presentation and clinical discussion A female patient 35 years old with no previous surgical history or known medical disease presented to our ER with right lower quadrant abdominal pain of one-day duration. On physical examination; there was right iliac fossa pain, tenderness, and rebound tenderness indicating acute appendicitis. Intraoperatively we operated appendectomy as usual through Gridiron incision. Upon opening of the parietal peritoneum, there was a hemorrhagic reaction with a catarrhal inflamed appendix. Ileal loops revealed a Meckel's diverticulum. With the peritoneal toilet, there was still a hemorrhagic reaction. Further exploration revealed a ruptured hemorrhagic ovarian cyst, which was managed using bipolar cautery and ligatures. Conclusion In the operative management of acute appendicitis, we recommend proper assessment for both the right ovary and at least two feet of ileum proximal to the ileocecal valve to exclude any ovarian abnormalities or Meckel's diverticulum respectively especially if the appendix was normal or just was catarrhal inflamed. Meckel’s diverticulum is the most common congenital anomaly of the small intestine-2% worldwide. Acute appendicitis is one of the most common presentations in a surgical emergency. The presentation of acute appendicitis, Meckel's, and an ovarian cyst is rare in literature In managing acute appendicitis, assess ileum proximal to the ileocecal valve to exclude ovarian abnormalities or Meckel's diverticulum.
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Mbaye PA, Fall M, Sabounji MS, Ndoye NA, Zeng FTA, Wellé IB, Seck NF, Ngom G. [Meckel's diverticulitis by ascaris in children: about a case]. Pan Afr Med J 2021; 39:92. [PMID: 34466194 PMCID: PMC8379397 DOI: 10.11604/pamj.2021.39.92.29237] [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: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 11/12/2022] Open
Abstract
Nous rapportons l´observation d´un enfant âgé de 4 ans de sexe masculin, qui a été reçu pour un bourgeon ombilical congénital accompagné de saignements récents. L´examen physique retrouvait un bourgeon ombilical de couleur rosée, taché de sang sans fistule objectivée, d´environ 1,5 cm de diamètre. Une échographie abdominale a été demandée faisant évoquer un sinus de l´ouraque. L´exploration chirurgicale a mis en évidence un bourgeon ombilical communiquant en intra-abdominal avec un diverticule de Meckel à 90 cm de l´angle iléo-caecal hyperhémié, inflammatoire à l´intérieur duquel siégeait beaucoup d´ascaris. L´examen anatomo-pathologique de la pièce opératoire était en faveur d´une diverticulite. Ainsi, le diagnostic d´une diverticulite de Meckel d´origine ascaridienne a été retenu. Une résection-anastomose avec exérèse du bourgeon fut réalisée. Les suites opératoires étaient simples et après un recul de 6 mois.
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Affiliation(s)
- Papa Alassane Mbaye
- Service de Chirurgie Pédiatrique, Hôpital d'Enfants Alber Royer, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Mbaye Fall
- Service de Chirurgie Pédiatrique, Hôpital Aristide Le Dantec, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Mohamed Salsabil Sabounji
- Service de Chirurgie Pédiatrique, Hôpital d'Enfants Alber Royer, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Ndeye Aby Ndoye
- Service de Chirurgie Pédiatrique, Hôpital d'Enfants Alber Royer, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Florent Tshibwid A Zeng
- Service de Chirurgie Pédiatrique, Hôpital d'Enfants Alber Royer, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Ibrahima Bocar Wellé
- Service de Chirurgie Pédiatrique, Hôpital d'Enfants Alber Royer, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Ndeye Fatou Seck
- Service de Chirurgie Pédiatrique, Hôpital d'Enfants Alber Royer, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Gabriel Ngom
- Service de Chirurgie Pédiatrique, Hôpital d'Enfants Alber Royer, Université Cheikh Anta Diop, Dakar, Sénégal
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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: 4] [Impact Index Per Article: 1.3] [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. A Littre's hernia (LH) is defined by the presence of Meckel's diverticulum (MD) in any kind of hernia sac. LH is an extremely rare complication of MD and its preoperative diagnosis is very difficult. Surgery represents the appropriate treatment of abdominal wall hernias and complicated MD. Routine resection of uncomplicated MD is not advised and it should be based on identified MD’ s risk factors.
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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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Shapiro DJ, Neal JT. A Young Boy with Fever and Grunting. Clin Pract Cases Emerg Med 2021; 5:125-126. [PMID: 33560971 PMCID: PMC7872619 DOI: 10.5811/cpcem.2020.11.49721] [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: 09/10/2020] [Accepted: 11/05/2020] [Indexed: 11/11/2022] Open
Abstract
CASE PRESENTATION A 16-month-old boy presented with a temperature of 99°Fahrenheit (F) (down from 102°F at home after antipyretics), grunting, and tachypnea. On examination, he was tachycardic, tachypneic, and ill-appearing with abdominal distention and diffuse tenderness. A plain film abdominal radiograph showed moderate free air, and emergent laparoscopy revealed perforated Meckel's diverticulitis with peritonitis. DISCUSSION Although tachypnea and grunting in preverbal or nonverbal patients are often considered to be signs of respiratory illness, these findings may reflect intra-abdominal emergencies. Perforated Meckel's diverticulitis is an important differential consideration in patients with pneumoperitoneum.
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Affiliation(s)
- Daniel J Shapiro
- Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts. Boston Children's Hospital, Division of Emergency Medicine, Boston, Massachusetts
| | - Jeffrey T Neal
- Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts. Boston Children's Hospital, Division of Emergency Medicine, Boston, Massachusetts
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14
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Krishnaswamy P, Krawitz R. Littre hernia: rare presentation of computed tomography-diagnosed strangulated umbilical Littres hernia repaired with mesh. ANZ J Surg 2021; 91:1927-1928. [PMID: 33439511 DOI: 10.1111/ans.16585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Pooja Krishnaswamy
- Department of General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Russel Krawitz
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Hornsby and Ku-ring-gai Hospital, Sydney, New South Wales, Australia
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15
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Lemke C, Biedermann U. A persistent vitelline artery in an adult. Case report and review of literature. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Vaabengaard S, Andersen L, Qvist N, Rasmussen L, Ifaoui I, Knudsen K, Ellebæk M. Complicated Meckel's Diverticulum in Children: Clinical Presentation, Diagnostic Work-Out, Surgical Approach and Postoperative Complications. Cureus 2020; 12:e12354. [PMID: 33520549 PMCID: PMC7839805 DOI: 10.7759/cureus.12354] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of cases are asymptomatic and in cases with complications, the diagnosis may be a challenge and the surgical approach is not obvious. The primary aim of the present study was to evaluate the diagnostic process and surgical approach in relation to clinical presentation. The secondary aim was to evaluate the severity of postoperative complications. Methods A two-center, retrospective analysis of all children below the age of 15 years, operated for complications to MD during the period from January 2003 to December 2016. Results A total of 58 patients were included. In the 40 patients presenting with an acute abdomen an average of 2.3 preoperative diagnostic investigations was performed. In only five cases an MD was recognized preoperatively. In the 18 patients presenting with rectal bleeding or melaena an average of 3.2 preoperative investigations were performed and in only one case the MD was recognized preoperatively. Laparoscopy was the surgical approach in 36 patients (62%) with a conversion in 8. Postoperative complications were seen in two patients (Clavien-Dindo II and IIIb). Conclusion Despite extensive diagnostic work-out an MD was recognized in only a few patients preoperatively. Laparoscopy was the surgical approach in two-thirds of the patients.
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Affiliation(s)
| | - Line Andersen
- Surgical Department, Odense University Hospital, Odense, DNK
| | - Niels Qvist
- Surgical Department, Odense University Hospital, Odense, DNK
| | - Lars Rasmussen
- Surgical Department, Odense University Hospital, Odense, DNK
| | - Inge Ifaoui
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen, DNK
| | - Kristine Knudsen
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen, DNK
| | - Mark Ellebæk
- Surgical Department, Odense University Hospital, Odense, DNK
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17
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Almetaher HA, Mansour MA. Acute abdomen in children due to different presentations of complicated Meckel’s diverticulum: a case series. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00055-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Meckel’s diverticulum (MD) is the commonest congenital abnormality of the gastrointestinal tract that occurs in 2% of general population. It remains asymptomatic, but it may lead to life-threatening complications. These complications may be misdiagnosed with other gastrointestinal disorders like acute appendicitis, making its diagnosis challenging among pediatricians and pediatric surgeons. In this study, we reported five cases with different presentations of complicated MD in children.
Results
Five patients with different presentations of MD were reported during the period from January 2016 to January 2020. Patients’ demographics, clinical presentations, investigations, operative data, and postoperative outcome were recorded and analyzed.
Conclusions
The present study highlights different presentations of MD. Surgical interference is the main key of treatment of symptomatic MD either by wedge resection of a small base diverticulum or by resection anastomosis of the small intestine in wide base and inflamed diverticulum.
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18
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Mariani A, Siddiqui M, Boulard N, Berrebi D, Bonnard A. Laparoscopic Management of Mechanical Small Bowel Obstruction Secondary to Meckel's Diverticulum with a Double Basis. A Rare Anatomic Presentation. European J Pediatr Surg Rep 2020; 8:e59-e61. [PMID: 33244449 PMCID: PMC7684991 DOI: 10.1055/s-0040-1713902] [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: 02/12/2020] [Accepted: 05/16/2020] [Indexed: 11/30/2022] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. Intestinal occlusion due to MD is a commonly observed consequence of intussusception or volvulus. Here, we report a case of an 11-year-old boy who presented to the emergency department with acute abdominal pain, bilious vomiting, and abdominal rebound tenderness. Computed tomography scan concluded a diagnosis of intestinal occlusion with no apparent cause. The patient was submitted to diagnostic laparoscopy, and mechanical occlusion by the permeable Meckel with double base was identified. A diverticulectomy by staplers was performed, and occlusion was alleviated. MD is a rare disease (for only 0.3–2.9% of the general population), and only 4.2 to 9% of patients diagnosed with MD have associated complications. MD can be a large base or a narrow base, with a mesodiverticular band but the diverticulum is usually a blind recess. In our case, the tube connected two intestinal segments. To the best of our knowledge, we have reported the first case of an MD-like permeable tube with a double basis.
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Affiliation(s)
- Aurora Mariani
- Department of Paediatric Surgery, Hopital Femme Mere Enfant, Bron, Auvergne-Rhône-Alpes, France
| | - Mohammed Siddiqui
- Department of Pediatric Surgery, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
| | - Nicolas Boulard
- Department of Pediatric Surgery, Hopital Jean Minjoz, Besancon, France
| | - Dominique Berrebi
- Department of Pediatric Pathology, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Sorbonne Paris Cité, Universite Paris Diderot, UMR 1149 Inserm, Paris, Île-de-France, France
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19
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Bindi E, Cruccetti A, Ilari M, Mariscoli F, Carnielli VP, Simonini A, Cobellis G. Meckel's diverticulum perforation in a newborn positive to Sars-Cov-2. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020; 62:101641. [PMID: 32904556 PMCID: PMC7456189 DOI: 10.1016/j.epsc.2020.101641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 01/10/2023] Open
Abstract
The health emergency linked to the Sars-Cov-2 infection represented an absolutely new problem for all health professionals. In particular, the information regarding the spread of the virus in the pediatric field and its manifestations are still incomplete. In this paper we present a case of neonatal infection which, as far as we know, represents one of the few published cases and which occurred in a patient who came to our attention for acute abdomen from intestinal perforation. The perforation was caused by Meckel's diverticulum, an event considered infrequent in the first year of life and almost exceptional in the neonatal period. This case required particular management, putting pediatric surgeons in front of new and difficult to solve problems. New onset clinical events, such as this one described, represent an opportunity for sharing useful data for the creation of universal protocols for the management of patients with problems that are becoming common and of which little is known.
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Affiliation(s)
- E Bindi
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - A Cruccetti
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - M Ilari
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - F Mariscoli
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - V P Carnielli
- Neonatology Unit, Salesi Children's Hospital, Ancona, Italy
- University Politecnica delle Marche, Ancona, Italy
| | - A Simonini
- Pediatric Intensive Care Unit, Salesi Children's Hospital, Ancona, Italy
| | - G Cobellis
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
- University Politecnica delle Marche, Ancona, Italy
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20
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Rahmat S, Sangle P, Sandhu O, Aftab Z, Khan S. Does an Incidental Meckel's Diverticulum Warrant Resection? Cureus 2020; 12:e10307. [PMID: 32923303 PMCID: PMC7480780 DOI: 10.7759/cureus.10307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Meckel's diverticulum (MD) is the most common gastrointestinal malformation. The management of symptomatic Meckel's diverticulum has been undecidedly resection; however, the management of incidental Meckel's diverticulum has been fraught in comparison. As a systematic literature review, PubMed, PubMed Central (PMC), and MEDLINE were used. The search phrase utilized was "Meckel Diverticulum/Surgery [Mesh]" and resection incidental. The search was completed on July 18, 2020 and was limited to 1980 until the day of the search. Searches resulted in 62 initial articles on PubMed. On initial screening, 23 of these articles met the criteria. The references of these 23 articles were screened for relevant studies, yielding a total of 31 studies of which all were assessed for quality. Four articles made a recommendation for no resection. Twelve studies made a recommendation for resection. Ten studies concluded that resection should be completed in the presence of risk factors. Lastly, five studies made no clear recommendation. In recent literature, there has been a shift towards resection for all or in those with high-risk factors. In the future, it will be necessary for researchers to determine if resection is recommended for all patients with incidental MD or in those with risk factors. If only in those with risk factors, it will be important that research is completed to create evidence-based guidelines to support the risk factors.
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Affiliation(s)
- Shermeen Rahmat
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Prerna Sangle
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Osama Sandhu
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Zarmeena Aftab
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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21
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Pokhrel B, Daha SK, Shrestha N, Sah PK, Khanal N. Massive Gastrointestinal Bleeding Masquerading Coagulopathy in Acute Viral Hepatitis: A Case Report. JNMA J Nepal Med Assoc 2020; 58:419-422. [PMID: 32788760 PMCID: PMC7580357 DOI: 10.31729/jnma.5007] [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: 11/16/2022] Open
Abstract
Hepatitis A virus infection is typically an acute self-limiting illness associated with general nonspecific symptoms such as fever, malaise, anorexia, nausea, vomiting, abdominal pain or discomfort, and diarrhea. This may have atypical manifestation like prolonged cholestasis. Despite having varying typical and atypical manifestations such a case may present with life-threatening bleeding from a co-existing surgical cause such as perforation of Meckel's diverticulum.
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Affiliation(s)
| | | | - Nikhil Shrestha
- Oxford University Clinical Research Unit-Nepal, Lalitpur, Nepal
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22
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Intestinal Obstruction by Meckel's Diverticulum in a 92 Years Old Woman. Case Rep Surg 2020; 2020:9303059. [PMID: 32551147 PMCID: PMC7277052 DOI: 10.1155/2020/9303059] [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: 11/16/2019] [Revised: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct that in most cases (53%) is diagnosed in the first two years of life. Case report. A variety of complications are related to Meckel's diverticulum including bleeding, intestinal obstruction, but in adults, the most important complication is intestinal obstruction. We reported Meckel's diverticulum in a 92-year-old woman with symptoms of intestinal obstruction including abdominal pain, vomitus, and abdominal distention who referred to the hospital emergency. Imaging findings showed intestinal obstruction and laparotomy showed that the cause of intestinal obstruction was Meckel's diverticulum. Finally, Meckel's diverticulum was resected and the patient recovered. Conclusion Intestinal obstruction because of a large Meckel's diverticulum in an elderly woman is rare and requires a high attention for diagnosis, and it is almost discovered by surgery.
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23
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Wu J, Huang Z, Wu H, Ji M, Wang Y, Tang Z, Huang Y. The diagnostic value of video capsule endoscopy for Meckel's diverticulum in children. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:429-433. [PMID: 32450705 DOI: 10.17235/reed.2020.6708/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is also an important cause of bloody stool and anemia in children. However, there are few data about video capsule endoscopy (VCE) for MD in children. This study aimed to evaluate the diagnostic value of VCE for MD in children. MATERIALS AND METHODS children who underwent VCE for obscure gastrointestinal bleeding from October 1st 2015 to August 31st 2019 at the Children's Hospital of Fudan University were included in this retrospective study. Medical data, VCE data and Meckel's scans, etc. were collected for each patient. RESULTS sixteen patients were diagnosed with MD by VCE, including 13 males and 3 females. The age of the patients ranged from 4 years to 13 years, with an average of 7.8 ± 2.7 years. Lower gastrointestinal tract bleeding was the main symptom for patients with MD, including hematochezia (75 %) and melena (25 %). Of the VCE findings, 14 patients had double lumen signs and 2 showed protruding lesions. Among the 16 patients diagnosed with MD by VCE, 14 patients were diagnosed with MD by Meckel's scan, 3 with MD by abdominal enhanced CT and 14 patients were diagnosed with MD by surgery. During the follow-up, bleeding occurred sporadically in patient 12 and the reason is still unknown. CONCLUSIONS VCE is useful for the diagnosis of MD and should be used as a valuable and less invasive examination to confirm or establish a diagnosis.
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Affiliation(s)
- Jie Wu
- Gastroenterology, Children's Hospital of Fudan University
| | - Zhiheng Huang
- Gastroenterology, Children's Hospital of Fudan University,
| | - Ha Wu
- Nuclear Medicine, Children's Hospital of Fudan University
| | - Min Ji
- Radiology, Children's Hospital of Fudan University
| | - Yuhuan Wang
- Gastroenterology, Children's Hospital of Fudan University
| | - Zifei Tang
- Gastroenterology, Children's Hospital of Fudan University
| | - Ying Huang
- Gastroenterology, Children's Hospital of Fudan University
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24
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LaFlam TN, Phelps A, Choi WT, Kornblith AE. Meckel Diverticulum Presenting as Abdominal Pain and Subsequent Bowel Perforation. J Emerg Med 2020; 58:e251-e254. [PMID: 32317193 DOI: 10.1016/j.jemermed.2020.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/25/2020] [Accepted: 03/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal pain is a common presenting symptom with a broad array of potential etiologies. Meckel diverticulum (MD), the most common congenital gastrointestinal malformation, classically presents with painless gastrointestinal bleeding. However, it can also lead to diverticulitis, intussusception, or obstruction, manifesting as abdominal pain. CASE REPORT A 2-year-old boy presented to the emergency department with intermittent abdominal pain, vomiting, and loose stools. Abdominal ultrasound findings were consistent with ileitis and ileocolic intussusception, but no such intussusception was seen during fluoroscopic air enema. The patient was admitted for serial abdominal examinations and subsequently developed an acute abdomen. Emergent laparotomy revealed a perforated MD. Small bowel resection and primary anastomosis were performed and no complications developed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The presence of an MD can lead to diverticulitis, intussusception, or obstruction, putting the patient at risk of bowel perforation. As such, it is important to consider MD in the differential diagnosis of patients with abdominal pain. In cases in which sonographic findings are ambiguous or transient, additional observation or alternative imaging, such as computed tomography, should be strongly considered.
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Affiliation(s)
- Taylor N LaFlam
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Andrew Phelps
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Won-Tak Choi
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Aaron E Kornblith
- Department of Pediatrics, University of California, San Francisco, San Francisco, California; Department of Emergency Medicine, University of California, San Francisco, San Francisco, California
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25
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Syal S, Sen A, Sugandhi N, Nanda M, Jhadav A. Metabolic profile and outcome of pre- and post-ampullary gastrointestinal obstruction in children: Conventional or unconventional wisdom. Afr J Paediatr Surg 2020; 17:18-22. [PMID: 33106448 PMCID: PMC7818667 DOI: 10.4103/ajps.ajps_27_17] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Conventionally, it is well accepted that the intestinal obstructions in children, especially gastric outlet obstruction are associated with significant metabolic derangement which has impact on its outcome. The study aimed to compare the metabolic profile and treatment outcome of pre- and post-ampullary gastrointestinal obstruction in children at a tertiary care setting. MATERIALS AND METHODS A prospective observational study was conducted on 30 children with intestinal obstruction and categorised into Group 1 (pre-ampullary, n = 11) and Group 2 (post-ampullary, n = 19) as per their anatomical site of pathology. Patients were evaluated at both pre- and post-operative period (Day 1 and 10) with haematological, biochemical and blood gas. The pre- and post-operative metabolic profile, resuscitative time and outcome were compared in two groups. RESULTS Except mild leucocytosis (Group II > I), rest of the pre-operative and post-operative haematological parameters were within normal range and statistically comparable among groups. Although the pre-operative sodium values were within the normal limit in both groups, it was relatively higher in Group I (Group I = 137.82 ± 4.238 vs. Group II = 134.26 ± 4.653), (P = 0.04). The mean bicarbonate values were within the normal limit in both groups (22.49 and 19.34), but the difference was statistically significant (P = 0.031). Mean partial pressure of carbon dioxide level was higher than normal range in Group I (38.464 ± 20.6493) but was comparable with Group II (P = 0.15). The time required for pre-operative resuscitation was 16.6 versus 24.87 h in Group I versus Group II (P = 0.02). In Group I, all children were improved, whereas four children expired in Group II. CONCLUSION Metabolic profile in both pre- and post-ampullary intestinal obstruction was found to be normal in majority of the scenario. Children with post-ampullary obstruction need extensive pre-operative resuscitation and have relatively poor outcome.
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Affiliation(s)
- Sarita Syal
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Amita Sen
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Nidhi Sugandhi
- Department of Pediatric Surgery, Safdarjung Hospital, New Delhi, India
| | - Monika Nanda
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Avinash Jhadav
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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26
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Oukhouya MA, Andaloussi S, Abdellaoui H, Tazi M, Mahmoudi A, Elmadi A, Khattala K, Bouabdallah Y. Meckel's diverticulum causing intestinal obstruction in the newborn. Pan Afr Med J 2019; 31:210. [PMID: 31447969 PMCID: PMC6691295 DOI: 10.11604/pamj.2018.31.210.14840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/22/2018] [Indexed: 11/11/2022] Open
Abstract
The causes of neonatal bowel obstruction are variable and dominated by malformations and the Meckel diverticulum must remain exceptional. We report a case of neonatal bowel obstruction in a six day old male neonate admitted on account of inability to pass stool, abdominal distension and bilious vomiting. The radiologic additional examinations are non-specific. Exploratory laparotomy found obstruction at the site of a Meckel's diverticulum.
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Affiliation(s)
| | - Saad Andaloussi
- University Sidi Mohamed Ben Abdellah, CHU Hassan II, Fès, Morocco
| | | | - Mohammed Tazi
- University Sidi Mohamed Ben Abdellah, CHU Hassan II, Fès, Morocco
| | | | - Aziz Elmadi
- University Sidi Mohamed Ben Abdellah, CHU Hassan II, Fès, Morocco
| | - Khalid Khattala
- University Sidi Mohamed Ben Abdellah, CHU Hassan II, Fès, Morocco
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27
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Cutaneous presentations of omphalomesenteric duct remnant: A systematic review of the literature. J Am Acad Dermatol 2019; 81:1120-1126. [PMID: 30797849 DOI: 10.1016/j.jaad.2019.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Disorders of the umbilicus are commonly seen in infancy, including hernias, infections, anomalies, granulomas, and malignancies. Meticulous inspection of the umbilicus at birth might reveal a persisting embryonic remnant, such as an omphalomesenteric duct (OMD), manifested by a variety of cutaneous signs, such as an umbilical mass, granulation tissue, or discharge. OBJECTIVE To systematically review the available data regarding the presence and management of OMD remnant with cutaneous involvement to suggest a practical approach for diagnosis and treatment. METHODS A systematic review of the literature evaluating OMD anomalies presenting with cutaneous symptoms was performed. In addition, an index case of an 11-month-old patient is presented. RESULTS We included 59 publications reporting 536 cases; 97% of the patients whose age was noted were infants (mean age 11 months). In 7.5% of the cases, diagnosis was established only after treatment failure. In 6.4% of patients, nonlethal complications were reported, and in 10.3%, the outcome was death, partly due to delayed diagnosis or mismanagement. LIMITATIONS Limited quality of the collected data, reporting bias. CONCLUSION OMD is relatively rare; however, the clinician must consider this remnant while examining patients with umbilical abnormalities because mismanagement could cause severe morbidity and mortality.
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28
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Keese D, Rolle U, Gfroerer S, Fiegel H. Symptomatic Meckel's Diverticulum in Pediatric Patients-Case Reports and Systematic Review of the Literature. Front Pediatr 2019; 7:267. [PMID: 31294008 PMCID: PMC6606722 DOI: 10.3389/fped.2019.00267] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction: Our aim was to highlight the characteristics of pediatric Meckel's diverticulum with a special focus on its complications. Methods: We report a group of seven patients with Meckel's diverticulum and its resection from the Department of Pediatric Surgery between 2012 and 2017. We reviewed all patient records, clinical presentation, and intraoperative findings. The diagnosis was confirmed by surgery and pathology. For a systematic literature review, we used PubMed, Medline and Google Scholar search engines to locate articles containing terms such as Meckel's diverticulum, children, pediatric, complications and symptomatic. We included article reporting on case series in English and German on pediatric patients only. Results: All included patients (n = 7) were symptomatic. Some patients showed isolated symptoms, and others presented with a combination of symptoms that consisted of abdominal pain, bloody stool or vomiting. The median age of our seven cases was 3.5 years, including 4 male and 3 female patients. Intestinal obstruction was the most common complication; it was seen in 5 out of 7 patients (intussusception in 4 cases, volvulus in 1 case). Ectopic gastric tissue was identified in 3 cases, and inclusion of pancreatic tissue was observed in 1 case. The literature review identified 8 articles for a total of 641 patients aged between 1 day and 17 years and a male:female ratio of 2.6:1. From this group, 528 patients showed clinical symptoms related to Meckel's diverticulum. The most common symptom was abdominal pain and bloody stool. The most common surgical finding in symptomatic patients was intestinal obstruction (41%), followed by intestinal hemorrhage (34%). Complications such as perforation (10%) and diverticulitis (13%) were less frequently reported. Heterotopic tissue was confirmed on histopathology in 53% of all patients enclosing gastric, pancreatic, and both gastric and pancreatic mucosae. In one case, large intestine tissue could be found. Overall, one death was reported. Conclusion: The presented case series and literature review found similar clinical presentations and complications of Meckel's diverticulum in children. Intestinal obstruction and bleeding are more frequent than inflammation in pediatric Meckel's diverticulum. Bowel obstruction is the leading cause for complicated Meckel's diverticulum in patients younger than 12 years.
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Affiliation(s)
- Daniel Keese
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Udo Rolle
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Stefan Gfroerer
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Henning Fiegel
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
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Noukpozounkou SB, Lawani I, Elegbede OTA, Seto DM, Assan BR, Houegban ASCR, Koco H, Fiogbe MA. [Littré's strangled umbilical hernia in children: a rare complication due to a common malformation of the small bowel]. Pan Afr Med J 2018; 30:214. [PMID: 30574233 PMCID: PMC6294977 DOI: 10.11604/pamj.2018.30.214.14486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/06/2018] [Indexed: 11/13/2022] Open
Abstract
Le diverticule de Meckel est l'anomalie congénitale la plus fréquente de l'intestin grêle. Bien qu'il s'agisse d'une anomalie courante dans la population générale, sa présence dans un sac herniaire, en particulier au niveau ombilical est une situation peu fréquente et constitue la hernie de Littré. Nous rapportons le cas d'un nourrisson de 6 mois de sexe féminin, admis pour une tuméfaction ombilicale douloureuse et irréductible. Le diagnostic de hernie ombilicale étranglée a été posé. En per opératoire, il était découvert dans le sac herniaire un diverticule de Meckel inflammatoire. On procéda à une résection cunéiforme du diverticule suivie de la fermeture de la brèche intestinale par une suture en surjet et de la réfection pariétale. Le diagnostic clinique de la hernie de Littré est difficile et l'attitude thérapeutique varie selon les équipes.
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Affiliation(s)
| | - Ismaïl Lawani
- Département de Chirurgie, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Bénin
| | | | - Djifid Morel Seto
- Clinique Universitaire de Chirurgie Pédiatrique CNHU-HKM, Cotonou, Bénin
| | | | | | - Houenoukpo Koco
- Clinique Universitaire de Chirurgie Pédiatrique CNHU-HKM, Cotonou, Bénin
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Parvanescu A, Bruzzi M, Voron T, Tilly C, Zinzindohoué F, Chevallier JM, Gucci M, Wind P, Berger A, Douard R. Complicated Meckel's diverticulum: Presentation modes in adults. Medicine (Baltimore) 2018; 97:e12457. [PMID: 30235734 PMCID: PMC6160168 DOI: 10.1097/md.0000000000012457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Complicated Meckel's diverticulum represents a common etiology of acute abdomen in children. However, this condition is less frequent in adults. We reviewed the records of adult patients who underwent the surgical removal of complicated Meckel's diverticulum between 2001 and 2017 at 2 tertiary French medical centers. We then analyzed the clinical characteristics, mode of presentation, and management for all patients.The Meckel's diverticulum was resected in 37 patients (24 males and 13 females). The mean patient age was 46.1 ± 21.4 years. The most common clinical presentations of complicated Meckel's diverticulum were diverticulitis (35.1%, n = 13), small-bowel obstruction (35.1%, n = 13), and gastrointestinal bleeding (29.8%, n = 11) (anemia, n = 1; hematochezia, n = 10). Age distribution was significantly different (P = .02) according to the 3 Meckel's diverticulum complications: patients with diverticulitis (P = .02) were statistically more frequently over 40 (P = .05), significantly older than patients with gastrointestinal bleeding who were more frequently <40 (P = .05). There was a preoperative diagnosis available for 15 of the 37 patients (40%). An exploratory laparoscopy was necessary to determine the cause of disease for the other 22 patients (60%). An intestinal resection was performed in 33 patients (89%) and diverticulectomy was performed in 4 patients (11%). There was heterotopic tissue found in only 6 patients (16%). Postoperative complications were as follows: 1 death by cardiac failure in a 92-year-old patient and 2 patients with postoperative wound infections. The follow-up time was 3 to 12 months.The correct diagnosis of complicated Meckel's diverticulum in adults is difficult due to the lack of specific clinical presentation. As a result, exploratory laparoscopy appears to play a central role in cases of acute abdomen with uncertain diagnosis.
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Affiliation(s)
- Alina Parvanescu
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Matthieu Bruzzi
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Thibault Voron
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Camille Tilly
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Franck Zinzindohoué
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Jean-Marc Chevallier
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Marco Gucci
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Philippe Wind
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Anne Berger
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Richard Douard
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
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Glenn IC, El-Shafy IA, Bruns NE, Muenks EP, Duran YK, Hill JA, Peter SDS, Prince JM, Lipskar AM, Ponsky TA. Simple diverticulectomy is adequate for management of bleeding Meckel diverticulum. Pediatr Surg Int 2018; 34:451-455. [PMID: 29460177 DOI: 10.1007/s00383-018-4239-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE It is unclear whether simple diverticulectomy, rather than segmental bowel resection (SBR), is adequate treatment for gastrointestinal bleeding (GIB) secondary to Meckel diverticulum (MD). There is concern that ulcers in the adjacent bowel may continue to bleed if only the diverticulum is removed. This study seeks to determine if diverticulectomy is satisfactory treatment for bleeding MD. METHODS A multi-institution, retrospective review was performed for patients with a diagnosis of MD and GIB who underwent simple diverticulectomy or small bowel resection. Exclusion criteria were comorbid surgical conditions and other causes of GIB. The primary outcome was post-operative bleeding during the initial hospitalization. Secondary outcomes were bleeding after discharge, transfusion or additional procedure requirement, re-admission, and overall complications. RESULTS There were 59 patients who met study criteria (42 diverticulectomy, 17 SBR). One patient in the SBR group had early post-operative bleeding (p = 0.288). There was one re-admission (p = 0.288) and three total complications in the SBR group (p = 0.021). There were no cases of bleeding or other complications in the diverticulectomy group. CONCLUSION This study suggests that simple diverticulectomy is adequate for treatment of GIB caused by MD. Furthermore, diverticulectomy appears to have a lower overall complication rate.
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Affiliation(s)
- Ian C Glenn
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Ibrahim Abd El-Shafy
- Cohen Children's Medical Center of New York, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Nicholas E Bruns
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - E Pete Muenks
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Yara K Duran
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Joshua A Hill
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Jose M Prince
- Cohen Children's Medical Center of New York, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Aaron M Lipskar
- Cohen Children's Medical Center of New York, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Todd A Ponsky
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
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Barry WE, Rosenberg DM, Warren M, Kim ES. Small bowel intussusception secondary to inverted Meckel's diverticulum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lei J, Xu W, Yang W, Xiao J, Huang H, Deng Q, Xu H, Feng L, Tao Q, Zhang S. A faster and simpler way of operation for Meckel's diverticulum: basal ligation combined with intraoperative frozen section. Surg Endosc 2017; 32:1464-1469. [PMID: 28916856 DOI: 10.1007/s00464-017-5833-1] [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: 04/24/2017] [Accepted: 08/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The key step in Meckel's diverticulectomy (MD) is to achieve complete resection of MD along with the ectopic epithelium. Currently main treatment methods for Meckel's diverticulum are either intestinal resection and anastomosis or wedge resection. Here we introduced a new method to treat MD. The goal of this study was to investigate the clinical effects and advantages of a new operation method for Meckel's diverticulum: basal ligation combined with intraoperative frozen section. METHODS 262 cases of Meckel's diverticulum were resected with simple basal ligation operation. Intraoperative frozen pathological section was performed to determine surgery strategies. Based on the existence of basal residual ectopic mucosa, surgery was either terminated or further wedge intestinal resection or bowel resection was performed. RESULTS All 262 surgeries were successfully completed. Additional wedge resection or bowel resection was performed in only 23 of them due to the presence of ectopic basal residual gastric mucosa. No ectopic mucosa was found for the other cases, and the operation ended after basal ligation. All patients had no complications such as intestinal fistula, bleeding for 6 months-7.6 years after surgery. CONCLUSIONS Intraoperative frozen pathological examination can well determine whether ectopic Meckel's diverticulum mucosa locates at the basal part. Basal ligation is a safe and effective operation method, and it can significantly shorten the operation time and postoperative fasting time.
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Affiliation(s)
- Jun Lei
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Wei Xu
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Wenping Yang
- Department of Pathology, Jiangxi Children's Hospital, Nanchang, 330006, Jiangxi, China
| | - Juhua Xiao
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, China
| | - Hui Huang
- Department of Pathology, Jiangxi Children's Hospital, Nanchang, 330006, Jiangxi, China
| | - QingQiang Deng
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Hongyan Xu
- Department of Pathology, Jiangxi Children's Hospital, Nanchang, 330006, Jiangxi, China
| | - Liang Feng
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Qiang Tao
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China
| | - Shouhua Zhang
- Department of General Surgery, Jiangxi Children's Hospital, No. 122, Yangming Road, Nanchang, 330006, Jiangxi, China.
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Lin XK, Huang XZ, Bao XZ, Zheng N, Xia QZ, Chen CD. Clinical characteristics of Meckel diverticulum in children: A retrospective review of a 15-year single-center experience. Medicine (Baltimore) 2017; 96:e7760. [PMID: 28796070 PMCID: PMC5556236 DOI: 10.1097/md.0000000000007760] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Meckel diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract in children. The aim of this study was to review and analyze clinical data on the diagnosis and management of Meckel diverticulum in pediatric patients. The records of 102 pediatric patients (<14 years old) who underwent surgery for Meckel diverticulum at our institute between 2001 and 2015 were reviewed. Clinical, imaging, laboratory, surgical, and pathological data were recorded. The series comprised 65 males and 37 females with a median age of 5.6 years. Lower gastrointestinal bleeding was the most frequently identified clinical manifestation of Meckel diverticulum, and this manifestation was observed in 41 patients. Intussusception secondary to Meckel diverticulum was identified in 32 patients. Twelve patients presented clinical features of peritonitis; of these patients, 8 had perforated Meckel diverticulum and 4 had Meckel diverticulitis. In 10 patients, Meckel diverticulum was incidentally diagnosed during other surgeries, including appendectomy and neonatal enterostomy. Seven patients were diagnosed with intestinal obstruction. Technetium-99m pertechnetate imaging offered high diagnostic yield. Open surgery was performed on 59 patients, while a laparoscopic approach was employed in 35 patients. The remaining 8 patients did not undergo resection of the Meckel diverticulum. Histology revealed ectopic gastric mucosa in 42 patients (44.7%), ectopic pancreatic tissue in 35 patients (37.2%), mucosa of the small intestine in 15 patients (16.0%), and both gastric and pancreatic ectopic tissue in 2 patients (2.1%). All patients recovered uneventfully except 2 patients in whom an intestinal adhesion obstruction was identified after discharge. Meckel diverticulum had various clinical manifestations in children. Technetium-99m pertechnetate imaging may be useful for diagnosing Meckel diverticulum. Surgical excision of the Meckel diverticulum may be safe and effective in symptomatic patients, and relatively better outcomes can be achieved using this approach.
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Affiliation(s)
- Xiao-kun Lin
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Xiao-zhong Huang
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Xiao-zhou Bao
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Na Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiong-zhang Xia
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Cong-de Chen
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Ultrasound assessment of the bowel: inflammatory bowel disease and conditions beyond. Pediatr Radiol 2017; 47:1082-1090. [PMID: 28779191 DOI: 10.1007/s00247-017-3877-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
Ultrasound (US) is a versatile imaging study for the evaluation of the bowel in children. US imaging of the bowel can be used as the initial examination or in follow-up for many common pediatric diseases. In this article, we highlight our bowel US technique and describe how US can depict the features of a select group of bowel pathologies relevant to pediatric practice.
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Morão S, Knoblich M, Alves F, Alves R, Pascoal J. Torsion and inflammation of Meckel's diverticulum: Rare cause of acute abdominal pain. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Farooq M, Rajesh A. Giant Meckel's diverticulum compressing root of mesentery - A rare cause of ileal gangrene - Case report and review of literature. Int J Surg Case Rep 2017; 38:53-56. [PMID: 28735118 PMCID: PMC5522956 DOI: 10.1016/j.ijscr.2017.06.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/16/2017] [Accepted: 06/11/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum (MD) commonly presents as gastrointestinal bleeding in the pediatric population and intestinal obstruction in adults. There is no consensus for surgical excision of an incidentally diagnosed MD. We present a hitherto unreported vascular cause of intestinal gangrene due to MD. CASE PRESENTATION A 16year old boy was referred as an acute abdomen for tertiary hospital management. Clinical examination and CT suggested small bowel obstruction and emergency laparotomy was performed. A giant MD compressing the root of mesentery, causing critical occlusion of the ileal vessels and extensive ileal gangrene was found. The gangrenous bowel was resected and a jejuno-ascending colon anastamosis was done. Postoperative recovery was uneventful. DISCUSSION This case report highlights an unrecognized complication of a giant Meckel's diverticulum. There are no clear guidelines on the management of an incidentally discovered MD though certain studies recommend resection of an incidental MD in males and individuals less than 50 years of age or when the MD is larger than 2cm or contains histologically abnormal tissue. Other meta-analyses do not recommend routine resection. MD has been identified as a high risk region for ileal malignancy and its resection usually has minimal morbidity. A valid consent for opportunistic resection of a Meckel's diverticulum in any laparotomy would be discerning. CONCLUSION Appropriate opportunistic resection of an incidental Meckel's diverticulum may prevent extensive surgical morbidity later. This case highlights the need to revisit guidelines for management of incidentally identified MD.
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Affiliation(s)
- Mohammed Farooq
- Madras Medical College, No.3 EVR Periyar Salai, Park Town, Chennai 600003, Tamil Nadu, India
| | - Aashish Rajesh
- Madras Medical College, No.3 EVR Periyar Salai, Park Town, Chennai 600003, Tamil Nadu, India.
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Abstract
There is a broad clinical spectrum of gastrointestinal bleeding in children, ranging from subtle laboratory findings to dramatic clinical presentations. This review provides a framework for the evaluation and management of gastrointestinal hemorrhage for pediatricians. It outlines strategies for obtaining a tailored patient history and conducting a thorough physical examination that can shed light on the location, severity, and likely etiology of bleeding. It appraises blood tests, radiologic tools, and endoscopic modalities frequently used to identify and control a source of bleeding.
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Affiliation(s)
- Anita K Pai
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Victor L Fox
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Çelebi S. Male predominance in Meckel's diverticulum: A hyperacidity hypotheses. Med Hypotheses 2017; 104:54-57. [PMID: 28673591 DOI: 10.1016/j.mehy.2017.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/21/2017] [Indexed: 12/15/2022]
Abstract
The symptomatic presentation of Meckel's diverticulum (MD) depends on a person's age, sex, and presence or absence of ectopic gastric tissue. There are no differences in the prevalence of asymptomatic MD between males and females; however, symptomatic MD has a distinct male predominance with a male-to-female ratio ranging from 2:1 to 5:1 in children. Furthermore, if the ectopic tissue contains gastric mucosa, MD has a greater chance of becoming symptomatic. Studies have shown that acid secretion is more likely to occur in male infants compared to female infants. In adults, men are known to have a higher level of acid production compared to women. Peptic ulcers (PU) are more common in males due to high acid secretion, and gastric tissues are affected by gastrin secretion in both conditions. MD is typically accompanied by ectopic gastric tissue, and could therefore be affected by gastrin and acid secretion in a similar manner to PU. Some of the major complications of MD are diverticulitis, ulcers, and bleeding from adjacent ectopic gastric tissue, and such complications resemble PU. PU also have male to female ratios ranging from 2:1 to 5:1, which is again similar to MD. Since the secretion of both gastrin and acid decrease with age, symptomatic presentation of MD also declines with age. Therefore, we hypothesize that higher gastrin and acid levels in males affect the ectopic gastric mucosa and lead to an increase in MD symptoms, which result an increased incidence of MD in males.
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Affiliation(s)
- Süleyman Çelebi
- Istanbul University Medical Faculty, Department of Pediatric Surgery, Istanbul, Turkey.
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40
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Huang HY, Huang XZ, Han YJ, Zhu LB, Huang KY, Lin J, Li ZR. Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception. Pediatr Surg Int 2017; 33:575-580. [PMID: 28124113 DOI: 10.1007/s00383-017-4060-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intestinal necrosis is the most serious complication of intussusception. The risk factors associated with intestinal necrosis in pediatric patients with intussusception have not been well characterized. OBJECTIVE This study aimed to investigate the risk factors associated with intestinal necrosis in pediatric patients with failed non-surgical reduction for intussusception. METHODS Hospitalized patients who failed the air-enema reduction for intussusception in the outpatient department and subsequently underwent surgery were retrospectively reviewed. All cases were categorized into two groups: intestinal necrosis group and non-intestinal necrosis group based on the surgical findings. Demographic and clinical features including the findings from the surgery were recorded and analyzed. Factors associated with intestinal necrosis were analyzed using univariate and multivariate unconditional logistic regression analyses. RESULTS A total of 728 cases were included. Among them, 171 had intestinal necrosis at the time of surgery. The group with intestinal necrosis had a longer duration of symptom or length of illness (P = 0.000), and younger (P = 0.000) than the non-intestinal necrosis group. Complex/compound type of intussusceptions is more likely to have intestinal necrosis. Multivariate analysis showed that the presence of grossly bloody stool (OR = 2.12; 95% CI 1.19-3.76, P = 0.010) and duration of symptom (OR = 1.07; 95% CI 1.06-1.08, P = 0.000) were independent risk factors for intestinal necrosis in patients hospitalized for surgical reduction for intussusceptions. CONCLUSION At time of admission, the presence of bloody stools and duration of symptom are the important risk factors for developing intestinal necrosis for those patients who failed non-surgical reduction. The length of illness has the highest sensitivity and specificity to correlate with intestinal necrosis. This finding may suggest that we should take the intussusception cases that have the longer duration of symptom directly to operation room for reduction.
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Affiliation(s)
- Hui-Ya Huang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiao-Zhong Huang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Yi-Jiang Han
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Li-Bin Zhu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Kai-Yu Huang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Jing Lin
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China. .,Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Zhong-Rong Li
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
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Restivo V, Costantino C, Tramuto F, Vitale F. Hospitalization rates for intussusception in children aged 0-59 months from 2009 to 2014 in Italy. Hum Vaccin Immunother 2017; 13:445-449. [PMID: 28075671 DOI: 10.1080/21645515.2017.1264784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The real cause of intussusception is not fully understood and a variety of conditions have been associated with it (Meckel diverticulum, polyps, duplication cysts, parasites, Henoch-Schönlein purpura, cystic fibrosis, hemolytic-uremic syndrome and infectious gastroenteritis). Furthermore few European countries, following WHO recommendation to monitor baseline incidence of intussusception before implementation of immunization program for rotavirus, used intussusception rate as a baseline value to compare the same figures in the period before and after introduction of vaccination. In this study, data of intussusception hospitalizations occurred among Italian children aged 0 through 59 months from 2009 to 2014 were analyzed. A total amount of 3,088 children were included, accounting for a hospitalization rate of 20.2 per 100,000. Overall, the hospitalization rate for intussusception had a slight increase in trend from 2009 to 2014 (18%). In particular children 0-11 months had a hospitalization rate higher than 12-59 months with an aggregate value of 36 Vs. 16 per 100,000 respectively. Among all children hospitalized for intussusception a total of 239 (7.7%) had also a previous or concomitant hospitalization for gastroenteritis. This study demonstrates that Italian hospitalizations for intussusception are increasing by time and the role played by different risk factors, including acute gastroenteritis, have to be investigated in the future. These data could be useful to monitor intussusception hospitalization in the perspective of anti-rotavirus vaccination introduction in Italy.
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Affiliation(s)
- Vincenzo Restivo
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Claudio Costantino
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Fabio Tramuto
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Francesco Vitale
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
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Abstract
OBJECTIVE The aim of this study was to review the management of pediatric cases of vitelline duct pathology (VDP) detected surgically or incidentally during the neonatal period and the outcomes. METHODS The data of newborns who were symptomatic and underwent VDP resection or who were incidentally diagnosed with VDP at a single institution between 1985 and 2015 were retrospectively analyzed in terms of age, sex, clinical features, treatment, perioperative findings, ectopic tissue pathology, and postoperative follow-up information. RESULTS Among the 36 newborns enrolled in this study, 26 were male and 10 were female (2.6:1). The median weight was 2400 g (range: 800-3090 g). In 16 cases (14 males and 2 females; 7:1) the VDP was surgically repaired. Pathological evaluation indicated that 43% (n=7) of the cases had ectopic gastric mucosa. VDP was incidentally discovered in 12 males and 8 females (1.5:1). VDP was removed in 10 cases (50%) and left intact in others. Ectopic gastric mucosa was observed in 10% of the VDP removal cases. Ectopic gastric tissue was more prevalent in the surgical VDP cases than in the incidentally discovered and VDP removal cases (p<0.05). Male predominance was greater in the surgically repaired cases than in the incidentally discovered cases (p<0.05). One patient whose VDP was discovered incidentally was admitted 3 years later with obstruction due to intussusception caused by Meckel's diverticulum, and 1 patient was admitted with rectal bleeding at 11 years of age. CONCLUSION Symptomatic VDP in the newborn demonstrates a significant gender difference. Symptomatic cases are more likely to have ectopic gastric tissue than non-symptomatic cases. Incidentally detected cases without removal should be followed closely for future complications.
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Fiegel H, Gfroerer S, Rolle U. Systematic review shows that pathological lead points are important and frequent in intussusception and are not limited to infants. Acta Paediatr 2016; 105:1275-1279. [PMID: 27588829 DOI: 10.1111/apa.13567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/31/2016] [Indexed: 01/10/2023]
Abstract
Intussusception is the most clinically relevant cause of bowel obstruction in infancy and can be idiopathic or occur as a result of pathological lead points. The incidence of these pathological lead points varies from 0.3 to 20%, and they can be mucosal, intramural or extrinsic structures. A systematic literature review was performed from 1998 to 2016 to evaluate the incidence and types of pathological lead points in paediatric intussusception, and this identified 31 epidemiological and retrospective case cohort studies, reviews and case reports. CONCLUSION Pathological lead points were frequent in intussusceptions and not limited to infants.
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Affiliation(s)
- Henning Fiegel
- Department of Paediatric Surgery and Paediatric Urology; University Hospital of the Goethe-University Frankfurt/M.; Frankfurt/M Germany
| | - Stefan Gfroerer
- Department of Paediatric Surgery and Paediatric Urology; University Hospital of the Goethe-University Frankfurt/M.; Frankfurt/M Germany
| | - Udo Rolle
- Department of Paediatric Surgery and Paediatric Urology; University Hospital of the Goethe-University Frankfurt/M.; Frankfurt/M Germany
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Abstract
BACKGROUND Meckel's diverticulum (MD) is the one of the most common congenital malformation of gastrointestinal tract and has varied clinical presentations. We are presenting here our 12-year experiences with MD in children at tertiary care hospital in North India. It highlights the fact that isolated gangrene of MD can occur, and it is associated with increased morbidity. MATERIALS AND METHODS This retrospective study is conducted by analysing the medical records of the patients who were operated for MD in the last 12 years in paediatric surgery department at our hospital. RESULTS Sixty-five patients were operated for MD in study period; in this 52 were males and 13 were females with mean age of presentation 3.2 years. The most common presentation was intestinal obstruction seen in 86.1% (56 cases). Intestinal haemorrhage was seen in 4.6% (3 cases) and diverticulitis in 3% (2 cases). Perforation of the gut with peritonitis was present in 6.1% (four cases). Cause of obstruction was intussusception in 21.4% (12 cases), fibrous band connected to umbilicus in 17.8% (10 cases), volvulus in 17.8% (10 cases), kinking in 16.0% (9 cases), knotting in 14.2% (8 cases) and herniation of gut below in 12.5% (7 cases). Isolated gangrene of MD was present in ten cases with intestinal obstruction. The ectopic gastric mucosa was seen in three and pancreatic mucosa in two cases. Mortality and morbidity during the study were one and three cases, respectively. CONCLUSION MD may remain clinically silent for lifetime, or it may have life-threatening complications. In our series, intestinal obstruction and not the haemorrhage was the most common presentation. Isolated gangrene of MD with obstruction was present in significant numbers, which we failed to find in literature.
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Affiliation(s)
| | - Jasbir Singh
- Department of Pediatrics, PGIMS, Rohtak, Haryana, India
| | - Poonam Dalal
- Department of Pediatrics, PGIMS, Rohtak, Haryana, India
| | - Ananta Rattan
- Department of Pediatric Surgery, PGIMS, Rohtak, Haryana, India
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Trotta F, Da Cas R, Bella A, Santuccio C, Salmaso S. Intussusception hospitalizations incidence in the pediatric population in Italy: a nationwide cross-sectional study. Ital J Pediatr 2016; 42:89. [PMID: 27677340 PMCID: PMC5039877 DOI: 10.1186/s13052-016-0298-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background Study to investigate the intussusception incidence background in the pediatric population and its temporal trend in Italy. Methods A cross-sectional study was conducted on the pediatric population aged 0 to 15 years, in the period 1 January 2002 to 31 December 2012. Intussusception cases were identified using the national hospital discharge database. The annual intussusception incidence, the incidence rate ratios (IRRs) and the related 95 % confidence Intervals (CI) were calculated. Results The overall intussusception incidence rate was 21 per 100,000 children aged ≤15 years, and was higher among boys than girls. The highest intussusception incidence rate occurred in infants <1 year of age (39 per 100,000 infants). Among infants, incidence varied with the geographical area, with higher rates in the central Italy (50 per 100,000 infants). The annual incidence rates in infants were stable since 2004 and up to 2012, ranging from 40.1 and 33.0 per 100,000 infants. Similar stable patterns were observed when conducting the analysis on children over 1 year of age. Conclusions This study provided the intussusception incidence background in Italy in different pediatric ages, including infants, over an 11-year period. This information is essential in post-marketing safety surveillance, to continuously monitor the benefit/risk profile of rotavirus vaccinations. Electronic supplementary material The online version of this article (doi:10.1186/s13052-016-0298-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesco Trotta
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy. .,National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy.
| | - Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Antonino Bella
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
| | - Carmela Santuccio
- Pharmacovigilance Office, Italian Medicines Agency (AIFA), Via del Tritone 181, Rome, 00187, Italy
| | - Stefania Salmaso
- National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, Rome, 00161, Italy
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Abbas SH, Akbari K, Mason J, Booth M. Mesenteric Meckel's diverticulum: an unusual cause of small bowel intussusception. BMJ Case Rep 2016; 2016:bcr-2016-214830. [PMID: 27060074 DOI: 10.1136/bcr-2016-214830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Meckel's diverticulum (MD) is the commonest congenital anomaly of the small intestine, affecting 1-4% of the population. Cardinal features emphasise an antimesenteric location two feet proximal to the ileocaecal valve, with a separate mesenteric blood supply and involvement of all layers of the small intestine. However, reports of MD arising from the mesenteric border of the small intestine are rare in the surgical literature. This report examines the case of a 45-year-old woman presenting with a 6-month history of episodic central abdominal pain and microcytic anaemia who underwent an elective diagnostic laparoscopy as initial CT findings were inconclusive. Intraoperatively, she was found to have small bowel intussusception approximately 40 cm proximal to the ileocaecal valve. Macroscopic examination of the resected small bowel segment revealed a mesenteric outpouching that was confirmed as mesenteric MD on histopathological analysis. Postoperatively, the patient recovered with no surgical complications and full symptom resolution.
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Affiliation(s)
| | | | - John Mason
- Royal Berkshire Hospital, Reading, Berkshire, UK
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Clinical and Ultrasonographic Features of Secondary Intussusception in Children. Eur Radiol 2016; 26:4329-4338. [PMID: 27048536 DOI: 10.1007/s00330-016-4299-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/01/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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49
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Abstract
The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most commonly in infancy; however, some may not present until adulthood. Most congenital anomalies of the small intestine will present with obstructive symptoms while some may present with vomiting, abdominal pain, and/or gastrointestinal bleeding. Various radiologic procedures can aid in the diagnosis of these lesions that vary depending on the particular anomaly. Definitive therapy for these congenial anomalies is surgical, and in some cases, surgery needs to be performed urgently. The overall prognosis of congenital anomalies of the small intestine is very good and has improved with improved medical management and the advent of newer surgical modalities. The congenital anomalies of the small intestine reviewed in this article include malrotation, Meckel's diverticulum, duodenal web, duodenal atresia, jejunoileal atresia, and duplications.
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Affiliation(s)
- Grant Morris
- Department of Pediatrics, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Alfred Kennedy
- Department of Pediatric Surgery, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - William Cochran
- Department of Pediatric Gastroenterology, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA.
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Alemayehu H, Stringel G, Lo IJ, Golden J, Pandya S, McBride W, Muensterer O. Laparoscopy and complicated meckel diverticulum in children. JSLS 2016; 18:JSLS-D-14-00015. [PMID: 25392652 PMCID: PMC4208888 DOI: 10.4293/jsls.2014.00015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy. Methods: A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum. Results: Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications. Conclusions: Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.
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Affiliation(s)
- Hanna Alemayehu
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Gustavo Stringel
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY
| | - Irene J Lo
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Jamie Golden
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
| | - Samir Pandya
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
| | - Whitney McBride
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
| | - Oliver Muensterer
- Department of Pediatric Surgery, New York Medical College, Valhalla, NY
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