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Konstantakis C, Mantzios P, Sotiropoulos C, Anesidis S, Thomopoulos KC. Intussuscepted Polypoid Meckel's Diverticulum Presenting With Gastrointestinal Bleeding in a Young Adult. Cureus 2024; 16:e51744. [PMID: 38318558 PMCID: PMC10840443 DOI: 10.7759/cureus.51744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
A 22-year-old female patient with a recent hospitalization for gastrointestinal bleeding presented with recurrent hematochezia and a positive shock index. Previous investigations, including endoscopy and wireless small bowel capsule, were non-diagnostic. CT angiography revealed extravasation in the ileum. Initial tests like technetium-99m scintigraphy and ileocolonoscopy were negative. Repeat wireless small bowel capsule identified a partially ulcerated polypoid mass in the distal ileum. At surgical exploration, an intussuscepted Meckel's diverticulum was identified and resected. A histopathologic examination confirmed the diagnosis. Meckel's diverticulum is a rare cause of gastrointestinal bleeding in adults. Preoperative diagnosis can be challenging. Reports of a polypoid morphology are very scarce in indexed literature and mostly derive from investigation with device-assisted enteroscopy. We report this extremely rare finding at capsule endoscopy to raise clinician awareness and to discuss diagnostic difficulties associated with similar cases, such as the negative scintigraphy result and the optimal timing of repeat capsule endoscopy.
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Affiliation(s)
| | - Petros Mantzios
- Gastroenterology Department, University General Hospital of Patras, Patras, GRC
| | | | - Stathis Anesidis
- General Surgery Department, University General Hospital of Patras, Patras, GRC
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Cytomegalovirus Graft Duodenitis Diagnosed by Transanal Double-Balloon Endoscopy Technique in an Enteric-Drained Pancreas Transplant Recipient: A Case Report. Transplant Proc 2022; 54:2761-2764. [DOI: 10.1016/j.transproceed.2022.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
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Yang J, Tian D, Wu L, Dong M, Zhong J. Meckel's diverticulum with polypoid hyperplasia of ectopic gastric mucosa diagnosed by double-balloon enteroscopy and single-photon emission computed tomography/computed tomography. J Int Med Res 2021; 48:300060520955055. [PMID: 32954882 PMCID: PMC7509755 DOI: 10.1177/0300060520955055] [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
Meckel’s diverticulum (MD) is a relatively common true congenital diverticulum on the ileum. Bleeding caused by polypoid hyperplasia of ectopic gastric mucosa in MD is rare. A 14-year-old Chinese boy presented with intermittent melena and haematochezia for 1 month. Laboratory data showed normocytic anaemia. Gastroscopic findings were normal. The patient underwent exploratory laparotomy without bowel preparation on day 2 because of sudden haematochezia and decreased haemoglobin. Intraoperative colonoscopy revealed inflammatory changes in the terminal ileal mucosa with diffuse haemorrhage. Melena with decreased haemoglobin recurred 20 days after the first operation. Computed tomography (CT) and angiography revealed a tubular lesion that was localised in the right lower abdominal quadrant. Single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging with 99m-technetium pertechnetate confirmed moderately increased uptake in the distal ileum. Retrograde double-balloon enteroscopy (DBE) showed a diverticulum with prominent mucosal polypoid hyperplasia at an insertion depth of 100 cm from the anastomotic stoma. Diverticulectomy and end-to-end anastomosis were performed, and MD was confirmed by a histopathological examination. The patient’s postoperative recovery was uneventful during the 2-month follow-up. MD with polypoid hyperplasia of ectopic gastric mucosa is rare. Complementary use of DBE and SPECT/CT can accurately diagnose MD by providing anatomical and functional information.
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Affiliation(s)
- Jun Yang
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Dan Tian
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Lihua Wu
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Mengjie Dong
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Jijun Zhong
- Department of Nuclear Medicine, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, P.R. China
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Azhar M, Zamir N, Taqvi SR, Shaikh M. Spectrum of Omphalomesenteric Duct Related Anomalies and Their Surgical Management in Children. Cureus 2021; 13:e13898. [PMID: 33880254 PMCID: PMC8046167 DOI: 10.7759/cureus.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to evaluate the clinical presentation and surgical management of omphalomesenteric duct (OMD) remnants in children. Material and methods A descriptive retrospective study was conducted at the Department of Paediatric Surgery of the National Institute of Child Health, Karachi, Pakistan, from April 2017 to January 2020. Children below 12 years of age with various OMD remnants were included in the study. Data regarding age of presentation, type of anomaly, and management collected during this period were reviewed and analyzed using SPSS Version 22 (IBM Corp., Armonk, NY, USA). Results A total of 86 patients, 47 males and 39 females, were managed during the study period. Intestinal obstruction was observed in 44 (51.16%) cases followed by OMD-related umbilical anomalies in 14 (16.27%) cases, acute abdominal pain in 12 (13.95%), rectal bleeding in 3 (3.48%) patients. In 13 (15.16%) cases, Meckel’s diverticulum was discovered incidentally. In 21 cases, wedge resection and ileal repair was performed, whereas 32 required segmental resection and end-to-end anastomosis, and in 32 cases ileostomy was created after resection. Histopathology showed the presence of ectopic mucosa in five cases. Conclusion Patients with OMD remnants had various presentations. The surgical procedure has to be tailored according to the clinical and surgical findings.
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Affiliation(s)
- Muhammad Azhar
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK.,Paediatric Surgery, Jinnah Sindh Medical University, Karachi, PAK
| | - Naima Zamir
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
| | - Syed R Taqvi
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
| | - Mishraz Shaikh
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
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Yamauchi N, Ito T, Matsuoka H, Chohno T, Hasegawa H, Kakeji Y, Ohnishi T. Intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing gastric cystica profunda component cells within the inverted Meckel's diverticulum: a case report. Surg Case Rep 2020; 6:286. [PMID: 33184680 PMCID: PMC7661620 DOI: 10.1186/s40792-020-01061-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Lipomas are the most common cause of intussusception in adults. To our knowledge, however, no cases of lipoma and ectopic gastric mucosa with gastritis cystica profunda (GCP) have been reported. We report a case of intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing GCP-component cells within the inverted Meckel’s diverticulum. Case presentation A female in her 40s underwent computed tomography for postoperative follow-up of left breast cancer. A tumor, suspected to be a lipoma, was found in the ileum. Since there were no symptoms, the patient underwent regular follow-up. However, gradual enlargement was observed, and surgery was recommended due to the risk of intussusception. After reduction via the Hutchinson technique, laparoscopically assisted partial resection of the small intestine was performed due to suspicion that the tumor was causing intussusception starting from the ileum. Histopathologic examinations revealed proliferation of mature adipose tissue in the subserosal layer, which was diagnosed as lipoma. Furthermore, adipose tissue was found in the stem area and accordingly, we diagnosed lipoma associated with the inverted Meckel’s diverticulum. Moreover, gastric mucosa-like crypt epithelium and proper glandular tissue were identified in the mucosal membrane at the area of onset, and signs of gastric pit dilatation over the submucosa and crypt epithelium hyperplasia were observed. Diagnosis was ectopic gastric mucosa containing GCP component tissue. Conclusions Intussusception in the small intestine complicated with lipoma and ectopic gastric mucosa with GCP within the Meckel’s diverticulum has not been reported, demonstrating the rarity of our case.
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Affiliation(s)
- Natsuko Yamauchi
- Department of Surgery, Nishiwaki Municipal Hospital, 652-1 Shimotoda, Nishiwaki, Hyogo, 677-0043, Japan.,Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takashi Ito
- Department of Surgery, Nishiwaki Municipal Hospital, 652-1 Shimotoda, Nishiwaki, Hyogo, 677-0043, Japan
| | - Hiroki Matsuoka
- Department of Surgery, Nishiwaki Municipal Hospital, 652-1 Shimotoda, Nishiwaki, Hyogo, 677-0043, Japan
| | - Teruhiro Chohno
- Department of Surgery, Nishiwaki Municipal Hospital, 652-1 Shimotoda, Nishiwaki, Hyogo, 677-0043, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takamasa Ohnishi
- Department of Diagnostic Pathology, Nishiwaki Municipal Hospital, 652-1 Shimotoda, Nishiwaki, Hyogo, 677-0043, Japan.
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Bhattacharyya R, Bethel C, Zuberi J. Spontaneous hemoperitoneum in a pediatric patient with Meckel's diverticulum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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