Meckel’s diverticulum masked by a long period of intermittent recurrent subocclusive episodes

Meckel's diverticulum - a congenital defect of the gastrointestinal tract underestimated in differential diagnostics. Own experience

Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct. It is the most frequent defect of the gastrointestinal tract and is present in approx. 2% of the population: more often in boys than in girls, at a 3:1 ratio. Meckel's diverticulum causes clinical symptoms only in 4-6% of individuals. It is situated approximately 60-100 cm away from the Bauhin's valve. The wall of Meckel's diverticulum consists of all layers typical of the small intestine. It is usually approx. 2-3 cm long, but it can reach lengths of over 10 centimetres. It is usually set on a narrow base. Related symptoms usually occur by the 2nd-3rd year of life and have an acute character. They may occur in older children, which must be remembered in differential diagnosis. An example can be the case of an 8.5-year-old boy with symptoms indicating obstruction of the gastrointestinal tract in which a large, atypically accreted and partly twisted Meckel's diverticulum was found with strangulation of the small intestine between the diverticulum and the mesentery.

Pediatric Meckel's Diverticulum: Report of 208 Cases and Review of the Literature

We report a review of 208 cases of Meckel's diverticulum among pediatric patients from one single institution. One of the aims of this report is to highlight the different diagnostic modalities of Meckel's diverticulum since a majority of cases is undiagnosed prior to surgery. Our review shows 58 cases containing gastric and/or pancreatic heterotopic tissue, including two unique cases. The first case reported is a desmoid tumor arising at the tip of diverticulum, a case that, to our knowledge, has not been previously reported. The second case involves a female patient appearing with an acute abdomen thought to be appendicitis, instead surgery revealed a diverticulum arising from the ileum. The cause of acute abdomen was due to gonococcal infection. In conclusion, we hope that this large series of Meckel's cases will enrich our readers on the differential diagnosis and preoperative diagnostic techniques of Meckels' diverticulum.

Giant Meckel diverticulum with enteroliths: a case report of a patient presenting with low back and episodic right lower quadrant pain

OBJECTIVES

The purpose of this case report is to describe a patient who presented with low back pain and episodic right lower quadrant pain who had a long-standing giant Meckel diverticulum with enteroliths.

CLINICAL FEATURES

A 49-year-old woman presented to a chiropractic clinic with low back pain and history of intermittent right lower quadrant pain. Lumbar radiography demonstrated calcifications in the pelvic basin that changed position with changes in patient posture. The patient was referred to an abdominal surgeon for consultation and management.

INTERVENTION AND OUTCOME

Computed tomography identified calcifications in the small bowel in the region of the ileocecal valve. The patient underwent prophylactic diverticulectomy with no complications. Gross pathology revealed a giant Meckel diverticulum measuring 24 inches (60.9 cm) containing 6 enteroliths.

CONCLUSIONS

A timely diagnosis resulted in a favorable surgical outcome for this patient with long-standing giant Meckel diverticulum and enteroliths.

Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum

Three of the most common causes of surgical abdominal pain in pediatric patients include appendicitis, Meckel diverticulum, and intussusception. All 3 can present with right lower quadrant pain, and can lead to significant morbidity and even mortality. Although ultrasound is the preferred method of diagnosis with appendicitis and intussusception, considerable variety exists in the modalities needed in the diagnosis of Meckel diverticulum. This article discusses the pathways to diagnosis, the modes of treatment, and the continued areas of controversy.

Intestinal obstruction caused by torsed gangrenous Meckel’s diverticulum encircling terminal ileum

Meckel’s diverticulum (MD) is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage, obstruction, and inflammation. Obstruction of various types is the most common presenting symptom in the adult population. Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications. The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies. Delay in the diagnosis of a complicated MD can lead to significant morbidity and mortality. Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum. To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.