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Ileal atresia with intraluminal Meckel's diverticulum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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2
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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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Patel AK, Boykow M, Sondhi N, Garizio J, Tsompanidis A, Iyengar DP. Hidden Dangers: A Gastrointestinal Stromal Tumor Concealed Inside of a Meckel's Diverticulum. Cureus 2022; 14:e24810. [PMID: 35686285 PMCID: PMC9170530 DOI: 10.7759/cureus.24810] [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] [Accepted: 05/07/2022] [Indexed: 12/03/2022] Open
Abstract
Meckel's diverticulum (MD) is one of the most common congenital abnormalities of the gastrointestinal tract, affecting approximately two percent of the population. Rarely, Meckel’s diverticula have been found to harbor various tumors, which go unnoticed until later in their course. The clinical presentation varies among each individual, and tumors have often metastasized or caused diverticular rupture at the time of diagnosis. This is a case of a 55-year-old male with a past medical history of alcohol abuse and asthma who presented to the emergency department with abdominal pain. He denied any fever, chills, chest pain, nausea, changes in urinary patterns, recent travel, or sick contacts. He is a non-smoker but has been a heavy drinker for many years. On physical exam, he was found to have diffuse abdominal tenderness with pain greatest in the epigastric region and no bowel sounds. He was afebrile but tachycardic at 112 bpm, hypertensive at 168/98 mmHg, and tachypneic at 38 bpm. Labs showed a markedly elevated white blood cell count, hemoglobin and platelet count, as well as metabolic acidosis and elevated lactate levels. Abdominal CT showed a mechanical small bowel obstruction with unclear etiology. Of note was a 7.2 cm thick-walled collection in the right lower quadrant having no clear communication with any bowel loops. Despite aggressive hydration and supportive care, his abdominal exam continued to worsen, prompting an exploratory laparotomy. During the laparotomy, a perforated MD with frank succus was found. On pathology, the affected segment of the bowel revealed a CD117 and CD34 positive spindle cell gastrointestinal stromal tumor (GIST) with mild cytological atypia, no necrosis, and no regional lymph node involvement. Cultures of peritoneal fluid were positive for Klebsiella oxytoca, and the patient was started on meropenem and doxycycline. The patient showed significant improvement with the appropriate administration of antibiotics and was eventually discharged to follow-up with hematology/oncology as an outpatient for further management and monitoring of his GIST tumor. This case is unique as there are only a few reported cases of patients developing GIST inside of MDs. Despite the high five-year survival rate of typically localized GIST tumors, the complications (such as perforation in the case of our patient) caused by tumor growth inside a MD are detrimental if not diagnosed promptly. Not only does perforation increase the risk of metastasis but also the risk of peritonitis and other complications. This case calls for more research on standardization of care for patients who have MD to prevent malignant transformations as well as potential prophylactic excision of incidental MD findings in adult patients.
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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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Abstract
Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallstones, and incidental appendectomy.
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Affiliation(s)
- Keely Reidelberger
- University of Nebraska Medical Center College of Medicine, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA
| | - Abbey Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA.
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Inarejos Clemente EJ, Navarro OM, Navallas Irujo M, Ladera E, Colombo C, Suñol M, Sousa P, Barber Martínez de la Torre I. Omphalomesenteric Duct Anomalies in Children: A Multimodality Overview. Radiographics 2021; 41:2090-2110. [PMID: 34723700 DOI: 10.1148/rg.2021210048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The omphalomesenteric duct is an embryologic structure that connects the yolk sac with the primitive midgut of the developing fetus. Omphalomesenteric duct anomalies include a group of entities that result from failed resorption of the omphalomesenteric duct. These anomalies include Meckel diverticulum, omphalomesenteric fistula, fibrous bands, cysts, and umbilical polyps. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic. Symptoms develop when Meckel diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. Hemorrhage is the most common complication of Meckel diverticulum, and technetium 99m-pertechnetate scintigraphy is the imaging modality of choice for detecting acute bleeding. US and CT are commonly used for the evaluation of patients with other complications such as obstruction and inflammation. Nevertheless, the diagnosis of these complications can be challenging, as their clinical manifestations are usually nonspecific and can masquerade as other acute intraabdominal entities such as appendicitis, inflammatory bowel disease, or other causes of bowel obstruction. There are other umbilical disorders, such as urachal remnants and umbilical granuloma, that may present with symptoms and imaging findings similar to those of omphalomesenteric duct anomalies. An accurate preoperative diagnosis of omphalomesenteric duct anomaly is crucial for appropriate management and a better outcome, particularly when these anomalies manifest as a life-threatening condition. The authors review the anatomy, clinical features, and complications of omphalomesenteric duct anomalies in children, describing the relevant differential diagnoses and associated imaging findings seen with different imaging modalities. ©RSNA, 2021.
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Affiliation(s)
- Emilio J Inarejos Clemente
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - María Navallas Irujo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Enrique Ladera
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Cecilia Colombo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Mariona Suñol
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Paulino Sousa
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Ignasi Barber Martínez de la Torre
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
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Redman EP, Mishra PR, Stringer MD. Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review. Pediatr Surg Int 2020; 36:869-874. [PMID: 32436063 DOI: 10.1007/s00383-020-04673-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
Recent reports have recommended laparoscopic diverticulectomy for symptomatic Meckel diverticulum (MD) rather than laparoscopic-assisted extracorporeal resection. This technique may risk leaving residual ectopic mucosa leading to complications. This systematic review attempts to quantify the relative risks of both approaches. A systematic review was conducted according to PRISMA guidelines. Articles were eligible for inclusion if they reported data on the laparoscopic management of symptomatic MD in children. Eleven reports were identified, all of which were institutional retrospective studies. Pooled outcome data on 248 children showed no statistically significant difference in complications between laparoscopic diverticulectomy (n = 133) and laparoscopic-assisted segmental resection (n = 115) (3% vs. 6.1%, p = 0.39). One patient from the diverticulectomy group re-presented with recurrent bleeding necessitating segmental small bowel resection. Conclusions are limited by the number of patients and variable follow up. Short, wide MD with a height:base ratio of < 2; diverticula with thickening or ischemia at the base and those complicated by volvulus or small bowel obstruction are probably best treated by laparoscopic-assisted extracorporeal resection. For other symptomatic diverticula laparoscopic diverticulectomy is a reasonable approach with a less than 1% risk of leaving residual ectopic gastric mucosa.
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Affiliation(s)
- E P Redman
- Department of Paediatric Surgery, Level 3 CSB, Wellington Children's Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand
| | - P R Mishra
- Department of Paediatric Surgery, Level 3 CSB, Wellington Children's Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand
| | - M D Stringer
- Department of Paediatric Surgery, Level 3 CSB, Wellington Children's Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand.
- Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, 6021, New Zealand.
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Ichikawa S, Onishi H, Motosugi U. Imaging Findings of Acute Abdomen due to Complications of Meckel Diverticulum. Can Assoc Radiol J 2020; 71:149-153. [DOI: 10.1177/0846537119899537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Meckel diverticulum is the most common and well-known congenital anomaly of the digestive system. Although most cases are asymptomatic, Meckel diverticulum can have a variety of complications, including gastrointestinal bleeding as a result of peptic ulceration, diverticulitis, and small bowel obstruction. Although the radiologic findings of these complications have been reported, they are difficult to diagnose preoperatively because Meckel diverticulum is a small entity. Computed tomography and scintigraphy play an important role in the diagnosis of Meckel diverticulum and its complications. It is important to be familiar with the radiologic features of acute abdomen due to complications of Meckel diverticulum to be able to manage the condition appropriately.
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Affiliation(s)
- Shintaro Ichikawa
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan
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A Moving Meckel Diverticulum on 99mTc-Pertechnetate Imaging in a Patient With Inguinal Hernia. Clin Nucl Med 2019; 45:154-155. [PMID: 31876817 DOI: 10.1097/rlu.0000000000002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A boy aged 1 year 8 months underwent Tc-pertechnetate scintigraphy to evaluate the cause of bloody stool. On the initial images, there was an abnormal activity in the right abdomen, which changed location to the right groin in later images. A Meckel diverticulum was identified by histopathology examination. We concluded this case of moving Meckel diverticulum was caused by the synergy between an inguinal hernia and high abdominal pressure.
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Charki MT, Oukhouya MA, Benmassaoud Z, Mahmoudi A, Khattala K, Bouabdallah Y. [Complications of Meckel's diverticulum in children: about 18 cases]. Pan Afr Med J 2019; 33:113. [PMID: 31489091 PMCID: PMC6711690 DOI: 10.11604/pamj.2019.33.113.18756] [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: 04/02/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
Meckel's diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel's diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient's outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.
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Affiliation(s)
- Mohammed Tazi Charki
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Mohammed-Amine Oukhouya
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Zineb Benmassaoud
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Abdelhalim Mahmoudi
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Khalid Khattala
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
| | - Youssef Bouabdallah
- Centre Hospitalier Universitaire Hassan II, Université Sidi Mohamed Ben Abdellah, Département de Chirurgie Pédiatrique, Fès, Maroc
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Cai P, Zhu Z, Chen J, Chen L, Pan J, Zhi W, Zhu J, Wu B, Gu Z, Huang S, Wang J. A newborn patient with both annular pancreas and Meckel's diverticulum: A case report of an unusual association. Medicine (Baltimore) 2018; 97:e0583. [PMID: 29703052 PMCID: PMC5944541 DOI: 10.1097/md.0000000000010583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Annular pancreas (AP) is recognized as a cause of duodenal obstruction in children, while children with Meckel's diverticulum (MD) are usually asymptomatic. Here we present a rare case with both AP and MD, which was identified by abdominal exploration during diamond-shaped duodenoduodenostomy. PATIENT CONCERNS A "double-bubble" sign was found by ultrasound at 35 week of pregnancy. After 39 weeks of pregnancy, the male patient was transferred to the Department of General Surgery, Children's Hospital of Soochow University because of a suspected duodenal stenosis. DIAGNOSES Preoperative abdominal X-ray examination indicated "double-bubble" sign. AP was confirmed by exploratory surgery, with an MD located 30 cm above the ileocecal valve. INTERVENTIONS Diamond-shaped duodenoduodenostomy and a wedge resection of the intestine with end-to-end anastomosis were performed OUTCOMES:: The patient recovered and his appetite was good without vomiting. LESSONS Our experience demonstrates that abdominal exploration is essential for children with gastrointestinal malformations.
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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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Symptomatic mesodiverticular bands in children. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000516208.20838.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bertozzi M, Melissa B, Magrini E, Di Cara G, Esposito S, Apignani A. Obstructive internal hernia caused by mesodiverticular bands in children: Two case reports and a review of the literature. Medicine (Baltimore) 2017; 96:e8313. [PMID: 29145243 PMCID: PMC5704788 DOI: 10.1097/md.0000000000008313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The mesodiverticular band (MDB) is an embryologic remnant of the vitelline circulation, which carries the arterial supply to the Meckel diverticulum. In the event of an error of involution, a patent or nonpatent arterial band persists and extends from the mesentery to the apex of the antimesenteric diverticulum. This creates a snare-like opening through which bowel loops may herniate and become obstructed. This report describes 2 rare cases of small bowel occlusion owing to an internal hernia caused by a MDB. CASES Case 1 was a 5-year-old boy who presented to our Emergency Department with colicky abdominal pain diffused to all abdominal quadrants. He also had 5 episodes of emesis, the last with bilious vomiting. Case 2, a 12-year-old boy, presented to our Emergency Department complaining of colicky abdominal pain. He had 2 episodes of nonbilious emesis. On physical examination, both children showed distension and tenderness of the abdomen and abdominal x-ray and ultrasound confirmed an occlusive picture without an apparent etiology. In case 1, an urgent laparotomy was performed and the MDB was ligated and cut, whereas in case 2 diagnosis and excision were performed in laparotomy. In both patients, there was a positive clinical evolution. CONCLUSION Although MDB causing internal hernia is very rare, it should be considered in patients with a clinical picture of small bowel obstruction. In these cases, early surgery is important to prevent strangulation and gangrene of the bowel and to avoid dramatic events. Moreover, laparoscopy seems a safe and effective technique in these patients, especially in children with mild abdominal distention without surgical or trauma history, highlighting that further studies on the value of laparoscopy for the treatment of small bowel obstruction in pediatric patients are urgently needed.
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Affiliation(s)
| | | | | | - Giuseppe Di Cara
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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Robinson JR, Correa H, Brinkman AS, Lovvorn HN. Optimizing surgical resection of the bleeding Meckel diverticulum in children. J Pediatr Surg 2017; 52:1610-1615. [PMID: 28359587 PMCID: PMC5610599 DOI: 10.1016/j.jpedsurg.2017.03.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/22/2017] [Accepted: 03/20/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Meckel diverticula containing gastric heterotopia predispose to local hyperacidity, mucosal ulceration, and gastrointestinal bleeding in children. Eradication of acid-producing oxyntic cells is performed by either of two surgical methods: segmental enterectomy including the diverticulum or diverticulectomy only. METHODS Retrospective review of all children having surgical resection of a Meckel diverticulum at a tertiary-referral children's hospital from 2002 to 2016 was performed. Demographic data, surgical method, pathological specimens, and outcomes were evaluated. RESULTS 102 children underwent surgical resection of a Meckel diverticulum during the study period. 27 (26.5%) children presented with bleeding, of which 16 (59%) had diverticulectomy only, and 11 (41%) had segmental ileal resection. All Meckel diverticula in children presenting with bleeding contained gastric heterotopia, and resection margins were free of gastric mucosa. Histologically, 19 specimens showed microscopic features of ulceration, on average 2.95mm (SD 4.49) from the nearest gastric mucosa (range: 0-16mm). Mean length of hospitalization after ileal resection was 4.0days (SD 1.2) compared to 1.6days (SD 0.9) for diverticulectomy only (p<0.001), with no re-bleeding occurrences. CONCLUSION In the operative management of children having a bleeding Meckel diverticulum, diverticulectomy-only completely eradicates gastric heterotopia without increased risk of continued bleeding or complications and significantly shortens hospitalization. LEVEL OF EVIDENCE Treatment Study: Level III.
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Affiliation(s)
- Jamie R. Robinson
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hernan Correa
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam S. Brinkman
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N. Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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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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17
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Torsion of Atypical Meckel's Diverticulum Treated by Laparoscopic-Assisted Surgery. Case Rep Med 2017; 2017:4514829. [PMID: 28785284 PMCID: PMC5530436 DOI: 10.1155/2017/4514829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/15/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum (MD) is the most common congenital anomaly of the intestine, with an incidence of 2~4%. Of those, only 2% of patients with MD are symptomatic. Torsion of MD is extremely rare, and only a dozen cases have been previously reported. CASE REPORT The patient was a 49-year-old male who presented to our emergency room with a chief complaint of lower abdominal pain. Computed tomography imaging revealed an irregular polycystic mass connected to the small intestine that measured 7.5 cm in a diameter. A laparoscopic-assisted partial resection of the jejunum was performed. The lesion was found to have caused torsion and was located 130 cm from the ileocecal valve. The specimen was polycystic in appearance and showed communicating links with the submucosal layer of jejunum but not with the lumen. The pathological diagnosis was a torsion of an atypical presentation of MD. CONCLUSION This case was different from typical cases of MD in that it was located on significantly oral side and had the appearance of polycystic morphology.
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18
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Mizutani Y, Nakamura M, Watanabe O, Yamamura T, Funasaka K, Ohno E, Kawashima H, Miyahara R, Murino A, Goto H, Hirooka Y. Specific characteristics of hemorrhagic Meckel's diverticulum at double-balloon endoscopy. Endosc Int Open 2017; 5:E35-E40. [PMID: 28191494 PMCID: PMC5291157 DOI: 10.1055/s-0042-119810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and study aims Diagnosis of Meckel's diverticulum (MD) before surgery may be challenging; double-balloon endoscopy (DBE) facilitates identification of MD in the setting of a gastrointestinal bleeding; however, MD can be found incidentally without this condition. The purpose of this research was to determine specific characteristic of hemorrhagic MD and incidental MD at DBE. Patients and methods Ectopic gastric mucosa enclosed in the MD and/or ulceration were defined as "major findings"; ring-like scar surrounding the MD was defined as "minor finding". We retrospectively reviewed the medical records of patients affected by MD and analyzed the findings that significantly affected the characterization of MD. Results MD was diagnosed in 33 patients. The axis of the diverticulum was longer in hemorrhagic MD compared to incidental MD (P = 0.031). The amount of transfusion was significantly higher (P = 0.018) in the hemorrhagic MD group. Hemorrhagic MD was significantly more correlated with major findings (P = 0.01) and minor findings (P < 0.01). The specificity of major finding was 100 % while the sensitivity of major and/or minor findings was 96 %. Conclusions The combination of major and minor findings appears to improve the diagnostic ability of hemorrhagic MD avoiding unnecessary diverticulectomy.
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Affiliation(s)
- Yasuyuki Mizutani
- Department of Gastroenterology and
Hepatology, Nagoya University Graduate School of Medicine, Nagoya,
Japan
| | - Masanao Nakamura
- Department of Gastroenterology and
Hepatology, Nagoya University Graduate School of Medicine, Nagoya,
Japan
| | - Osamu Watanabe
- Department of Gastroenterology and
Hepatology, Nagoya University Graduate School of Medicine, Nagoya,
Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University
Hospital, Nagoya, Japan
| | - Kohei Funasaka
- Department of Endoscopy, Nagoya University
Hospital, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and
Hepatology, Nagoya University Graduate School of Medicine, Nagoya,
Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and
Hepatology, Nagoya University Graduate School of Medicine, Nagoya,
Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and
Hepatology, Nagoya University Graduate School of Medicine, Nagoya,
Japan
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free
Hospital and University College London Institute for Liver and Digestive health,
London, United Kingdom
| | - Hidemi Goto
- Department of Gastroenterology and
Hepatology, Nagoya University Graduate School of Medicine, Nagoya,
Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University
Hospital, Nagoya, Japan
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19
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Intestinal hemorrhage caused by Meckel's diverticulum with ectopic gastric mucosa on polypoid lesion: a case report. Surg Case Rep 2016; 2:124. [PMID: 27815920 PMCID: PMC5097056 DOI: 10.1186/s40792-016-0252-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
Meckel’s diverticulum may sometimes present as an intraluminal polypoid mass causing small bowel obstruction; however, gastrointestinal bleeding due to Meckel’s diverticulum with a polypoid lesion is rare. A 14-year-old girl presented with tarry stool and syncope in our hospital. Laboratory examination showed iron-deficiency anemia with a low hemoglobin level of 5.8 g/dl. The bleeding site was detected by neither upper gastrointestinal endoscopy nor colonoscopy. Transanal double-balloon enteroscopy showed a diverticulum with an ulceration at a site approximately 50 cm from the ileocecal valve and a polypoid lesion inside of the diverticulum. Histopathological examination of a polypoid lesion revealed an ectopic gastric mucosa of the fundic type. Furthermore, technetium-99m pertechnetate scintigraphy showed a hot spot in her lower right abdomen. On the basis of these findings, she was diagnosed as having hemorrhagic Meckel’s diverticulum. Single-incision laparoscopy-assisted segmental bowel resection of the ileum was performed. The patient recovered well, and she was discharged from the hospital on postoperative day 7. She was doing well 6 months later without evidence of reoccurrence. In this report, we describe a case of Meckel’s diverticulum with a polypoid lesion; hemorrhage may have occurred owing to the ulceration of the ileal mucosa with which the polypoid lesion directly came in contact. We consider this case to be of interest to gain insight into the site and mechanism of ulceration associated with Meckel’s diverticulum.
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Intraluminal Meckel's Duplication Cyst Causing Bowel Obstruction in an Infant: A Role for Laparotomy. Case Rep Pediatr 2016; 2016:4717403. [PMID: 27818823 PMCID: PMC5081433 DOI: 10.1155/2016/4717403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/21/2016] [Indexed: 12/19/2022] Open
Abstract
This report describes a two-month-old girl who presented with signs and symptoms of a distal small bowel obstruction. She underwent an abdominal ultrasound that revealed a right lower quadrant cystic mass. A Technetium-99 scan revealed increased activity in the right lower quadrant consistent with a Meckel's diverticulum. Following a nondiagnostic laparoscopic evaluation, a laparotomy was performed to allow direct palpation of the small bowel and colon. Direct palpation of the ileum revealed a soft intraluminal mass at the ileocecal valve. The child underwent an ileocecectomy and anastomosis incorporating the intraluminal mass. Pathologic analysis revealed an intraluminal enteric duplication cyst containing ectopic gastric mucosa. This case represents the first report of such an entity in an infant. A discussion of the diagnostic and therapeutic aspects of the case and enteric duplication cysts is provided.
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21
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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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