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Alzahrani L, Joueidi F, Abodahab FM, Joueidi K, Khan A. Explorative laparotomy of cecal volvulus in a pediatric patient. A case report and review of literature. Int J Surg Case Rep 2024; 117:109495. [PMID: 38471217 PMCID: PMC10945278 DOI: 10.1016/j.ijscr.2024.109495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cecal volvulus is a rare intestinal pathology that occurs due to abnormal cecum mobility associated with spectrum of complications. It is usually manifested in adults. However, on extremely rare occasions, it occurs in pediatrics. We presented a case of cecal volvulus demonstrating the significance of early diagnosis and treatment to reach successful outcomes. CASE PRESENTATION A 12 year old boy who presented to the emergency department for clinical evaluation for acute abdomen. History and clinical examination was suggestive of acute bowel obstruction. Abdominal x-ray showed a large, distended gas filled viscus with base pointed towards the right lower quadrant. On the bases of radiological investigations, diagnosis of cecal volvolus made. Accordingly, the patient underwent emergency exploratory laparotomy. The post operative course was uneventful and was discharged in stable condition. CLINICAL DISCUSSION Cecal volvulus is an extremely rare manifestation of intestinal obstruction and malrotation. The clinical presentation of cecal volvulus depending on the duration and extent of the involvement of cecal malrotation The exact pathogenesis of cecal volvulus is unclear. However the association of the embryological development of the colon, affects the attachment to the posterior parietal peritoneum after ordinary anatomical rotation of 270°. The core-stone management of cecal volvulus is surgical approach. CONCLUSION Cecal volvulus requires a high index of suspicion and delicate care by the pediatric surgeon as it is considered an extremely rare entity in this age group. We highlighted the significance of early diagnosis, surgical treatment and the possibility of developing postoperative complications if left untreated.
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Affiliation(s)
- Lujain Alzahrani
- Department of Pediatric Surgery, Maternity and Children Hospital, Makkah, Saudi Arabia
| | - Faisal Joueidi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | | | - Khaled Joueidi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Asim Khan
- Department of Pediatric Surgery, Maternity and Children Hospital, Makkah, Saudi Arabia
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Gama JM, Oliveira RC, Fonseca R, Cipriano MA, Casanova J. Extraskeletal myxoid chondrosarcoma metastasis to a Meckel's diverticulum adenocarcinoma. Rev Esp Patol 2024; 57:141-145. [PMID: 38599736 DOI: 10.1016/j.patol.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 04/12/2024]
Abstract
Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumour with a high local and distant metastasis rate and limited response to chemotherapy. Meckel's diverticulum is the most frequent congenital anomaly, and it is associated with a considerable risk of malignant transformation. In this case report, we describe a 50-year-old female patient with a history of extraskeletal myxoid chondrosarcoma of the lower limb and metastasis to the forearm who went to the emergency department with abdominal pain. The investigations revealed a caecal volvulus. A lesion in the middle third of the ileum was incidentally discovered and removed during surgery. Pathology examination revealed a Meckel's diverticulum adenocarcinoma, with metastasis of extraskeletal myxoid chondrosarcoma. Resection was complete; however, the patient had diffuse metastatic pulmonary disease and died eight months later due to disease progression. This mechanism of tumour-to-tumour metastasis is described in other locations, but, regarding the Meckel's diverticulum, this is a unique situation, previously unreported in the literature.
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Affiliation(s)
- João Martins Gama
- Centro Hospitalar e Universitário de Coimbra, Pathology Department, Coimbra, Portugal; Doctoral Programme in Molecular Pathology and Genetics, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal.
| | - Rui Caetano Oliveira
- Centro Hospitalar e Universitário de Coimbra, Pathology Department, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research Area of Environment Genetics and Oncobiology, Coimbra, Portugal
| | - Rúben Fonseca
- Centro Hospitalar e Universitário de Coimbra, Pathology Department, Coimbra, Portugal
| | | | - José Casanova
- University of Coimbra, Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research Area of Environment Genetics and Oncobiology, Coimbra, Portugal; Orthopedics Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Aryal K, Regmi PR, Adhikari G, Shrestha B, Lohani P. A rare case report of patent vitellointestinal duct presenting as a periumbilical pain in an adult. Radiol Case Rep 2024; 19:1476-1479. [PMID: 38312749 PMCID: PMC10835116 DOI: 10.1016/j.radcr.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/19/2023] [Accepted: 01/01/2024] [Indexed: 02/06/2024] Open
Abstract
The vitellointestinal duct (VID) is an embryological remnant of the vitelline duct, a structure that connects the developing fetus to the yolk sac and is responsible for the nutritional support of the fetus during the early embryological days. The VID usually gets obliterated by the fifth to ninth week of gestational age after the establishment of placental nutrition. The patent VIDellointestinal duct is a relatively rare congenital condition that occurs in approximately 2% of the general population, with the most common presentation being Meckel's diverticulum. Complete patency is rarer, occurring in 0.1% of the general population. The complete persistence of the VID results in enterocutaneous fistula, and the presentation may vary, ranging from cutaneous manifestations like skin lesions, granulomas, abscesses, or umbilical discharge to abdominal symptoms including acute abdominal pain and hematochezia. Some patients are even asymptomatic and are detected incidentally. We present a rare case of complete patency of the VID in a 30-year-old adult male presenting with acute periumbilical pain. Imaging findings guided the diagnosis, and surgical resection with histopathological examination further confirmed the condition.
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Affiliation(s)
- Krishnaraj Aryal
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Pradeep Raj Regmi
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Gauri Adhikari
- Department of Medicine, Nepalese Army Student of Health Science- College of Medicine, Kathmandu, Nepal
| | - Bigya Shrestha
- Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Priyesh Lohani
- Department of Surgery, Patan Academy of Health Sciences, Lalitpur, Nepal
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Najib FE, Sridi A, Chouchen A. Meckel's diverticulum: A rare cause of acute intestinal occlusion. J Visc Surg 2024:S1878-7886(24)00031-6. [PMID: 38555204 DOI: 10.1016/j.jviscsurg.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract (Lequet et al., 2017). It results from incomplete obliteration of the vitelline (omphaloenteric) duct. Observed diverticulum complications include inflammation and perforation, hemorrhage and obstruction (Kawamoto et al., 2015). We are reporting on a case of Meckel's diverticulum revealed by acute intestinal obstruction.
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Affiliation(s)
- Fatma Ezzahra Najib
- Department of General Surgery, Hospital of the Internal Security Forces, La Marsa, Tunis, Tunisia.
| | - Azza Sridi
- Department of General Surgery, Hospital of the Internal Security Forces, La Marsa, Tunis, Tunisia.
| | - Adnen Chouchen
- Department of General Surgery, Hospital of the Internal Security Forces, La Marsa, Tunis, Tunisia.
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Wang C, Wang Y, Zhao P, Li T, Li F, Li Z, Qi Y, Wang X, Shi W, Liu L, Li G, Wang Y. Application of enhanced recovery after surgery during the perioperative period in children with Meckel's diverticulum-a single-center prospective clinical trial. Front Pediatr 2024; 12:1378786. [PMID: 38590767 PMCID: PMC11000669 DOI: 10.3389/fped.2024.1378786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background Enhanced recovery after surgery (ERAS) has been widely used in adult surgery. However, few studies have reported the efficacy of ERAS in paediatric patients with Meckel's diverticulum (MD), the aim of the study was to prospectively evaluate the safety and efficacy of ERAS in treating MD. Methods A prospective randomised controlled study of children with MD admitted to our hospital from Jan 1, 2021 to Dec 31, 2023 were conducted, we developed and implemented an ERAS program for this patients. All cases were strictly selected according to the inclusion and exclusion criteria. Among these patients, they were randomly assigned to the ERAS group or the traditional (TRAD) group with random number table row randomization. The main observational indicators were operation time, intraoperative hemorrhage, FLACC pain scale results on 2 h, 6 h, 12 h, 24 h after surgery, length of postoperative stay (LOPS), time to first defecation, time to first eating after surgery, time to discontinuation of intravenous infusion, total treatment cost, incidence of postoperative complications, 30-day readmission rate and parental satisfaction rate. Results A total of 50 patients underwent Meckel's diverticulectomy during this period, 7 patients were excluded, 23 patients were assigned to the ERAS group and 20 patients were assigned to the TRAD group. There were no significant differences in demographic data and operation time, intraoperative hemorrhage. The FLACC pain scale results on 2 h, 6 h, 12 h, 24 h after surgery were significantly lower in the ERAS group. The LOPS was 6.17 ± 0.89 days in the ERAS group and 8.30 ± 1.26 days in the TRAD group, resulting in a significantly shorter LOPS in ERAS group. ERAS could also reduce the first postoperative defecation time, the time to first eating after surgery and the time to discontinuation of intravenous infusion. The treatment cost was decreased in the ERAS group. The rate of complications and 30-day readmission were not significantly different between the two groups. Conclusions In this single-center study, the ERAS protocol for patients with MD requiring surgery was safe and effective.
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Affiliation(s)
- Cuicui Wang
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Youliang Wang
- Department of Pediatric General Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Ping Zhao
- Department of Pediatric Urology Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Ting Li
- Department of Pediatric Urology Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Fan Li
- Department of Pediatric General Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Zhi Li
- Department of Pediatric Urology Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Yingwen Qi
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Xuewu Wang
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Weidong Shi
- Department of Pediatric General Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Lina Liu
- Department of Obstetrics, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Gamei Li
- Department of Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
| | - Yong Wang
- Department of Pediatric Surgery, Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, China
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Touati MD, Ben Othmane MR, Belhadj A, Saïdi A, Saidani A, Chebbi F. A rare case report of an appendico-sigmoid fistula complicating untreated acute appendicitis: Unraveling complexity in diagnosis and treatment. Int J Surg Case Rep 2024; 116:109298. [PMID: 38342027 PMCID: PMC10943657 DOI: 10.1016/j.ijscr.2024.109298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION Appendiculocolonic fistulas, often arising from benign conditions like abscess-forming appendicitis, manifest subtly. This case emphasizes their rarity, intraoperative discovery during acute appendicitis, and explores diagnostic intricacies, sensitive imaging, and distinctions in managing benign versus malignant cases. CASE PRESENTATION A 23-year-old intellectually disabled patient, lacking regular medical follow-up and surgical history, presented to our emergency department with persistent right iliac fossa pain six months ago. Due to financial constraints, a CT scan was not performed despite an inflammatory syndrome, and the patient left against medical advice. Currently experiencing the same symptoms, investigations led to the diagnosis of acute appendicitis with a probable appendico-sigmoid fistula. Surgical exploration confirmed the appendico-sigmoid fistula and the presence of an uncomplicated Meckel's diverticulum. A conservative approach, including appendectomy, Meckel's diverticulum resection, and sigmoid fistula suturing, yielded favorable results. CLINICAL DISCUSSION Appendiculocolonic fistulas often arise from acute or chronic appendicitis with local abscess formation. Our case highlights the unusual progression of untreated acute appendicitis, evolving into an appendico-sigmoid fistula. While generally benign, documented cases of malignant causes, such as appendiceal cancer, exist. Diagnosis is intricate, requiring diverse methods, with abdominal CT as a sensitive imaging tool. Conservative approaches are generally recommended for benign cases. CONCLUSION Appendiculocolonic fistulas, though rare, pose a clinical challenge due to their elusive symptoms. Primarily associated with benign conditions, notably abscess-forming appendicitis, or, as in our case, untreated acute appendicitis. This case underscores the role of abdominal CT in precise diagnosis, guiding treatment decisions based on the lesion's nature.
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Affiliation(s)
- Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia.
| | - Mohamed Raouf Ben Othmane
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Aymen Saïdi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
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Tahmasbi H, Haghbin Toutounchi A, Hasanzade A, Sadeghmousavi S, Aghaei M. The omphalomesenteric duct fibrous band as a rare cause of bowel obstruction: A case report and literature review. Int J Surg Case Rep 2024; 116:109354. [PMID: 38340631 PMCID: PMC10943667 DOI: 10.1016/j.ijscr.2024.109354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The omphalomesenteric duct (OMD) is an embryonic structure that normally undergoes obliteration during embryonic development, typically not persisting after birth. Failure of complete or partial obliteration can result in a type of malformation known as OMD remnant. CASE PRESENTATION We report a case of a 24-year-old male patient diagnosed with bowel obstruction. Abdominal computed tomography (CT) scan revealed the presence of an adhesion band. During surgery, a fibrous band connecting from the umbilicus to the mesentery of terminal ileum was found and resected. Pathological investigation confirmed the presence of an OMD remnant fibrous band. CLINICAL DISCUSSION OMD remnant can manifest in different forms such as Meckel's diverticulum, umbilical polyp, OMD cyst, OMD fistula, and fibrous band, occurring in approximately 2 % of infants and often presenting symptoms in early childhood. These conditions rarely cause complications in adults. Complications may include obstruction, gastrointestinal bleeding, bowel perforation, and omphalitis which can present with symptoms such as abdominal pain, vomiting, melena, lack of defecation, umbilical discharge, and dermal manifestations. Diagnostic approaches vary depending on the type of OMD remnant and associated complications, but ultrasonography and CT scan can be useful. While asymptomatic OMD remnants generally do not require further intervention, surgical treatment is the main option for complicated and symptomatic cases. CONCLUSION OMD remnant is a rare condition in adults that can lead to complications. Given that obstruction is a common complication of OMD remnant, OMD remnant should be considered in the differential diagnosis of patients presenting with bowel obstruction.
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Affiliation(s)
- Hamed Tahmasbi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arman Hasanzade
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Sadeghmousavi
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Aghaei
- Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Hernández JD, Valencia G, Girón F, García Sierra AM, Núñez-Rocha RE, Rodríguez LM, Rey Chaves CE, Londoño EE, Nassar R. Meckel's diverticulum: analysis of 27 cases in an adult population. Front Surg 2023; 10:1327545. [PMID: 38179318 PMCID: PMC10765580 DOI: 10.3389/fsurg.2023.1327545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Background Meckel's diverticulum is a rare congenital pathology among newborns. Nevertheless, it is an uncommon abdominal pathology in the adult population. Therefore, we aim to provide a detailed account of our surgical approach in treating 27 cases of Meckel's diverticulum. Methods This study is a cross-sectional analysis that utilized a database with prospectively collected data from 2004 to 2022. All patients under the age of 18 were excluded from the population. We described the population's demographic characteristics, symptoms, anatomopathological study, surgical technique, complications, morbidity, and mortality. A subgroup analysis was performed between the symptomatic and asymptomatic patients. Results A total of 27 patients who underwent surgical resection for a posteriorly diagnosed Meckel's diverticulum were included. The male population accounted for 81.4% (n = 22) of the sample size. The symptomatic group consisted of 18 male and four female patients. Abdominal pain was the predominant symptom in 85% of the patients. Out of the 22 symptomatic patients, only 9% had a positive perioperative diagnosis of Meckel's diverticulum. All 27 patients with diverticulum diagnosis received the resection through diverticulectomy (n = 6), small bowel resection with end-to-end anastomosis (n = 6), and small bowel resection with lateral to lateral anastomosis (n = 15). The mean distance between the diverticulum and the ileocecal valve was 63.4 cm. The symptomatic group had an average diverticulum length of 3.54 cm, with an average base width of 2.47 cm. In the other group, the values were 2.75 and 1.61 cm. The average length of hospital stay in the symptomatic group was 7.3 days. Conclusions Meckel's diverticulum is a rare pathology in the adult population. Its presentation varies from asymptomatic to symptomatic patients, and surgery is the cornerstone treatment for this pathology.
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Affiliation(s)
- Juan David Hernández
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Gustavo Valencia
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Felipe Girón
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Andrés Mauricio García Sierra
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, United States
| | | | | | - Carlos Eduardo Rey Chaves
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | - Eduardo Emilio Londoño
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Ricardo Nassar
- Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
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Trigui R, Hasnaoui A, Heni S, Kammoun H. An unusual form of incisional hernia: A case report of Littre's hernia. Int J Surg Case Rep 2023; 113:109066. [PMID: 37979554 PMCID: PMC10694304 DOI: 10.1016/j.ijscr.2023.109066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023] Open
Abstract
INTRODUCTION Littre's hernia (LH) is a rare condition involving Meckel's diverticulum within a hernia sac, with an incidence of <0.1 % of all complicated hernias. To this day, only a few case reports have been published concerning this entity. CASE PRESENTATION A 48-year-old patient with a history of four midline C sections and an incarcerated incisional midline hernia was admitted to the emergency department for small bowel obstruction evolving for 12 h. Examination revealed an incarcerated midline incisional hernia. An abdominal CT scan was performed, showing a multi-orifice incisional hernia with a small bowel loop and a 3 cm abscess. The patient underwent an urgent midline laparotomy. During surgery, we found a small bowel loop with a perforated Meckel's diverticulum, located 50 cm from the ileocaecal valve, associated with a 3 cm abscess. Surgical drainage of the abscess, resection of 20 cm of small bowel, including the diverticulum, and an appendicectomy were performed. The incisional midline hernia was managed by herniorrhaphy. The post-operative course was uneventful. CLINICAL DISCUSSION Surgeons need to keep in mind the possibility of discovering Meckel's diverticulum in a hernia sac in every incarcerated hernia. Complete history intake and careful physical examination are important to uncover signs prompting clinical suspicion. Littre's hernia is rare and difficult to diagnose, with no distinguishing clinical features or physical signs. CONCLUSION Managing LH involves treating the symptomatic Meckel's diverticulum with various resection methods and the hernia itself, with mesh application being a controversial topic. Prophylactic resection remains debatable among experts.
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Affiliation(s)
- Racem Trigui
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Anis Hasnaoui
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis el Manar University, Tunisia
| | - Sihem Heni
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Houda Kammoun
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
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Chaouch MA, Abdelali M, Hammouda SB, Zayati M, Taieb AH, Noomen F. A case report of small bowel occlusion due to Meckel diverticulum causing a life-threatening condition. Int J Surg Case Rep 2023; 112:108982. [PMID: 37883867 PMCID: PMC10667897 DOI: 10.1016/j.ijscr.2023.108982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Meckel's diverticulum is a common congenital abnormality. In this study, we reported a case of small bowel occlusion due to Meckel's diverticulum causing a small bowel obstruction and a life-threatening condition. CASE PRESENTATION 28-year-old man complaining of abdominal pain for 3 days. The physical examination found the patient appeared profusely unwell with a blood pressure of 80/40 mmHg. The abdominal examination found abdominal rigidity suggesting peritonitis. The patient's C-reactive protein was 210 mg/l with normal white blood cell count. Consequently, the patient was operated on using a laparotomy. A mechanical bowel obstruction due to a gangrenous Meckel's diverticulum was confirmed during the operation. Meckel's diverticulitis with the tip attached to the ileal mesentery through a band. A section of the band was performed followed by a resection of the Meckel's diverticulum and an ileo-ileal anastomosis. The postoperative follow-up was uneventful. CASE DISCUSSION Meckel's diverticulum results from yolk sac persistence during embryonic development, often remaining asymptomatic. However, it can lead to symptoms like abdominal pain, diarrhoea, and fever when inflamed or infected. Treatment involves surgery (diverticulectomy) for severe cases with complications, with good prognosis but associated surgical risks. CONCLUSION The diverticulum can present a life-threatening condition. The treatment is essentially surgical. This surgery should be performed emergently to enhance the prognosis.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Mabrouk Abdelali
- Department of Radiology, Monastir University Hospital, Monastir, Tunisia
| | | | - Mohamed Zayati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Sushma A, Redkar R, Sharma RD, Singh S, Thakur S, George AM. Type VI Choledochal Cyst - An Emerging Rare Entity (11 th Pediatric Case of Type VI) with a Review of Literature. J Indian Assoc Pediatr Surg 2023; 28:453-456. [PMID: 38173633 PMCID: PMC10760617 DOI: 10.4103/jiaps.jiaps_144_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/07/2023] [Accepted: 07/29/2023] [Indexed: 01/05/2024] Open
Abstract
Choledochal cysts (CCs) are abnormal dilatations of the biliary system. Usually, CCs are classified into five types. The sixth type (Type VI) is an emerging and rare type, reported the first case in 1991. We report this rare CC, Type VI seen in our experience for the first time. We have also reviewed the literature; only 26 cases of Type VI were found, including adults and children, ever since the first case has been reported in 1991. To the best of our knowledge, this is the 11th pediatric case report of a Type VI choledochal cyst.
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Affiliation(s)
- A Sushma
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rajeev Redkar
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rahul Deo Sharma
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Surendra Singh
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sonia Thakur
- Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Asha Mary George
- Consultant Histopathologist, Lilavati Hospital and Research Centre, Maharashtra, India
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12
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Saad Eddin A, Chowdhury AJ, Saad Aldin E. Meckel's diverticulum: Unusual cause of significant bleeding in an adult male. Radiol Case Rep 2023; 18:3608-3611. [PMID: 37577078 PMCID: PMC10415815 DOI: 10.1016/j.radcr.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Meckel's diverticulum is a common congenital gastrointestinal malformation affecting 2% of the general population. Most affected patients are asymptomatic, and excessive bleeding causing a significant drop in hemoglobin count is an uncommon complication of Meckel's diverticulum, especially in adult patients. Herein, we present an adult case of Meckel's diverticulum that nearly led to hemodynamic instability. Laparotomy and segmental small bowel resection were critical in treating the patient.
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Ali AY, Sarac A, Abdi AM, Mohamed AA. A strangulated umbilical hernia with perforated Meckel diverticulum: Case report. Int J Surg Case Rep 2023; 110:108681. [PMID: 37634437 PMCID: PMC10509809 DOI: 10.1016/j.ijscr.2023.108681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Meckel's diverticulum (MD) is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. Strangulated umbilical hernia with a perforated Meckel diverticulum is an extremely rare event. CASE PRESENTATION We reported here a case of one year old boy of a strangulated umbilical hernia with perforated MD that operated at the Mogadishu hospital. A wedge resection of the MD and anastomosis was performed. CLINICAL DISCUSSION MD is one of the most common gastrointestinal anomalies and affects 2-3 % of the population. About 60 % of cases come to medical attention before the age of ten, with the remainder of patients presenting in adolescence and adulthood. It is more difficult to diagnose in males, especially in adulthood. CONCLUSION Being aware of the likelihood that there could be a perforated Meckel's diverticulum in a sac of strangulated umbilical hernia has notable importance and may lead to innovative treatment and postoperative rehabilitation modalities.
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Affiliation(s)
- Abdullahi Yusuf Ali
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia.
| | - Ahmet Sarac
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia; Department of Pediatric Surgery, Samsun Training and Research Hospital, Turkey
| | - Abdishakur Mohamed Abdi
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Abdikafi Abdullahi Mohamed
- Department of Pediatric Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
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14
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Vargas Aignasse RA, Pantoja Pachajoa DA, Llahi F, Parodi M, Doniquian AM, Viscido GR. Emergency laparoscopic intervention for fibrous band-induced intestinal obstruction and ischemia associated with Meckel's diverticulum: A case report. Int J Surg Case Rep 2023; 109:108614. [PMID: 37557036 PMCID: PMC10424198 DOI: 10.1016/j.ijscr.2023.108614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Meckel's diverticulum (MD) is a common congenital malformation of the digestive tract, often asymptomatic but occasionally leading to complications such as bowel obstruction and ischemia. Timely recognition and treatment of these complications are crucial. PRESENTATION OF CASE We report the case of a 27-year-old male patient presenting with complete intestinal obstruction and ischemia of the ileum due to a fibrous band associated with MD. The patient presented with severe abdominal pain lasting for 10 h. Physical examination revealed a distended abdomen, antalgic position, and positive decompression. Laboratory tests showed leukocytosis and elevated lactic acid levels. Computed tomography revealed dilated small bowel loops with signs of intestinal ischemia. Emergency exploratory laparoscopy confirmed a complete ileum with ischemia and identified a fibrous band originating from the mesentery, strangulating the affected loop. The fibrous band was dissected and sectioned, confirming its association with the MD, which was resected with subsequent recovery of peristalsis and vascularization of the compromised segment. The patient had a favorable postoperative recovery without complications. DISCUSSION MD is a rare cause of bowel obstruction, requiring a high index of suspicion for diagnosis. Despite the challenges in preoperative identification, early surgical intervention is crucial to prevent adverse outcomes. This case emphasizes the importance of promptly recognizing and managing MD-related complications to optimize patient outcomes. CONCLUSION MD should be considered in cases of acute occlusive abdomen, despite its infrequent occurrence. Early diagnosis and timely surgical intervention are essential to minimize morbidity and mortality associated with MD-related complications.
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Affiliation(s)
- Ramiro A Vargas Aignasse
- General Surgery Department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Diana A Pantoja Pachajoa
- General Surgery Department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina.
| | - Florencia Llahi
- General Surgery Department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Matias Parodi
- General Surgery Department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Alejandro M Doniquian
- General Surgery Department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - German R Viscido
- General Surgery Department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
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15
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Ajagbe O, Okor M, Ojediran O, Dada O, Ayandipo O, Ajani M. INTESTINAL OBSTRUCTION FROM MECKEL'S DIVERTICULUM IN AN ADULT; UNSUSPECTED BUT FOUND- A CASE REPORT. Ann Ib Postgrad Med 2023; 21:84-88. [PMID: 38298334 PMCID: PMC10811716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/30/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Most cases of Meckel's Diverticulum (MD) are asymptomatic and when symptomatic, preoperative diagnosis of MD maybe a dilemma. Intestinal obstruction is a major complication in the adult population. Case presentation We report a case of a 24-year-old female presenting with intestinal obstruction from Meckels Diverticulum. Conclusion MD is largely asymptomatic in adults, however may be present and should be included in our array of differential diagnoses.
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Affiliation(s)
- O.A Ajagbe
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - M.C Okor
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - O.T Ojediran
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - O.E Dada
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - O.O Ayandipo
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M.A Ajani
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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16
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Dang VC, Tran PN, Tran MC, Pham VT, Nguyen TTN. Intestinal obstruction due to ligament arising from the distal end of Meckel's diverticulum: A case report. Clin Case Rep 2023; 11:e7608. [PMID: 37361647 PMCID: PMC10288014 DOI: 10.1002/ccr3.7608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023] Open
Abstract
Intestinal obstruction due to ligament (fibrous band) arising from the top of Meckel's diverticulum is a rare cause. To date, in the world, only a few cases have been reported and there are not enough statistics on the incidence of this disease. This case presentation will help doctors working in the field of pediatric surgery or of pediatric imaging diagnosis have more experiences on diagnosis and treatment, and enrich the medical literature on this rare disease. We report a case of an 8-year-old boy with intestinal obstruction due to ligament arising from Meckel's diverticulum with complete data set such as clinical manifestations, imaging diagnosis (ultrasound, unprepared abdominal x-ray, computerized tomography scanner with contrast injection), surgical information, and histopathological findings. Intestinal obstruction due to the ligament arising from the apex of Meckel's diverticulum is an extremely rare disease and has asymptomatic imaging features so the preoperative diagnosis is only based on the indirect findings of computerized tomography scanner. The early diagnosis of an intestinal obstruction due to fibrous band can be made by using imaging methods such as ultrasound, unprepared abdominal x-ray, computerized tomography scanner with contrast injection, contributing to the prompt diagnosis in order to avoid serious complications including bowel necrosis, intestinal perforation, and perforated diverticulum.
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Affiliation(s)
- Van Chuc Dang
- Pediatric Department, Hai Phong University of Medicine and PharmacyNeonate Department of Haiphong Children's HospitalHai PhongVietnam
| | - Phan Ninh Tran
- Imaging Diagnosis DepartmentVietnam National Hospital of PediatricsHanoiVietnam
- Imaging Diagnosis DepartmentThainguyen University of Medicine and PharmacyThai NguyenVietnam
| | - Minh Canh Tran
- Pediatric Surgery DepartmentHai Phong Children's HospitalHaipongVietnam
| | - Van Thuc Pham
- Department of Pathophysiology–Allergy–ImmunologyHai Phong University of Medicine and PharmacyHai PhongVietnam
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17
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Jabra SB, Chaouch MA, Moussa A, Jallali M, Toumi O, Noomen F. Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction. Int J Surg Case Rep 2023; 106:108159. [PMID: 37086501 PMCID: PMC10154727 DOI: 10.1016/j.ijscr.2023.108159] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The common mesentery is an abnormal rotation of the primitive intestinal loop or omphalomesenteric loop. It is not necessarily symptomatic, but a clinical presentation of acute bowel obstruction on the band or volvulus can reveal it. We report a case of small bowel obstruction due to Ladd's band and Meckel's diverticulum on the incomplete common mesentery. PRESENTATION OF CASE We report a case of a 54-year-old man with no previous abdominal surgery who experienced periumbilical abdominal pain and vomiting. Physical examination revealed a diffusely tender and distended abdomen. Laboratory data showed a biological inflammatory syndrome. An abdominal CT scan revealed a small bowel mechanical obstruction with a double transitional level under the umbilical without a loop enhancement. An emergent laparotomy was performed. We found an incomplete common mesentery. The small bowel obstruction was due to a Ladd's band attrapping the Meckel's diverticulum. This association was responsible for dilating ileal loops at the superior part of the mechanical obstruction with necrosis of 30 cm of the small bowel. We have sectioned the congenital band and resected the necrotic segment, followed by an intestinal anastomosis. The postoperative follow-up was uneventful. CLINICAL DISCUSSION Incomplete common mesentery with Ladd's band and Meckel's diverticulum is an extremely rare association. Causing a small bowel obstruction remains an uncommon complication and circumstance of discovery. This complication presents a life-threatening condition. An abdominal CT scan could help for the diagnosis in some cases. Surgery is the standard treatment in most cases. CONCLUSION The association of incomplete common mesentery with Ladd's band and Meckel's diverticulum is uncommon and should be known to avoid intraoperative misdiagnose.
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Affiliation(s)
- Sadok Ben Jabra
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Tunisia.
| | - Amani Moussa
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Tunisia
| | - Maissa Jallali
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Tunisia
| | - Omar Toumi
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Tunisia
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18
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Odongo CN, Godier-Furnemont A, Moro J, Oyania F. A case report of an asymptomatic necrotic Meckel's diverticulum in an inguinal hernia during elective surgery in a resource limited setting: Littre's hernia. Int J Surg Case Rep 2023; 105:108011. [PMID: 36963222 PMCID: PMC10060671 DOI: 10.1016/j.ijscr.2023.108011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Although the common complications of Meckel's diverticulum (MD) are well known, that these congenital intestinal outpouchings may become involved as the content of abdominal hernia sacs is not well appreciated. MD is the most prevalent congenital abnormality of the gastrointestinal tract, but involvement in a hernia, known as Littre's hernia (LH), accounts for less than 1 % of MD cases. Incarcerated LH has been reported sporadically in the literature, with MD found in the sacs of paraumbilical, femoral, inguinal, and incisional hernias. PRESENTATION OF CASE We report a LH in a 3-year-old male child who was scheduled for elective herniotomy for a reducible left inguinal hernia. Intraoperatively we found the hernia sac contained a necrotic and perforated MD with viable associated bowel loop. The patient was successfully managed by diverticulectomy and primary repair through a trans-inguinal incision and herniotomy was performed. CLINICAL DISCUSSION LH is a rare presentation of MD, and preoperative diagnosis of LH is challenging. Even in the case of a strangulated MD, a patient may not present with the typical signs and symptoms associated with compromised viscous. Once identified, repair of Littre hernia consists of resection of the diverticulum, or segmental bowel resection if necessary, and herniotomy. CONCLUSION The finding of a perforated MD during elective hernia repair emphasizes the importance of awareness of unusual variants of inguinal hernia, and the necessity of identifying a MD given the risk of sequelae in the case of necrosis or perforation, if not repaired.
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Affiliation(s)
- Charles Newton Odongo
- Mbarara University of Science and Technology, Department of Surgery, Division of Pediatric Surgery, Uganda.
| | - Amandine Godier-Furnemont
- University of California, San Francisco, Department of Surgery, Center for Health Equity in Surgery and Anesthesia, San Francisco, CA, USA
| | - Joshua Moro
- Mbarara University of Science and Technology, Department of Surgery, Division of Pediatric Surgery, Uganda
| | - Felix Oyania
- Mbarara University of Science and Technology, Department of Surgery, Division of Pediatric Surgery, Uganda
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19
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Zello A, Kirschner D. Diagnosis of a rare pediatric case of small-bowel obstruction secondary to a phytobezoar in a Meckel's diverticulum aided by point-of-care ultrasound. CAN J EMERG MED 2023; 25:244-247. [PMID: 36749555 DOI: 10.1007/s43678-023-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/13/2023] [Indexed: 02/08/2023]
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20
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Gupta R, Mathur P. Incarcerated Littre's Hernia in a Neonate Presenting as Enteroscrotal Fistula. J Indian Assoc Pediatr Surg 2023; 28:164-166. [PMID: 37197233 PMCID: PMC10185031 DOI: 10.4103/jiaps.jiaps_110_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/09/2022] [Accepted: 10/26/2022] [Indexed: 05/19/2023] Open
Abstract
A 27-day-old male neonate, presented with feculent discharge from the scrotum. Operative findings revealed incarcerated right inguinal hernia with perforated Meckel's diverticulum as its content, leading to enteroscrotal fistula. Resection of the Meckel's diverticulum and end-to-end ileoileal anastomosis was performed along with repair of inguinal hernia from within the abdominal cavity. The outcome was favorable. Enteroscrotal fistula due to incarceration of inguinal hernia is a rare presentation. We are adding to the literature, an extremely rare case of incarcerated Littre's hernia in the right inguinal region presenting as enteroscrotal fistula in a neonate.
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Affiliation(s)
- Rahul Gupta
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Praveen Mathur
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
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21
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Kafshgari R, Rezaei Majd A, Taherinezhad Ledari A. Meckel's diverticulum axial torsion: A rare complication case report of a 5-year-old girl. Int J Surg Case Rep 2023; 103:107883. [PMID: 36630762 PMCID: PMC9841019 DOI: 10.1016/j.ijscr.2023.107883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. Axial torsion of the diverticulum followed by gangrene is the rarest complication that can occur mainly in children. CASE PRESENTATION A 5-year-old girl complaining of vomiting, fever and abdominal pain came to hospital. In Laboratory findings, leukocytosis (WBC = 22.5 ∗ 103/μl) was observed and mild interloop fluid with a whirlpool-like structure which suggests volvulus like obstruction was seen in sonography. The patient underwent emergency laparotomy. A necrotic congested Meckel's diverticulum was found during the surgery, which was axially twisted. After the operation, the patient recovered and was discharged six days later. DISCUSSION Axial twisting of Meckel's diverticulum is known as one of the rarest related complications, and it is caused by the rotation of the diverticulum around its axis. Among the factors that can make Meckel's diverticulum prone to twisting are its connection to the intestinal mesentery or the umbilical cord, or the presence of mesodiverticular bands. One of the appropriate diagnostic methods is the use of technetium-99. In Cases of small bowel obstruction, diverticulectomy and segmental or wedge resection have been introduced as suitable surgical methods. The delay in diagnosing a complex Meckel's diverticulum can lead to complications and mortality. CONCLUSION Rapid management of Meckel's diverticulum, which has become challenging due to its difficult diagnosis, is very important to obtain acceptable results.
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Affiliation(s)
- Ramin Kafshgari
- Assistant Professor of Pediatric Surgery, Department of Pediatrics, Amirkola Hospital, Babol University of Medical Sciences, Babol, Iran
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22
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Shen HY, Li X, Ye BX, Jiang JX. A fundic gland polyp and peptic ulcer in Meckel's diverticulum. Dig Liver Dis 2022; 54:1439-1440. [PMID: 35236642 DOI: 10.1016/j.dld.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Hao-Yang Shen
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bi-Xing Ye
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian-Xia Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Khurana A, Ravindra SG, Garg S, Jaleel J, Yadav DK, Kumar R. Lower Gastrointestinal Bleed Playing Hide and Seek. Indian J Nucl Med 2022; 37:404-405. [PMID: 36817191 PMCID: PMC9930449 DOI: 10.4103/ijnm.ijnm_127_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
A 13-year-old adolescent male presented with an episode of rectal bleed. He has had five such episodes in the past year where he witnessed black tarry stools mixed with fresh blood, painless, not associated with fever or hematemesis. Clinical examination revealed pallor and a soft, non-tender abdomen. Vitals were stable. Blood investigations revealed haemoglobin of 102g/L, WBC count of 10 X 109/L and platelet count of 165 × 109/L. The clotting screen was normal. Upper GI endoscopy and colonoscopy revealed no abnormality. The patient underwent Tc-99m pertechnetate scintigraphy to look for Meckel's Diverticulum in view of painless lower GI bleed.
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Affiliation(s)
- Aditi Khurana
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shubha Gadde Ravindra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Garg
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jasim Jaleel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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24
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Bejiga G, Ahmed Z. Gangrenous Meckel's diverticulum with small bowel obstruction mimicking complicated appendicitis: 'Case report'. Int J Surg Case Rep 2022; 97:107419. [PMID: 35863288 PMCID: PMC9403201 DOI: 10.1016/j.ijscr.2022.107419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Though Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is uncommon in the general population and rare in adults. Its preoperative diagnosis is challenging. While obstruction is the commonest complication, its occurrence with gangrenous Meckel's diverticulum is rare. The aim of this presentation is to report this combination and to create awareness among surgeons and radiologists to increase preoperative diagnosis of Meckel's diverticulum preventing morbidity and mortality from delay in intervention. PRESENTATION OF THE CASE A twenty-years-old male presented with periumblical pain that later shifted to lower abdomen, vomiting and fever of 10 h durations. He has no history of smoking or diabetes. Physical examination showed tachycardia, fever, and lower abdominal tenderness. Exploratory laparotomy revealed gangrenous Meckel's diverticulum and ileal obstruction by a band arising from the tip of diverticulum to ileal mesentery. We did segmental resection of the ileum containing Meckel's diverticulum and end-to-end anastomosis with the excellent outcome. DISCUSSION Preoperative diagnosis of Meckel's diverticulum is challenging because of non-specific clinical presentations and less sensitivity and specificity of imaging investigations. A high index of suspicion can improve its diagnosis. Axial torsion with gangrenous Meckel's diverticulum is the rarest complication. Management of symptomatic Meckel's diverticulum is surgery. Treatment of silent Meckel's diverticulum is controversial with no strong evidence to treat or not to treat. CONCLUSION Gangrenous Meckel's diverticulum causing small bowel obstruction is rare. Surgeons must have a high index of suspicion to increase preoperative diagnosis of complicated Meckel's diverticulum.
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Affiliation(s)
- Gosa Bejiga
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia.
| | - Zubeyri Ahmed
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia
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Almas T, Alsubai AK, Ahmed D, Ullah M, Murad MF, Abdulkarim K, Alwheibi ES, Alansaari M, Abdullatif T, Hadeed S, Khan MO, Alsufyani M, Alzadjali E, Samy A, Oruk M, Kadom M, Alhajri FS, Barakat A, Alrawashdeh MM, Said M, AlDhaheri R, Mansoor E. Meckel's diverticulum causing acute intestinal obstruction: A case report and comprehensive review of the literature. Ann Med Surg (Lond) 2022; 78:103734. [PMID: 35592821 PMCID: PMC9110976 DOI: 10.1016/j.amsu.2022.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Meckel's diverticulum is a congenital anomaly that is often detected incidentally. When it presents symptomatically, it causes painless gastrointestinal bleeding. Nevertheless, in rare instances, it can cause acute intestinal obstruction, often obscuring the true clinical picture. Case presentation A 31-year-old male presented to the emergency department with a 24-h history of unremitting nausea, biliary emesis, abdominal distension, and absolute constipation. After ruling out the most common etiologies of acute bowel obstruction, radiological imaging was obtained and was suggestive of meckel's diverticulum. Laparoscopic meckel's diverticulectomy was performed, with the subsequent histopathological analysis confirming ectopic gastric tissue. Discussion Meckel's diverticulum occurs consequent to incomplete obliteration of the vitelline or omphalomesenteric duct, which connects the developing intestines to the yolk sac. It is found in roughly 2% of the population, of which only about 4% may become symptomatic due to any number of complications. Specifically, small bowel obstruction (SBO) and diverticulitis secondary to ectopic gastric or pancreatic tissue are the most common presentations of symptomatic MD. Conclusion Although relatively rare in adults, MD should be considered in the list of differentials in patients with intussusception leading to SBO, especially on a background history unremarkable for the most common etiologies causing SBO including post-operative adhesions and hernias.
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Affiliation(s)
- Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Danyal Ahmed
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Muneeb Ullah
- Maroof International Hospital, Islamabad, Pakistan
| | | | | | | | | | | | | | | | | | | | - Arjun Samy
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mert Oruk
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mhmod Kadom
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Ahmed Barakat
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Mohammad Said
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Emad Mansoor
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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McNickle L, Visa A, Clarke S, Yardley I, Tan YW. Exomphalos with intestinal fistulation: Case series and systematic review for clinical characterization, management and embryopathogenesis. J Pediatr Surg 2022; 57:661-669. [PMID: 34311970 DOI: 10.1016/j.jpedsurg.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/29/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Exomphalos with intestinal fistulation (EIF) is a rare variant of exomphalos with intestine opening to the surface of an intact sac, and may result in a diagnostic challenge. We report 3 new cases and conducted a systematic review of the literature, to characterize its association with the type of exomphalos and vitellointestinal duct (VI) as well as to evaluate its management and outcomes. METHODS A literature search from PubMed using keywords pertaining to exomphalos and fistulation was used to identify all unique cases reported between 1950 and 2020, in addition to the case series reported here, to establish the clinical presentation, histological findings, management and outcomes. RESULTS We found a total of 28 cases of EIF, of which 25 had been reported in 70 years from 19 reports. There was a male predominance (4-to-1 ratio). The majority presented as an exomphalos minor (n = 23, 82%) with a prolapsing patent VI duct (n = 16, 57%), most had evidence of Meckel's diverticulum (n = 25, 89%). All but one case were managed by fistula excision with or without ileal resection and anastomosis, followed by primary closure of the abdominal wall defect. All patients, except one with Trisomy 13 who received only palliative care, underwent surgery. Post-operative complications occurred in 7 patients (25%). Congenital anomalies were present in 12 (43%) and none had Beckwith-Wiedemann syndrome. Mortality occurred in 4 patients (14%) between 3 and 17 days. One EIF with exomphalos major failed early conservative treatment due to sac disintegration and sepsis, requiring staged closure, but had a good outcome. DISCUSSION EIF is a rare entity usually associated with exomphalos minor and vitelline duct involvement. EIF presentation is variable but primary surgery is the mainstay of treatment with generally good outcomes. Common features of EIF suggest a different embryopathogenesis to other forms of exomphalos.
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Affiliation(s)
- Luke McNickle
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Arjun Visa
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Simon Clarke
- Chelsea Children's Hospital, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London SW10 9NH, UK
| | - Iain Yardley
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Yew-Wei Tan
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Chelsea Children's Hospital, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London SW10 9NH, UK.
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Devi GK, Goei AHY, Ragavendra K, Lim X, Choo CSC, Ong LY, Eu-Leong Teo HJ, Laksmi NK. Meckel's Diverticulum - Clinical Presentation and Pitfalls in Diagnosis in the Pediatric Age Group in Singapore. J Indian Assoc Pediatr Surg 2022; 27:340-344. [PMID: 35733589 PMCID: PMC9208684 DOI: 10.4103/jiaps.jiaps_392_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/23/2021] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to study the presentation of patients who underwent Meckel's diverticulectomy (MD) and utility of pertechnetate Meckel's scan in the diagnosis of MD. Methods The clinical presentation of a retrospective cohort of patients who underwent MD from January 2007 to December 2019 was studied. The modes of presentation, treatment, and the diagnostic utility of pertechnetate Meckel's scans were evaluated. False-positive and false-negative scans were reviewed. The presence of gastric mucosa on histology of Meckel's was correlated with presentation as gastrointestinal bleeding and positive scan results. Results Ninety-nine patients underwent MD. Thirty-five out of 263 (13.3%) Meckel's scans done were positive. There was a male preponderance (86.9%). The peak age of presentation was 0-4 years (rectal bleeding or intestinal obstruction). Only a third of the patients with Meckel's diverticulum Meckel's had a preoperative diagnosis of Meckel's. The sensitivity/specificity of Meckel's scan was higher in patients presenting with painless rectal bleeding. Seven patients were false positive (weak tracer uptake or ectopic uptake) and five were false negative. Two patients with false-negative Meckel's scan, having gastrointestinal bleeding had gastric mucosa on histology of Meckel's. Conclusion Meckel's diverticulum has a male predominance. Meckel's scan has a high sensitivity in the children presenting with fresh painless rectal bleeding but is of limited use in the diagnosis of Meckel's diverticulum in other forms of presentations. False-positive scans can be anticipated in the presence of weak or ectopic uptake. False-negative scans can occur even in the presence of bleeding and in spite of the presence of gastric mucosa in the Meckel's diverticulum. Laparoscopy is a useful tool in diagnosis and treatment.
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Affiliation(s)
| | - Anne Hui Yi Goei
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | | | - Xuxin Lim
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Candy S. C. Choo
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | | | - Narasimhan Kannan Laksmi
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore,Address for correspondence: Prof. Narasimhan Kannan Laksmi, Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail:
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Al Laham O, Albrijawy R, Alsamman MI, Shaheen J, Atia F, Merhij A. Spontaneously perforated Meckel's diverticulum due to diverticulitis with histopathological finding of gastric mucosa in an adult female - A case report. Int J Surg Case Rep 2021; 89:106619. [PMID: 34861550 PMCID: PMC8640473 DOI: 10.1016/j.ijscr.2021.106619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/17/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Meckel's Diverticulum (MD) is the most occurring congenital anomaly of the gastrointestinal tract. It characterizes a patent remnant of the omphalomesenteric duct. Despite remaining asymptomatic most of the time, the rarity of its occurrence is reflected by the scarcity of data involving it in the literature. Gastrointestinal bleeding, bowel obstruction, and inflammation are the most prevalent complications of MD. Perforation of MD is very rare. CASE PRESENTATION We present the case of a previously healthy 32-year-old female, who presented to the emergency department with a 2-day-history of generalized abdominal pain. Radiological analysis suggested a perforated viscus and an inflamed Appendix. CLINICAL DISCUSSION Our patient was diagnosed preoperatively with perforated hollow viscus and an exploratory laparotomy was indicated. Intraoperatively, a perforated MD was found and treated by surgical excision of the affected loop of bowel with end-to-end anastomosis and the specimens were sent for histopathological analysis. Histopathology revealed a perforated MD containing gastric mucosa. The patient had successful recovery. CONCLUSION Early recognition with swift surgical intervention must take place to provide therapeutic outcome for patients and to limit the resulting morbidity. This case highlights the necessity of considering MD as core differential diagnosis in patients with acute abdomen. Due to the scarcity of data on perforated MDs in adult females, it's worthy of studying to highlight its incidence. Due to the rarity of a perforated MD in an adult female, it's worthy to consider such cases to explore preoperative assessment techniques, surgical interventions options, and postoperative complications.
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Affiliation(s)
- Omar Al Laham
- Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Al Assad University Hospital, April 17th St., Kafar Sousah, Damascus, Syria.
| | - Reham Albrijawy
- Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Al Assad University Hospital, April 17th St., Kafar Sousah, Damascus, Syria.
| | - Mhd Imadaldin Alsamman
- Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Al Assad University Hospital, April 17th St., Kafar Sousah, Damascus, Syria.
| | - Jack Shaheen
- Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Al Assad University Hospital, April 17th St., Kafar Sousah, Damascus, Syria.
| | - Fareed Atia
- Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Al Assad University Hospital, April 17th St., Kafar Sousah, Damascus, Syria.
| | - Alhasan Merhij
- Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Al Assad University Hospital, April 17th St., Kafar Sousah, Damascus, Syria.
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Takura K, Takayama S, Kani H, Sakamoto M, Ishikawa K, Katada T. A case of intestinal obstruction caused by a mesodiverticular band in Meckel's diverticulum with ectopic pancreas treated by laparoscopic surgery. Int J Surg Case Rep 2021; 88:106557. [PMID: 34741859 PMCID: PMC8577079 DOI: 10.1016/j.ijscr.2021.106557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction We report a case of a patient who underwent laparoscopic surgery for intestinal obstruction caused by the mesodiverticular band of Meckel's diverticulum, with pathological specimens showing ectopic pancreas. Presentation of case A 56-year-old woman presented to our hospital with complaints of abdominal pain and vomiting. Upon close examination, we suspected strangulated intestinal obstruction, and performed an emergency surgery. An internal hernia with a band leading to a Meckel's diverticulum was noted. Focusing on the attachment of the band, leading to the Meckel's diverticulum, we suspected a mesodiverticular band and deemed it necessary to be resected. Surgery was completed with resection of the band to relieve the intestinal obstruction, with simultaneous resection of the Meckel's diverticulum. It was necessary to resect Meckel's diverticulum simultaneously for histopathological examination. Histopathological examination revealed a mesodiverticular band in the resected band and ectopic pancreas in the Meckel's diverticulum. Discussion We chose to perform a complete laparoscopic resection because of the presence of simple intestinal obstruction caused by mesodiverticular bands or diverticula. We believe that small laparotomy can be opted in less severe cases, regardless of laparoscopic completion. Conclusion We suspected adherent bowel obstruction and detected a band. We focused on band attachment and determined that the band should be resected if it was attached to Meckel's diverticulum. The resection method should be carefully selected, and the specimen should be histopathalogically examined. We report a case of intestinal obstruction due to a mesodiverticular band. The resection method for Meckel's diverticulum should be carefully selected. Histopathological examination of the specimen should be performed. Small laparotomy can be opted for less severe cases.
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Affiliation(s)
- Kohei Takura
- Department of Surgery, Nagoya Tokushukai General Hospital, 2-52, Kozojicho-kita, Kasugai-Shi, Aichi 487-0016, Japan.
| | - Satoru Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, 2-52, Kozojicho-kita, Kasugai-Shi, Aichi 487-0016, Japan
| | - Hisanori Kani
- Department of Surgery, Nagoya Tokushukai General Hospital, 2-52, Kozojicho-kita, Kasugai-Shi, Aichi 487-0016, Japan
| | - Masaki Sakamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, 2-52, Kozojicho-kita, Kasugai-Shi, Aichi 487-0016, Japan
| | - Ken Ishikawa
- Department of Surgery, Nagoya Tokushukai General Hospital, 2-52, Kozojicho-kita, Kasugai-Shi, Aichi 487-0016, Japan
| | - Takeyasu Katada
- Department of Surgery, Nagoya Tokushukai General Hospital, 2-52, Kozojicho-kita, Kasugai-Shi, Aichi 487-0016, Japan
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Tracy M, Weil BR, Verhave M. Where Did the Blood Go?: A Meckel's Diverticulum Bleed Without Hematochezia or Melena. JPGN Rep 2021; 2:e119. [PMID: 37206468 PMCID: PMC10191587 DOI: 10.1097/pg9.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/16/2021] [Indexed: 05/21/2023]
Abstract
A 2-year-old patient with chronic abdominal pain presented with acutely worsening abdominal pain and acute anemia. The patient had no stigmata of bleeding including no hematemesis, melena or hematochezia, but had falling hemoglobin and hematocrit over the course of 24 hours. Abdominal ultrasound and computerized tomography showed a large cystic, fluid filled mass in the right midabdomen. The patient was taken to the operating room and a blood-filled mass arising from the ileum was identified and resected by the surgical team. Pathology was consistent with Meckel's diverticulum with heterotopic gastric mucosa. This is an atypical presentation of Meckel's diverticulum with bleeding contained within the diverticulum rather than bleeding in the intestinal lumen. Gastroenterologists must consider this unusual presentation when encountering progressive, acute anemia even in the absence of overt gastrointestinal blood loss.
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Affiliation(s)
- Michaela Tracy
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Brent R. Weil
- Division of Pediatric Surgery, Department of Surgery, Boston Children’s Hospital, Boston, MA
| | - Menno Verhave
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
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Elgazar A, Awad AK. 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 DOI: 10.1016/j.ijscr.2021.106462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Jha SK, Ghimire S, Koirala DP. Torsed gangrenous Meckel's diverticulum causing gangrenous ileal segment: A rare case report of small bowel obstruction in children. Ann Med Surg (Lond) 2021; 69:102723. [PMID: 34457256 PMCID: PMC8379479 DOI: 10.1016/j.amsu.2021.102723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system. It is caused by an incomplete obliteration of the vitelline duct. Rarely, it can present with complications like torsion and gangrene formation. CASE PRESENTATION A 13-year previously healthy girl presented with sudden onset periumbilical pain and bilious vomiting who was subsequently diagnosed with Meckel's diverticulum. Intraoperatively, torsed gangrenous diverticulum forming band adhesion was found. Resection of Meckel's diverticulum along with gangrenous ileal segment followed by ileoileal anastomosis was done. DISCUSSION Axial torsion of Meckel's diverticulum with gangrene formation is a rare occurrence. Mesodiverticular band adhesion along with herniation of small bowel segments under it endangers viability of herniating segments. Preoperative diagnosis of complicated MD is difficult as it mimics other common acute abdominal conditions. CT scan and enteroclysis are imaging modalities of choice. Surgical resection of MD along with resection and anastomosis of gangrenous bowel segment results in complete cure. CONCLUSION Meckel's diverticulum with complications should be kept in the differential of acute abdominal conditions presenting with atypical symptoms. Surgical resection ensures complete cure.
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Affiliation(s)
- Saroj Kumar Jha
- Maharajgunj Medical Campus, Institute of Medicine, 44600, Kathmandu, Nepal
| | - Sharmila Ghimire
- Maharajgunj Medical Campus, Institute of Medicine, 44600, Kathmandu, Nepal
| | - Dinesh Prasad Koirala
- Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, 44600, Kathmandu, Nepal
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Badour M, Hammed A, Baqla S. Lethargy as an initial symptom of intussusception secondary to Meckel's diverticulum in a 2.5 year-old girl: Case report. Ann Med Surg (Lond) 2021; 68:102562. [PMID: 34377446 PMCID: PMC8329513 DOI: 10.1016/j.amsu.2021.102562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION and importance: Intussusception is one of the most common causes of acute abdomen and surgical morbidities in the childhood. In a paediatric presentation of intussusception due to Meckel's diverticulum there may be acute onset of abdominal pain, vomiting or painless red currant stools. However, Lethargy has been described as a rare presenting symptom. CASE PRESENTATION We present a case of 2,5 - year old female complained of acute alternation in consciousness followed by continuous vomiting two days later. CLINICAL DISCUSSION Her neurological examination showed a lethargic child, not reactive and hypotonic. Her past medical history was unremarkable. Abdominal ultrasonography was compatible with ileocolic intussusception. The necrotic bowel and diverticulum were resected, followed by anastomosis of the viable bowel segments. postoperatively the infant recovered dramatically. CONCLUSION Although lethargy is a rare presenting symptom of Intussusception, it should be kept as a differential diagnosis when a child presents with acute onset of drowsiness with or without abdominal symptoms.
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Affiliation(s)
- Maysaa Badour
- Pediatric University Hospital, Division of Neurology, Damascus, Syria
| | - Ali Hammed
- Tishreen University Hospital, Department of Neurosurgery, Lattakia, Syria
| | - Sameer Baqla
- Pediatric University Hospital, Division of Neurology, Damascus, Syria
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Wong JYJ, Conroy M, Farkas N. Systematic review of Meckel's diverticulum in pregnancy. ANZ J Surg 2021; 91:E561-E569. [PMID: 34152674 DOI: 10.1111/ans.17014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future. MATERIALS AND METHODS The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed. RESULTS Twenty-seven cases were included. Average age = 26.9 years. Average gestation = 25.1 weeks. Occurrence: first trimester = 3.7%; second trimester = 48.1% and third trimester = 48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms = 3.4 days. Diagnostic imaging modalities utilised: ultrasound = 40.7%; CT = 25.9%; MRI = 14.8%; abdominal X-ray = 11.1% and endoscopy = 7.4%. All cases required definite surgical management: laparotomy = 65.4%; laparoscopy = 15.4%; C-section = 19.2% and unreported = 3.8%. Main intra-operative findings: perforated MD = 40.7%; intussusception with MD as a lead point = 11.1%; bleeding MD = 11.1%, inflamed MD = 11.1%; small bowel obstruction = 11.1%; gangrenous MD = 3.7%; volvulus = 3.7% and unspecified = 7.4%. Mean length from ileocolic junction = 51.7 cm. Average length of stay was 7.1 days. T-test (p-value = 0.12) when comparing management strategy. Three maternal complications and two foetal mortalities. CONCLUSION MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.
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Affiliation(s)
- Joshua You Jing Wong
- West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Li F, Jia G. Gastrointestinal stromal tumor in ruptured Meckel's diverticulum located in jejunum caused myelosuppression for a short time: A case report. Int J Surg Case Rep 2021; 84:105968. [PMID: 34225064 PMCID: PMC8259299 DOI: 10.1016/j.ijscr.2021.105968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastrointestinal stromal tumor (GIST) in Meckel's diverticulum (MD) is rare but it seems to be a common phenomenon that GIST triggers MD perforation or rupture; the exact mechanism is unclear. In addition, the location of GIST in perforated or ruptrued MD is most common in ileum, rarely in jejunum. We herein report a GIST in ruptured MD Located in jejunum and severe peritoneal cavity infection leads to myelosuppression. CASE PRESENTATION A female patient was admitted to our hospital with "abdominal pain". Physical examination and laboratory tests revealed that the patient was in shock and myelosuppression. Abdominal X-ray photograph and computed tomography indicated perforation of digestive tract. Laparotomy revealed rupture of MD located 90 cm from the Treitz ligament and a tumor was also found in the MD. As the condition is critical, the MD was excisioned from its root and the small bowel gap was closed and repaired. Laboratory indicators showed that myelosuppression was removed 24 h after operation. The pathological findings established a GIST in the MD. The patient was discharged on postoperative day 5 without significant complications. CLINICAL DISCUSSION A GIST in ruptured MD Located in jejunum caused the severe peritoneal cavity infection and myelosuppression In a short time, as seen in this case. Failure to recognize the severity of the disease and delay in treatment will endanger the life of the patient. CONCLUSION GIST in MD Located in jejunum is very rare, and the rupture of the MD can be life-threatening at any time.
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Affiliation(s)
- Fengjuan Li
- Department of Neurology, Baotou Eighth Hospital, Baotou, Inner Mongolia, China
| | - Guoqun Jia
- Department of General Surgery, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, Inner Mongolia, China.
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Skertich NJ, Ingram MC, Grunvald MW, Williams MD, Ritz E, Shah AN, Raval MV. Outcomes of Laparoscopic Versus Open Resection of Meckel's Diverticulum. J Surg Res 2021; 264:362-367. [PMID: 33848834 DOI: 10.1016/j.jss.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/27/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Meckel's Diverticulum (MD) is a common congenital anomaly accounting for half of pediatric gastrointestinal bleeds. No large-scale studies exist comparing open and laparoscopic surgery and conversion rates remain high. We sought to compare postoperative outcomes associated with each approach and to determine risk factors for conversion. MATERIALS AND METHODS NSQIP-Pediatric was used to identify patients who underwent a MD resection from 2012 to 2018. Outcomes between patients treated with a laparoscopic versus open versus laparoscopic converted to open (LCO) surgery were compared. Chi-square tests and adjusted logistic regression analysis were used to determine significance and factors associated with conversion. RESULTS Six hundred eighty-one patients were identified, 295 (43.3%) underwent open, 267 (39.2%) laparoscopic, and 119 (17.5%) LCO resection. Patients undergoing laparoscopic compared to open procedures had shorter length of stay (LOS; 3 versus 4, P= 0.009), and similar morbidities (10.5% versus 16.6%, P= 0.164) and operative times (71.6 versus 76.6 mins, P= 0.449) on adjusted analysis. Patients with LCO compared to open procedures had similar LOS (4 versus 4, P= 0.334) and morbidities (14.3% versus 16.6%, P= 0.358), but longer operative times (90.1 versus 76.6 mins, P= 0.002) on adjusted analysis. Patients with laparoscopic and LCO procedures had fewer unplanned intubations compared to open procedures (0.0% versus 0.0% versus 2.4%, P= 0.011) and lower mortality (0.0% versus 0.0% versus 1.7%, P= 0.046) on univariate analysis. CONCLUSIONS Laparoscopic MD resection has shorter LOS and similar complications and operative time compared to an open approach while LCO resection increases operative time but not LOS or morbidities.
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Affiliation(s)
- Nicholas J Skertich
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, Chicago, Illinois; Department of Surgery, Rush University Medical Center, Chicago, Illinois.
| | - Martha-Conley Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Miles W Grunvald
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael D Williams
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ethan Ritz
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ami N Shah
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Alves JR, Justino GB, Justino LB, Ternes CMP, Rech JVT, Graffunder FP. Meckel's Diverticulum Perforation by Foreign Body: A Case Report. Bull Emerg Trauma 2021; 9:101-104. [PMID: 34150921 PMCID: PMC8195832 DOI: 10.30476/beat.2021.86253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/10/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
Meckel's diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 reported cases of Meckel's diverticulum perforation by chicken bone. We report a case of a 24-year-old man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel's diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged after 5 days. Although rare, its clinical presentation might be similar to acute appendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel in order to investigate a possible Meckel's diverticulum complication in the differential diagnosis.
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Affiliation(s)
- José Roberto Alves
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Gustavo Busch Justino
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Leonardo Busch Justino
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Caique Martins Pereira Ternes
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - João Vítor Ternes Rech
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Fabrissio Portelinha Graffunder
- Diseases of the Abdominal Wall and Digestive System Research Group of the Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Rhodes E, Stone T, Spruill L, Hardie AD. A case report of inverted Meckel's diverticulum. Radiol Case Rep 2021; 16:1118-1122. [PMID: 33732404 PMCID: PMC7937938 DOI: 10.1016/j.radcr.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
Inverted Meckel's diverticulum is an entity often discovered incidentally or through a clinical evaluation for gastrointestinal bleeding. While rare, inverted Meckel's diverticulum should be considered in the evaluation of a patient presenting with gastrointestinal bleeding, intestinal obstruction, or intussusception. In this case, a 67-year-old female with a remote history of surgically treated breast cancer presents to an urgent care facility with weakness and fatigue. She was found to be anemic with hemoglobin of 4. Imaging revealed a blind-ending pouch in the mid to distal ileum consistent with an inverted Meckel's diverticulum. Inverted Meckel's diverticulum is identified on computerized tomography as an intraluminal, blind-ending structure in the mid to distal ileum. The possibility of a lead point should be investigated and surgical resection is indicated to prevent intestinal obstruction.
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Affiliation(s)
- Elizabeth Rhodes
- College of Medicine, Medical University of South Carolina University Medical Center, Charleston, South Carolina
| | - Trevor Stone
- Department of Radiology, Medical University of South Carolina University Medical Center, 25 Courtenay St., Charleston, SC, 29412 USA
| | - Laura Spruill
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina University Medical Center, Charleston, South Carolina
| | - Andrew D Hardie
- Department of Radiology, Medical University of South Carolina University Medical Center, 25 Courtenay St., Charleston, SC, 29412 USA
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Mitani Y, Noguchi K, Nishikawa M, Yamaue H. Ultrasound findings for spontaneous regression of omphalomesenteric remnant after birth. J Clin Ultrasound 2020; 49:636-638. [PMID: 33289095 DOI: 10.1002/jcu.22957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
We report a rare case of spontaneous regression of omphalomesenteric remnant after birth. Unlike previously reported cases, no surgery was required. The omphalomesenteric duct sometimes persists at birth. Its regression after birth, however, is extremely rare. A neonate passed a bloody stool 3 minutes after birth. Meckel's scan detected slight technetium-99 m uptake around the umbilicus. Sonographic examination detected a luminal structure connected to the small bowel, which gradually regressed, however, and was no longer visible by the 52nd day after birth. Careful follow-up is required after occurrence of bloody stool and intestinal obstruction from Meckel's diverticulum.
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Affiliation(s)
- Yasuyuki Mitani
- Department of Surgery and Endoscopic Surgery, Izumiotsu Municipal Hospital, Osaka, Japan
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kohei Noguchi
- Department of Surgery and Endoscopic Surgery, Izumiotsu Municipal Hospital, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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. J Pediatr Surg Case Rep 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Newme K, Hajong R, Khongwar D. Meckel's diverticulum causing acute intestinal obstruction: Report of two cases. J Family Med Prim Care 2020; 9:4409-4411. [PMID: 33110870 PMCID: PMC7586558 DOI: 10.4103/jfmpc.jfmpc_1130_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 11/04/2022] Open
Abstract
Reporting herewith 2 cases of Meckel's diverticulum presenting with acute intestinal obstruction. The patients were managed surgically. The cases were presented in emergency department and management were based on clinical and imaging after a initial resuscitation. The intra-operative findings are discussed in herewith.
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Affiliation(s)
| | - Ranendra Hajong
- Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Donkupar Khongwar
- Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
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Tartaglia D, Cremonini C, Strambi S, Ginesini M, Biloslavo A, Paiano L, Quilici F, Castagna M, Di Saverio S, Coccolini F, Chiarugi M. Incidentally discovered Meckel's diverticulum: should I stay or should I go? ANZ J Surg 2020; 90:1694-1699. [PMID: 32783315 DOI: 10.1111/ans.16189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to assess the indication for surgical treatment of incidentally discovered Meckel's diverticulum (MD) on the basis of clinical and histological features. METHODS The charts of patients undergoing surgery for MD were analysed. Two groups were identified: (1) patients who had incidentally discovered MD resected (incidental MD, IMD) and (2) patients who received first-line surgery for a complicated MD (CMD). Demographics and intraoperative and post-operative outcomes were compared. Histological findings were also analysed and compared. RESULTS Sixty-five patients were included in the study. IMD was observed in 39 patients (60%), while CMD was observed in 26 (40%). Male gender was significantly more frequent in CMD (P = 0.020), and mean age was significantly higher in IMD (P = 0.025). Body mass index and the American Society of Anesthesiologists score >2 were similar in both groups. Laparoscopy was carried out in 36% of IMD and in 50% of CMD patients (P = 0.309). A tangential resection was performed in 92% of IMD and 73% of CMD patients (P = 0.07). No complications related to diverticular resection were found in IMD, while they occurred in 8% of CMD patients (P = 0.931). Meanly, diverticula were longer when complicated (P = 0.001). CMD showed significant histological differences and more frequent gastric ectopic mucosa (P = 0.039). A malignant tumour was incidentally found in IMD. CONCLUSION As surgery is mandatory in CMD, the optimal management of IMD remains uncertain. Mucosal abnormalities may favour complications, but these cannot be identified before excision. Stapled diverticulectomy is safe and effective. A surgical approach to IMD may prevent complications at a very low cost.
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Affiliation(s)
- Dario Tartaglia
- Emergency Surgery Unit and Trauma Center, The University of Pisa, Pisa, Italy
| | - Camilla Cremonini
- Emergency Surgery Unit and Trauma Center, The University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Emergency Surgery Unit and Trauma Center, The University of Pisa, Pisa, Italy
| | - Michael Ginesini
- Emergency Surgery Unit and Trauma Center, The University of Pisa, Pisa, Italy
| | - Alan Biloslavo
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy
| | - Lucia Paiano
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy
| | - Francesca Quilici
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, The University of Pisa, Pisa, Italy
| | - Maura Castagna
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, The University of Pisa, Pisa, Italy
| | | | - Federico Coccolini
- Emergency Surgery Unit and Trauma Center, The University of Pisa, Pisa, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit and Trauma Center, The University of Pisa, Pisa, Italy
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Huang MM, Patel HD, Matoso A, Kauffmann JR, Allaf ME. Detection of a Meckel's diverticulum on PSMA PET/CT: A case report. Urol Case Rep 2020; 33:101306. [PMID: 33102009 PMCID: PMC7573858 DOI: 10.1016/j.eucr.2020.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. In this report, we present a patient with a Meckel's diverticulum that was incidentally discovered on prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) imaging performed for prostate cancer staging. We discuss hypotheses for why the Meckel's diverticulum showed high uptake of PSMA-targeted radiotracer and the clinical implications of this finding.
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Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andres Matoso
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Spangler H, Fisher J. The rule of two's didn't work: Meckel's diverticulum with hemorrhagic shock in an adolescent. Am J Emerg Med 2020; 38:1541.e1-1541.e2. [PMID: 32224041 DOI: 10.1016/j.ajem.2020.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/22/2020] [Indexed: 11/19/2022] Open
Abstract
Meckel's diverticulum classically follows the rule of two's; presenting before the age of two years, found 2 ft. from the ileocecal valve, approximately 2 in. in length, and present in roughly 2% of the population. To our knowledge, there are few cases detailing emergent medicine management of hemorrhagic shock in patients with acute blood loss from a Meckel's diverticulum. We report the case of a 13-year-old male presenting in hemorrhagic shock secondary to an undifferentiated gastrointestinal bleed who was effectively resuscitated in a children's emergency department. Meckel's scan revealed abnormal tracer uptake consistent with Meckel's diverticulum and the patient underwent surgical resection of the diverticulum. This case report details the importance of prompt recognition and appropriate volume resuscitation in a pediatric patient suffering from hemorrhagic shock. Emergency medicine physicians should maintain an index of suspicion for Meckel's diverticulum in any pediatric patient presenting with undifferentiated gastrointestinal hemorrhage.
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Affiliation(s)
- Hillary Spangler
- Department of Internal Medicine and Pediatrics, UNC Hospitals, Chapel Hill, NC, United States of America.
| | - Joseph Fisher
- Department of Emergency Medicine, UNC Hospitals, Chapel Hill, NC, United States of America
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Yi G, Chavda K, Omodon M. CT findings of Meckel's diverticulum perforation in a geriatric patient. Radiol Case Rep 2020; 15:592-595. [PMID: 32215159 PMCID: PMC7083787 DOI: 10.1016/j.radcr.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/12/2022] Open
Abstract
Meckel's diverticulum is a remnant of the omphalomesenteric duct, found only in approximately 2% of the population. Although Meckel's diverticulum is often diagnosed in nonsymptomatic patients as incidental radiologic findings, complications of Meckel's diverticulum can also be seen on radiologic evaluation. We present a rare care of perforated Meckel's diverticulum in a geriatric patient demonstrated on contrast computed tomography. This was later confirmed during laparoscopic surgery with pathologic evaluation.
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Affiliation(s)
- Grace Yi
- Regional Medical Center Bayonet Point, 14000 Fivay Road, Hudson, FL 34667, USA
| | - Kiran Chavda
- Regional Medical Center Bayonet Point, 14000 Fivay Road, Hudson, FL 34667, USA
| | - Melvin Omodon
- Regional Medical Center Bayonet Point, 14000 Fivay Road, Hudson, FL 34667, USA
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Curmi A, Dimech AP, Dalli R, Mostafa A, Debono J. A Rare Case of Acquired Transthoracic Littre's Hernia. Surg J (N Y) 2019; 5:e150-e153. [PMID: 31620563 PMCID: PMC6794146 DOI: 10.1055/s-0039-1696727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/17/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction The Littre hernia is a rare complication of Meckel's diverticulum. Meckel's diverticulum is vestigial remnant of the omphalomesenteric duct occurring in approximately 2% of the general population with an estimated 4 to 16% risk of complications. Usual sites of the Littre hernia include inguinal (50%), umbilical (20%), and femoral (20%). We report a case of an acquired transthoracic Littre's hernia occurring through the left part of the diaphragm triggered by a history of traumatic rib fractures associated with alcohol abuse. Case Report A 71-year-old man presented with 4-day history of worsening shortness of breath, colicky lower abdominal pain, and inability to open bowels despite passing flatus, without nausea or vomiting. His past medical history was remarkable for multiple traumatic rib fractures caused by falls which were associated with excessive alcohol consumption. A noncontrast computed tomography (CT) scan of the abdomen and pelvis showed distended jejunal loops containing air/fluid levels likely resulting from herniated jejunum between the left chest wall and left diaphragm. An urgent laparotomy was performed which revealed small bowel and omentum herniating through a small defect in the left posterior hemidiaphragm. The contents of the sac were reduced and a Meckel's diverticulum was found inside the sac, characteristic of Littre's hernia. The diaphragmatic defect was closed and the Meckel diverticulum stapled and excised. Discussion Herniation of Meckel's diverticulum through the diaphragm most commonly occurs in the pediatric population. Acquired transthoracic Littre's hernia is rare and may arise following thoracobdominal trauma caused by surgery, motor vehicle accidents, and falls from height. Left-diaphragmatic tears are characteristically more clinically apparent and symptomatic than the right since the liver often has a protective effect on the right part of the diaphragm. Herniation of abdominal contents in the chest cavity causes respiratory distress and requires urgent surgical correction. Diagnosis is often delayed since diaphragmatic hernia tends to present very late after the initial trauma, subjecting the patient to possible life-threatening complications. While it is easier to reduce the herniated contents and repair the diaphragm via a thoracic approach, laparotomy is often preferred in cases of acute trauma associated with intra-abdominal injuries. Repair of Littre's hernia then consists of resection of the diverticulum and herniorraphy. Conclusion Internal Littre's hernia is usually of congenital origin. This is the first case of a transthoracic Littre's hernia caused by traumatic rib fractures. Hence, it is of utter importance that a clinician is aware of such uncommon pathology.
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Affiliation(s)
- Arthur Curmi
- Department of Surgery, Mater Dei Hospital, Triq Dun Karm, Msida MSD, Malta
| | - Anthony P Dimech
- Department of Surgery, Mater Dei Hospital, Triq Dun Karm, Msida MSD, Malta
| | - Rebecca Dalli
- Department of Surgery, Mater Dei Hospital, Triq Dun Karm, Msida MSD, Malta
| | - Ayman Mostafa
- Department of Surgery, Mater Dei Hospital, Triq Dun Karm, Msida MSD, Malta
| | - Joseph Debono
- Department of Surgery, Mater Dei Hospital, Triq Dun Karm, Msida MSD, Malta
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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