Extremely Rare Synchronous Primary Neoplasms of Meckel's Diverticulum and Colon: a Report of Three Cases

Synchronous primary neoplasms of Meckel's diverticulum and colon malignancies are rarely reported in the literature. We present three patients with synchronous primary neoplasms of Meckel's diverticulum and colon malignancies. All tumors located in Meckel's diverticulum were incidentally found at laparotomy and the definitive diagnosis was made with microscopic examination of surgical specimens. Synchronous primary neoplasms of Meckel's diverticulum and colon malignancies are rarely encountered. Moreover, this is the first case of synchronous colon cancer and pancreatic intraepithelial neoplasia (PanIN) arising from pancreatic heterotopia within Meckel's diverticulum. The diagnosis of Meckel's diverticulum should be kept in mind in patients who underwent laparotomy for any reason; when found incidentally at laparotomy, it should be carefully examined for any suspicious abnormality and surgery should be considered that it can be performed without any problems.

Ectopic pancreatic adenocarcinoma in Meckel's diverticulum: a case report

BACKGROUND

Malignant neoplasms arising from Meckel's diverticulum are rare and an adenocarcinoma in Meckel's diverticulum originating from ectopic pancreatic tissue is even rarer. Herein, we report a patient with an ectopic pancreatic adenocarcinoma in Meckel's diverticulum who was successfully treated with surgery and chemotherapy.

CASE PRESENTATION

A woman in her sixties presented to another hospital with abdominal pain. Plain computed tomography suggested an abdominal tumor and she was referred to our hospital. Enhanced computed tomography revealed a 23-mm low-density tumor in the abdominal cavity. Surgery was performed with a tentative diagnosis of a mesenteric tumor, such as a gastrointestinal stromal tumor, schwannoma, or lymphoma. First, we inspected the peritoneal cavity with a laparoscope. This revealed numerous nodules in the small bowel mesentery, suggesting peritoneal dissemination. A 20-mm-diameter white tumor was found in the small intestine and diagnosed as a small intestinal cancer. The small intestine was partially resected laparoscopically through a small skin incision. The patient's postoperative course was uneventful, and she was discharged on postoperative day 9. Pathological examination revealed well-differentiated adenocarcinoma in the small intestine. The tumor had developed from a sac-like portion protruding toward the serosal side and had a glandular structure lined with flattened atypical cells. Neither pancreatic acinar cells nor islets of Langerhans were evident, suggesting a Heinrich type 3 ectopic pancreas. The final diagnosis was an adenocarcinoma originating from an ectopic pancreas in Meckel's diverticulum. After a smooth recovery, the patient commenced chemotherapy for pancreatic cancer.

CONCLUSIONS

We present a very rare case of ectopic pancreatic carcinoma in Meckel's diverticulum.

Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case reports

BACKGROUND

Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding.

CASE SUMMARY

This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided.

CONCLUSION

Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.

Simultaneous resection of a neuroendocrine tumor in an incidental Meckel's diverticulum with transabdominal preperitoneal hernial repair: a case report

BACKGROUND

As laparoscopic surgery becomes more prevalent worldwide, Meckel's diverticula are increasingly being discovered incidentally during surgery. There is no consensus on whether to follow up or resect such diverticula, which are usually asymptomatic. In cases of transabdominal preperitoneal inguinal hernia repair, resection of such a diverticulum might add the risk of mesh infection. Thus, it is unclear whether simultaneous intestinal resection is advisable.

CASE PRESENTATION

A 64-year-old man diagnosed with a left indirect inguinal hernia underwent laparoscopic inguinal hernia repair, during which a 2-cm Meckel's diverticulum located contralateral to the mesentery of the ileum approximately 30 cm from Bauhin's valve was detected incidentally. Because of the potential risk of future complications such as hemorrhage, diverticulitis, or tumor development, wedge resection of the ileum was performed extracorporeally through an extended umbilical port site after completion of the hernia repair. Pathological examination revealed a neuroendocrine tumor (G1) in Meckel's diverticulum, which was successfully resected without any mesh infection or postoperative complications.

DISCUSSION

Our patient's clinical course raises two important issues. First, a Meckel's diverticulum detected incidentally during laparoscopic surgery should be resected promptly because malignant tumors within such diverticula have frequently been reported. Second, simultaneous resection with hernia repair using mesh seems to be as safe as other clean-contaminated surgery.

CONCLUSIONS

Management of incidental Meckel's diverticula should be selected by appropriate assessment for the risk of malignancy and complications.

Torsion of Meckel's diverticulum-a case report and literature review

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Torsion is a rare complication of MD with only 48 cases described in the English literature to date. We describe a case of a 22-year-old male who presented to the emergency department with lower abdominal pain. Pre-operative computed tomography scan suggested a torted MD. This was confirmed on diagnostic laparoscopy and managed with segmental resection of the MD and a concurrent appendicectomy. Histopathology confirmed torsion of MD and a normal appendix. The patient recovered well without any complications. Torsion occurs invariably with giant MD defined as a length of >5 cm. Surgical options for MD include diverticulectomy, wedge resection and segmental resection via laparoscopic or open approach. The rate of pre-operative diagnosis remains low but with advances in imaging and awareness of this condition, this is likely to increase with time.

Gastric, Duodenal, and Small Bowel Emergencies

Gastric and small bowel emergencies are often seen in the emergency department and require rapid assessment and intervention as patients can deteriorate quickly. Some of the more frequently seen gastric emergencies include gastric volvulus and peptic ulcer disease, which can present with ischemia, strangulation, perforation, or severe bleeding. Swift diagnosis is crucial to ensuring the proper management whether that is endoscopic or with surgical exploration. Perforated peptic ulcers that are not contained will require surgical intervention, whereas bleeding ulcers can often be controlled with endoscopic interventions.

Mechanical ileus of the small bowel due to an inflamed Meckel's diverticulum with an enterolith - a case report with literature review

BACKGROUND

Meckel's diverticula result from incomplete obliteration and regression of the omphaloenteric duct and are the most common congenital intestinal malformations. Many Meckel's diverticula remain asymptomatic and are discovered as incidental findings. They present a diagnostic challenge.

METHODS

We report the case of a 35-year-old man who presented with an acute abdomen and ileus. Computed tomography of the abdomen showed a mechanical small bowel ileus. There was a calibre jump in the terminal ileum with a round endoluminal definable hyperdense structure of almost 2 cm in diameter.

RESULTS

An exploratory laparoscopy was performed revealing an inflamed Meckel's diverticulum with impacted enterolith as the cause of the intestinal obstruction.

CONCLUSION

In symptomatic Meckel's diverticula, haemorrhage and obstruction are the most common complications. The development of ileus due to a Meckel's diverticulum with an enterolith is considered extremely rare but should be taken into account.

Small bowel obstruction caused by a mango phytobezoar within a Meckel's diverticulum

A fit and well gentleman in his 40s presented with vomiting and obstipation. His only relevant history being recent ingestion of a large quantity of mangoes. A computer tomography demonstrated a small bowel obstruction with a transition point in the right iliac fossa, but no other pathological findings. After a short period of non-operative management he proceeded to surgery, where a phytobezoar was identified at a Meckel's diverticulum causing a pantaloon shaped intra-luminal obstruction. A small bowel resection and primary anastomosis was performed and the patient had an uncomplicated post-operative course. Meckel's diverticuli are a relatively common phenomenon and may pre-dispose to bowel obstructions through a number of different mechanisms. This unusual case highlights the importance of considering this as a differential, and one that will likely require timely operative intervention.

Regular use of low-dose of opioids after gastrointestinal surgery may lead to postoperative gastrointestinal tract dysfunction in children: a Chinese national regional health center experience sharing

BACKGROUND

The need for pain management is increasing in pediatrics, but the side effects of overuse or abuse of analgesics can be harmful to children's health and even life-threatening in severe cases.

METHODS

Patients who underwent resection of Meckel's diverticulum at the Children's Hospital of Chongqing Medical University from July 1, 2019, to July 1, 2022, were included in this study. Opioids were administered through patient-controlled analgesia (PCA). Based on the preoperative choices made by the legal guardians, patients were stratified into two groups: PCA Group (PCAG) and Non-PCA Group (NPCAG). Data pertaining to the clinical characteristics and prognoses of these patients were subsequently collected and analyzed to assess the impact of opioid administration.

RESULTS

In the study, a total of 126 patients were enrolled, with 72 allocated to the Patient-Controlled Analgesia Group (PCAG) and 54 to the Non-Patient-Controlled Analgesia Group (NPCAG). When compared to the NPCAG, the PCAG exhibited a longer duration of postoperative fasting (median 72 vs. 62 h, p = 0.044) and increased utilization of laxatives (12[16.7%] vs. 2[3.7%], p = 0.022). However, the PCAG also experienced higher incidences of intestinal stasis and abnormal intestinal dilation (13[18.1%] vs. 3[5.6%], p = 0.037). No statistically significant differences were observed in pain assessments at the conclusion of the surgical procedure (0 vs. 1[1.9%], p = 0.429) or within the first 24 h postoperatively (16[22.2%] vs. 18[33.3%], p = 0.164). Additionally, NPCAG patients did not necessitate increased administration of rescue analgesics (2[2.8%] vs. 4[7.4%], p = 0.432).

CONCLUSIONS

The administration of opioids did not demonstrably ameliorate postoperative pain but was associated with a heightened incidence of postoperative gastrointestinal tract dysfunction. The retrospective nature of the current research should be considered and should be clarified further.

Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.

Meckel's Diverticulum as a Cause of Small Bowel Obstruction Complicated with Gangrene in the Third Trimester of Pregnancy: A Case Report

Acute abdomen during pregnancy is rare. Despite advances in diagnostic imaging, preoperative diagnosis in the pregnant population due to anatomical and physiological changes can pose difficulties. Diagnosis and surgery delays increase the risk of adverse outcomes for both maternal and fetal health. In symptomatic cases, explorative surgery might be essential for correct diagnosis and patient treatment. Here, we present Meckel's diverticulum as an unusual cause of small bowel obstruction complicated with gangrene in a 34-week pregnant patient. The diagnosis was only apparent during explorative surgical laparotomy.

Imaging of Gastrointestinal Tract Ailments

Gastrointestinal (GI) disorders comprise a diverse range of conditions that can significantly reduce the quality of life and can even be life-threatening in serious cases. The development of accurate and rapid detection approaches is of essential importance for early diagnosis and timely management of GI diseases. This review mainly focuses on the imaging of several representative gastrointestinal ailments, such as inflammatory bowel disease, tumors, appendicitis, Meckel's diverticulum, and others. Various imaging modalities commonly used for the gastrointestinal tract, including magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT), and photoacoustic tomography (PAT) and multimodal imaging with mode overlap are summarized. These achievements in single and multimodal imaging provide useful guidance for improved diagnosis, staging, and treatment of the corresponding gastrointestinal diseases. The review evaluates the strengths and weaknesses of different imaging techniques and summarizes the development of imaging techniques used for diagnosing gastrointestinal ailments.

Torsion of the whole ileum and hemorrhagic necrosis because of a giant Meckel's diverticulum in a 9-month-old child

Intestinal ischemia caused by torsion of a freely hanging Meckel's diverticulum (MD) resulting in the need for resection is an uncommon complication. We present an extraordinary case of a 9-month-old male with acute abdominal symptoms because of intestinal ischemia and necrosis that necessitated resection of the entire ileum. This was caused by torsion around a particularly large MD.

Inverted Meckel's Diverticulum Causing Adult Intussusception after Blunt Trauma

Meckel's diverticulum is an uncommon though well described clinical entity. There are few cases of a Meckel's diverticulum having been identified as the lead point for adult intussusception. We report the surgical management of a 45-year-old patient with an inverted Meckel's diverticulum causing distal ileal intussusception after blunt abdominal trauma requiring small bowel resection.

Small bowel segment with Meckel's diverticulum volvulus related to short mesodiverticular band: a case report

BACKGROUND

Meckel's diverticulum is a remnant of the omphalomesenteric duct and occurs in only about 2% of people. Mesodiverticular band is the congenital remnant of the vitelline artery and is an even less often occurring phenomenon.

PRESENTED CASE

We present the case of a 56-year-old Caucasian male who was admitted to the emergency department with a very intense, sudden abdominal pain, without past abdominal surgery history. Contrast enhanced computed tomography showed a possibly ischemic closed loop of the small intestine. Urgent laparotomy was performed, during which bloody content in the peritoneal cavity and torsed loop of the small intestine with Meckel's diverticulum were found. The bowel loop and Meckel's diverticulum were ischemic. At the tip of Meckel's diverticulum there was a broken fibrous band extending to mesentery with pulsating artery. We did segmental resection of small intestine including Meckel's diverticulum and primary end-to-end anastomosis. The patient had an unremarkable postoperative hospital stay and was discharged home after 5 days.

CONCLUSION

In our case, we describe a patient with the volvulus of a segment of small bowel and Meckel's diverticulum, which eventually led to small bowel obstruction and ischemia. It was a very rare case that required urgent surgical treatment.

An Atypical Case of Meckel's Diverticulum with Small Bowel Obstruction: Surgical Anatomy, Embryology and Clinical Implications

Abstract

Meckel's diverticulum (MD) is the most frequent congenital anomaly of the gastrointestinal (GI) tract. Atypical presentations with life threatening complications include intestinal obstruction, intussusceptions, peritonitis, foreign body lodgement in the MD, perforated viscera etc. which require prompt diagnosis. Ectopic gastric and pancreatic tissues are found in up to half of the cases which can escalate the complications. However clinical diagnosis is not easy especially when the presentation is atypical. A high index of clinical suspicion is required to diagnose elusive MD with associated complications. Surgical resection is safe and the gold standard treatment for complicated MD. A case of Meckel's diverticulum with concomitant mesodiverticular band (MDB) in a 13 years old male child presented as intestinal obstruction to emergency department is described which was promptly managed surgically with required pre-operative investigations. The aim of this report is to make clinicians aware about a complicated MD with MDB clinically presenting as small bowel obstruction.

Imaging congenital anomalies of the ileum in adults:a pictorial review

The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.

Endoscopic characteristics of Meckel's diverticulum in adults: a retrospective case-series from two tertiary general hospitals in China

BACKGROUND

To analyze the diversity in endoscopic manifestations of Meckel's diverticulum (MD) in adults by using balloon-assisted enteroscopy (BAE) and supply more information on the application of BAE.

METHODS

A retrospective study was carried out on adult patients diagnosed with MD by BAE in two tertiary general hospitals in China, from May 2007 to September 2021. The patients were divided into a small bowel bleeding (SBB) group and a control group according to their main symptoms. Clinical charts and endoscopic images were reviewed, analyzed, and summarized.

RESULTS

Single diverticulum in the ileum and double-lumen sign were observed in all patients. The SBB group consisted of 51 patients, among which 35 cases of ulcerative lesions, 9 cases of erosive lesions, 9 cases of active bleeding/blood clots, and 4 cases of lumps inside the diverticulum were observed respectively. Majority of ulcerative lesions were inside the diverticulum (23/35). A circumferential stricture inside the diverticulum was discovered in 11 cases, and ulcerative lesions tended to occur at this structure (10/11). In the control group consisting of 15 patients, 1 case of erosive lesions at the orifice edge was observed. The percentage of patients with MD-associated ulcerative lesions was significantly higher in the SBB group than that in the control group (p < 0.001).

CONCLUSIONS

The endoscopic manifestations of MD in adults are extraordinarily complex and connected with the patients' primary symptoms. The internal features of MD should be regarded as crucial observational objectives in adult patients.

Heterotopic pancreas in Meckel's diverticulum in an adult man with lower gastrointestinal bleeding: a case report and literature review

Background

Meckel's diverticulum is a blind-end true diverticulum that contains all of the layers, which is normally found in the ileum. Prevalence of Meckel's diverticulum is around 2% in the general population, and even rare among adults. Gastrointestinal (GI) bleeding is a common complication of Meckel's diverticulum in children and in most cases, caused by peptic ulceration, due to ectopic gastric mucosa, while in minority cases, pancreatic tissue would also appear consisting around 6% of all Meckel's diverticulum patients.

Case Description

Herein, we reported a 45-year-old man presented with recurrent hematochezia for over one-month without other remarkable symptoms or past medical history or signs on physical examination. Laboratory examinations showed hemoglobin of 114 g/L and ++++ in stool occult blood test without red blood cell. Contrasted abdominopelvic computerized tomography (CT) were normal and Meckel's electroconvulsive therapy (ECT) for identification was also negative. Considering gastroscopy and colonoscopy were both unremarkable in local hospital, double balloon enteroscopy was adopted and revealed double duct sign at about 100 cm proximal to the ileocecal valve and thus indicated existence of diverticulum. Further, ulceration was found at the far-end bottom of the blind-ending tube. The patient then underwent laparoscopic resection of Meckel's diverticulum and pathology study showed heterotopic pancreas in Meckel's diverticulum. The patient started feeding two days after surgery and was discharged on regular out-patient follow-up two weeks later. Till now, no reappear of hematochezia episode was observed.

Conclusions

Heterotopic pancreas in Meckel's diverticulum is relative rare clinical condition in adult which can cause recurrent lower GI bleeding. Thus, special attention should be paid in cases with unexplained lower GI bleeding in adult.

Meckel's Diverticulum with Dieulafoy's Lesion: A Cause of Severe Hematochezia

BACKGROUND

Meckel's diverticulum (MD) is a remnant of the omphalomesenteric duct. Although the majority of MD are asymptomatic, it can present with severe hematochezia. Hematochezia is generally considered to result from a peptic ulcer caused by ectopic gastric mucosa in MD. However, this hypothesis has not been proved.

METHODS

10 cases of surgically resected MD initially presenting with severe hematochezia were histologically examined.

RESULTS

Ectopic gastric mucosa was present in 9 cases, two of which also contained ectopic pancreas. No ectopic tissue was found in one case, which shows that bleeding can occur in MD without ectopic gastric mucosa. In addition, a rupture of aberrant submucosal arterioles through the overlying mucosa, a vascular abnormality called Dieulafoy's lesion, was detected in all the 10 cases.

CONCLUSION

This study suggests that the actual cause of massive bleeding in MD is not a peptic ulcer, but Dieulafoy's lesion.

Giant Meckel's Diverticulum in a 9-Year-Old Boy: An Unusual Presentation With Isolated Faltering Growth

Meckel's diverticulum is the most common congenital gastrointestinal abnormality. Clinical presentation is normally in childhood with either hemorrhage or an acute surgical abdomen. The much rarer giant Meckel's diverticulum is associated with a more varied clinical presentation. In this case report, we provide a unique example of presentation with isolated faltering growth related to a giant Meckel's diverticulum in a young boy. We discuss the diagnostic process, imaging modalities, and subsequent surgical procedure.

An unusual presentation of intestinal duplication mimicking torsion of Meckel's diverticulum: a rare report of a pediatric case

Background

Enteric duplication is a congenital disease that occurs throughout the entire gastrointestinal tract. Although it may sometimes cause intestinal volvulus, a few reports have described cases of enteric duplication twisted on itself. We experienced a rare pediatric case of long-segment tubular ileal duplication showing torsion. Torsion of enteric duplication is extremely rare. We herein report a pediatric case showing unusual torsion of ileal duplication requiring emergency surgery.

Case presentation

A 3-year-old boy presented with abdominal pain and vomiting. Contrast-enhanced computed tomography (CT) revealed a cystic luminal structure with a blind end and fluid collection in the pelvic cavity. CT also showed no findings of ileus or intestinal dilatation except for a cystic luminal structure. The preoperative diagnosis was torsion of Meckel’s diverticulum. The patient underwent emergent explorative diagnostic laparoscopy. As a result, a necrotic luminal structure and bloody ascites were recognized, and small-scale laparotomy was performed. Long-segment ileal duplication was recognized. The long-segment tubular ileal duplication shared the anti-mesenteric side of the intestinal wall along one-third of its length. The residual two-thirds of its length was free from the ileum and its blind end was twisted in a manner that looked similar to Meckel’s diverticulum. Normal ileum and the duplication, including the twisted necrotic portion, were resected, and ileal anastomosis was performed. The postoperative course was uneventful. A pathological examination confirmed the definitive diagnosis of enteric duplication.

Conclusions

We reported the unusual presentation of intestinal duplication mimicking torsion of Meckel’s diverticulum. Enteric duplication shows various clinical symptoms and presentations. We must understand that the classification of digestive enteric duplication is diverse with a variety of associated clinical symptoms.

Meckel's Diverticulum, A Rare Presentation in a Neonate

Meckel's diverticulum is commonly symptomatic the first 2 years of life. Complications associated with Meckel's diverticulum are due to gastrointestinal (GI) bleeding or obstruction. A 5-day-old male presented to the emergency department (ED) with an episode of bright red blood per rectum (BRBPR) associated with emesis. Vital signs were normal and abdomen soft and non-distended. Serial abdominal radiographs progressed to show distention of small bowel and air fluid levels. Operative intervention was undertaken with diagnosis of intestinal obstruction. On exploratory laparotomy, 24 cm of a fibrosed, ischemic closed-loop ileal segment densely adherent to the tip of a Meckel's diverticulum was identified and resected, followed by primary reanastamosis. Histologic findings confirmed ectopic gastric tissue. Symptomatic Meckel's diverticulum is often secondary to intestinal obstruction and hematochezia, findings which are caused by incarcerated inguinal hernia or ileocolic intussusception. Our patient presented with a closed loop, which has not been previously reported.

Peritonealized urachal remnant and obstructive congenital peritoneal band. A case report

INTRODUCTION

Intestinal obstruction as a result of congenital peritoneal bands is rare in surgical practice. It typically compromises the small bowel, and it also has been reported to involve the appendix or a Meckel's diverticulum. However, peritonealized urachal remnant as part of a congenital band is highly infrequent.

CASE REPORT

5-year-old boy presenting with intestinal obstruction related to a peritoneal band from the mesentery to the appendix and a peritonealized urachal remnant, associated with an incidental finding of a Meckel's diverticulum. Diagnosis was achieved laparoscopically. The peritoneal band, the urachal remnant, and the Meckel's diverticulum were resected.

DISCUSSION

Kerkeni's congenital band classification consists of 4 independent groups. This case combines both a band stemming from an embryological remnant and an idiopathic band.

[Perforation of Meckel's diverticulum by a fishbone]

Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.

Axially torsional Meckel's diverticulum accompanied by small bowel volvulus: a case report

Small bowel volvulus secondary to Meckel’s diverticulum is rare, and a delayed diagnosis results in disastrous outcomes. Computed tomography is conducive to early differential diagnosis. In particular, a blind-ending pouch structure on CT always indicates Meckel’s diverticulum. Diverticulectomy with or without adjacent partial small intestinal resection is the standard treatment for symptomatic Meckel’s diverticulum. However, the therapy for asymptomatic Meckel’s diverticulum is controversial. Here, we report the case of a 20-year-old man who suffered intestinal obstruction secondary to small bowel volvulus caused by an axially torsional, gangrenous, and giant Meckel’s diverticulum. Diverticulectomy with partial intestinal resection was performed.

Synchronous tumor duplicity of a neuroendocrine tumor of Meckels diverticulum with liver metastases and colorectal carcinoma

INTRODUCTION

Meckels diverticulum (MD) is a developmental abnormality and a true diverticulum of the small intestine which can give rise to a malignant tumor. Neuroendocrine tumors (NETs) are the most common tumors arising in MD, but due to the prevalence of MD and its malignancy rate, there is no uniform guideline regarding these tumors. Recent knowledge shows that their biological behavior is aggressive and unrelated to size. Their behavior resembles that of an ileal NET.

CASE REPORT

A 62-year-old male was examined for enterorrhagia, and an adenocarcinoma of the ascending colon was diagnosed along with multiple liver lesions that resembled metastases. Needle biopsy of a liver lesion was performed and showed the lesions to be NET metastases of unknown origin. Treatment with somatostatin analogs was commenced, and because of the patients anemization a right hemicolectomy was indicated, during which a normal Meckels diverticulum was found and resected. Histological evaluation of MD confirmed a moderately differentiated NET.

CONCLUSION

Surgery is the primary modality for treating MD, including cases in which MD is asymptomatic and found incidentally during surgery for other causes. In the case of NET of MD, a radical surgical treatment is needed because of the risk of early metastatic dissemination. When liver metastases are present, an aggressive approach combining surgical and systemic treatment is recommended to improve the prognosis of the disease.

A Strangulated Meckel's Diverticulum in an Inguinal Hernia: A Case Report and Literature Review

Background

Meckel's diverticulum is an embryologic remnant of the vitelline duct, occurring in approximately 2% of the adult population. A hernia containing a Meckel's diverticulum is called a Littré's hernia and is rarely reported in the medical literature. Clinically, a Littré's hernia is indistinguishable from a hernia containing small bowel and is often discovered incidentally during a repair.

Case Presentation

Herein, we report a rare case of strangulated Littré's hernia in a patient's right groin. The sac contained a long segment of small bowel in addition to a large Meckel's diverticulum. The bowel was irreducible through the groin incision, and a lower midline laparotomy was made. Necrotic bowel including the Meckel's diverticulum was resected. Given the presence of necrotic bowel and potential for infection, the hernia was repaired with a Bassini herniorrhaphy, reinforced with absorbable mesh. The patient recovered uneventfully.

Conclusion

Littré's hernia is a rare clinical entity. Treatment is similar to any bowel-containing hernia. Repair of the hernia defect with permanent mesh should be weighed against the risk of implant infection.

Meckel's diverticulum with polypoid hyperplasia of ectopic gastric mucosa diagnosed by double-balloon enteroscopy and single-photon emission computed tomography/computed tomography

Meckel’s diverticulum (MD) is a relatively common true congenital diverticulum on the ileum. Bleeding caused by polypoid hyperplasia of ectopic gastric mucosa in MD is rare. A 14-year-old Chinese boy presented with intermittent melena and haematochezia for 1 month. Laboratory data showed normocytic anaemia. Gastroscopic findings were normal. The patient underwent exploratory laparotomy without bowel preparation on day 2 because of sudden haematochezia and decreased haemoglobin. Intraoperative colonoscopy revealed inflammatory changes in the terminal ileal mucosa with diffuse haemorrhage. Melena with decreased haemoglobin recurred 20 days after the first operation. Computed tomography (CT) and angiography revealed a tubular lesion that was localised in the right lower abdominal quadrant. Single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging with 99m-technetium pertechnetate confirmed moderately increased uptake in the distal ileum. Retrograde double-balloon enteroscopy (DBE) showed a diverticulum with prominent mucosal polypoid hyperplasia at an insertion depth of 100 cm from the anastomotic stoma. Diverticulectomy and end-to-end anastomosis were performed, and MD was confirmed by a histopathological examination. The patient’s postoperative recovery was uneventful during the 2-month follow-up. MD with polypoid hyperplasia of ectopic gastric mucosa is rare. Complementary use of DBE and SPECT/CT can accurately diagnose MD by providing anatomical and functional information.

An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

Intestinal obstruction and ischemia by necrotic annular Meckel's diverticulum: Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Meckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Diagnosis of MD is a challenge because of its rarity and frequent asymptomaticity. Radiological exams generally aren't useful for its diagnosis. Intestinal obstruction represents the most common complication of MD in adults. Surgery is the appropriate treatment of complicated MD.

CASE PRESENTATION

A 70-year-old Caucasian male was admitted to the Emergency Department with a two-day history of abdominal pain associated with inability to pass gas or stool, nausea and vomiting. Physical examination revealed abdominal distention and abdominal pain without Blumberg's sign. Abdominal contrast-enhanced computed tomography (CECT) showed small bowel obstruction caused by suspected MD. Laboratory tests reported high serum levels of glycemia, LDH, C-reactive protein and leukocytosis. After diagnosis of intestinal obstruction, the patient underwent exploratory laparotomy: a segmental resection of ischemic distal ileum bearing a necrotic MD was performed. The postoperative course of patient was uneventful.

CLINICAL DISCUSSION

MD is found in 2%-4% of the population in large autopsy and surgical series. MD is mostly asymptomatic and incidentally discovered if not complicated; a debate exist about management of asymptomatic MD. Surgery represents the definitive treatment of complicated MD.

CONCLUSION

MD is a true diverticulum rarely discovered in adults. Diagnosis of MD is difficult even with the help of radiological exams. Although surgical resection represents the correct treatment of symptomatic MD, nowadays there is no consensus on the optimal treatment of asymptomatic and incidentally discovered MD.

Meckel's diverticulum in an adult with iron deficiency

Meckel's diverticulum is a true diverticulum caused by the incomplete obliteration of the vitelline duct during gestation. It is the most common congenital malformation of the gastrointestinal tract. Meckel's diverticulum is a rare presentation in adults, especially because symptomatic patients present in early childhood. We present a 57-year-old woman with symptomatic iron deficiency after recent nonsteroidal anti-inflammatory use. After normal upper and lower endoscopy, a capsule endoscopy showed an oozing polyp in the distal ileum. The small bowel was surgically resected, and histopathology confirmed Meckel's diverticulum as the cause of her small bowel bleeding. Rare causes such as Meckel's diverticulum should be kept in mind in the differential diagnosis for patients with suspected small bowel bleeding.

Meckel's Diverticulum Bleeding Missed by the First but Detected by the Second Capsule Endoscopy

A 13-year-old boy was admitted to our hospital because of bloody stools. Although a Meckel's diverticulum (MD) was suspected, capsule endoscopy (CE) revealed no remarkable findings. Seven months later, he was admitted again because of rebleeding. CE was performed again and revealed an elevated lesion and fresh blood in the ileum. A single balloon endoscopic examination revealed a diverticulum with an elevated lesion in it. Histologic findings showed ectopic gastric mucosa, thus we diagnosed this patient as having MD. Although CE is useful for the examination of obscure gastrointestinal bleeding, a single CE is not enough to diagnose MD bleeding. The timing in performing CE and the evaluation of other modalities would be valuable for patients suspected of having MD.

Meckel's diverticulum and indications for resection

Meckel's diverticulum (MD) is a rare congenital abnormality. Not all MD require resection. MD is resected when it is symptomatic; when it causes perforation, bleeding, or intestinal obstruction; or when malignancy is confirmed or suspected.

Intestinal obstruction caused by the strangulation of a Treves' field pouch hernia from a Meckel's diverticulum - A case report

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Treves’ field pouch hernial Intestinal obstruction from a Meckel’s diverticulum and a Treves’s field pouch hernia.

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Intestinal obstruction from a Meckel’s diverticulum with tip adherent causing strangulation of a Treves’s field pouch hernia.

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Meckel’s diverticulum and Treves’ field pouch hernia are both rare congenital abnormalities of the digestive tract.

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An abdominal sonography of an encapsulated segment of bowel suggestive of a Treves’ field pouch hernia.

Introduction

The etiology for intestinal obstruction is often difficult to determine especially in a young patient with a virgin abdomen. Differential diagnosis may include congenital abnormalities such as a more common Meckel’s diverticulum but also a rarer mesenteric type internal hernia. Although the definite diagnosis is not as important in an acute setting and diagnosis is often made postoperatively, the preoperative differential diagnosis including the two should be considered for successful management.

Presentation of case

We report a case of a 16-year-old young female who has a history of abdominal complaints but treated successfully conservatively. She eventually presented to us with suspicion of intestinal obstruction and image study confirmed an internal hernia. Operative findings showed a Meckel’s diverticulum with tip adherent leading to the strangulation of a Treves’ field pouch hernia. The encapsulated small bowel resulted in an intestinal obstruction of the terminal ileum.

Discussion

Meckel’s diverticulum is a common congenital abnormality but often asymptomatic. Treves’ field of the mesentery is also a congenital abnormality but a much rarer finding often only impressed if herniation of the bowel is involved. However, both can lead to an abdominal emergency.

Conclusion

Intestinal obstruction is often an emergent situation and prompt surgery is usually required. The exact etiology may not be obvious preoperatively especially in a young patient with a virgin abdomen, but differential diagnosis like Meckel’s diverticulum and Treves’ filed hernia should be important for successful management.

Omphalomesenteric duct resection using an intraumbilical round incision or a transumbilical vertical incision: report of two cases

We report our experience with two patients who underwent omphalomesenteric duct resection: one for a patent omphalomesenteric duct and the other for a Meckel diverticulum connected to the umbilicus by a fibrous cord. We used an intraumbilical round incision and a transumbilical vertical incision, respectively. The first patient was a neonate with a patent omphalomesenteric duct who appeared to have a small stoma after ligature of the umbilical cord. Contrast media, injected through a catheter inserted into the stoma, entered the lumen of the small bowel. The second patient was an infant with a Meckel diverticulum connected to the umbilicus by a fibrous cord. After bloody stool was noted, nuclear imaging using 99^m technetium pertechnetate revealed a small, round area of intense tracer activity in the midabdomen, suggesting the presence of ectopic gastric mucosa. Using either an intraumbilical or a transumbilical incision is safe and provides good cosmesis.

An atypical presentation of a mesenteric Meckel's diverticulum in a 7-year-old warmblood mare: case report

Background

Meckel’s diverticula are a rare cause of small intestinal strangulation, diagnosed at laparotomy or necropsy. This congenital anomaly of the gastrointestinal tract originates from a remnant of the vitelline duct. In reported equine cases, they present as a full-thickness diverticulum on the antimesenteric border of the distal jejunum or proximal ileum.

Case presentation

On laparotomy a Meckel’s diverticulum positioned at the mesenteric side was found to be the cause of small intestinal strangulation. This position is very uncommon and to the best knowledge of the authors there is no unambiguous description of another case.

Conclusions

Meckel’s diverticula should be on the list of differential diagnoses in cases of small intestinal strangulation. As in humans, equine Meckel’s diverticula can have the standard antimesenteric as well as a more exceptional mesenteric location. This case adds to the series of anecdotal reports of anomalies with regard to Meckel’s diverticula in the horse.

Gastrointestinal stromal tumor in perforated Meckel's diverticulum: a case report and literature review

Introduction

Gastrointestinal stromal tumor (GIST) is rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. GIST has been found largely in the stomach, small bowel, colon and rectum, and esophagus, but about 5% are found in other locations. We herein report a 56-year-old woman with a GIST in perforated Meckel's diverticulum. After encountering this patient, a review of the literature found reports of 18 similar patients.

Case presentation

A 56-year-old woman diagnosed with galactosialidosis (β-galactosidase-neuraminidase deficiency) presented with vomiting. On contrast-enhanced computed tomography, peritonitis due to perforation of the intestine was diagnosed based on the free air and dilated loop of the small bowel. Laparotomy revealed perforation of Meckel’s diverticulitis located 50 cm from the ileocecal valve. Partial resection of the ileum, including the diverticulum, and end-to-end anastomosis of the small intestine were performed. Regarding the pathological findings, the edge of the diverticulum wall consisted of a solid mass measuring 1.0 cm in size, and the tumor cells were spindle-shaped with 1 mitosis present per 50 high-power fields. The diagnosis was established as GIST of the Meckel's diverticulum. The postoperative period was uneventful. Follow-up at two years revealed no evidence of recurrence.

Conclusion

GIST in perforated Meckel's diverticulum is very rare. The potential for the coexistence of GIST or other tumor should be considered in the treatment of perforated Meckel's diverticulum.

Two-stage laparoscopic surgery for incarcerated umbilical Littre's hernia in severely obese patient: a case report

Background

Littre's hernia containing Meckel's diverticulum is an extremely rare disease. We report an adult case of two-stage laparoscopic surgery for incarceration of Meckel's diverticulum in an umbilical hernia.

Case presentation

The case involved a 23-year-old, severely obese man with BMI 36.5 kg/m². After experiencing effusion from the umbilicus for 2 months, and was referred from a local dermatologist. We diagnosed an infected urachal remnant, and antibiotic therapy was performed first. Surgery was planned for after the infection disappeared. During follow-up, effusion from the umbilicus took on an intestinal fluid-like character, so we diagnosed small intestinal cutaneous fistula and performed surgery. Under laparoscopy, we found a Meckel's diverticulum incarcerated in an umbilical hernia. The diverticulum was resected first, and the incarceration was released. The umbilicus was infected, so we planned repair of the umbilical hernia in a second surgery. The postoperative course was uneventful and the patient was discharged on postoperative day 5. One month after the initial operation, we confirmed that there were no signs of infection, and performed umbilical hernia repair using the laparoscopic intraperitoneal onlay mesh (IPOM) repair. Postoperative progress was uneventful and he was discharged on postoperative day 4. No recurrence or infection was observed until 8 months postoperatively.

Conclusions

We performed dissection of the diverticulum and umbilical hernia repair for the incarcerated umbilical Littre's hernia under laparoscopy in a severely obese patient. The risk of mesh infection seems to be avoidable using a two-stage surgery, and the risk of recurrence can be reduced using the IPOM repair compared with simple suture closure.

A case of perforation of Meckel's diverticulum with enterolith

Background

Perforation of Meckel’s diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel’s diverticulum with one enterolith, which could not be accurately diagnosed by preoperative computed tomography.

Case presentation

A 16-year-old male patient with acute onset of severe abdominal pain and a localized muscle guarding in the right hypochondrium had a solitary stone detected in the right abdomen by radiography. Abdominal computed tomography revealed a saclike outpouching of the small intestine, which contained fluid levels and an enterolith, with a mesenteric inflammatory change in the right paraumbilical area. He was diagnosed with peritonitis due to appendicitis or Meckel’s diverticulitis with enterolith, and emergency operation was indicated. The perforated Meckel’s diverticulum was identified approximately 30 cm proximal to the ileocecal valve. The diverticulum was transected at the base and removed. The patient’s postoperative course was uneventful.

Conclusions

It is crucial for clinicians to thoroughly examine patients and appropriately request investigations that consider perforation of Meckel’s diverticulum as a possible diagnosis to facilitate prompt treatment.

Management of incidentally discovered unaffected Meckel's diverticulum - a review

Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract, with its incidence estimated at 1-4% in the general population. In most cases Meckel's diverticulum is a latent, asymptomatic anomaly, but in some cases, it may lead to complications such as intestinal obstruction, bleeding and inflammation. The literature provides no precise recommendations for the management of accidentally diagnosed, unaffected Meckel's diverticulum. The aim of this study was to review the literature on the subject to determine the current state of knowledge. Based on an analysis of 17 papers, the following criteria (risk factors) were identified justifying 'preventive' resection of an accidentally found, unaffected Meckel's diverticulum: age &lt;50 years, male gender, length &gt;2 cm, macroscopic abnormalities suggesting the presence of ectopic gastric mucosa as well as narrow neck of the diverticulum. When the criteria are not met, there is a minimal lifetime risk of complications. Leaving diverticulum intact is recommended in cases of peritonitis, major abdominal trauma and at older age. Nevertheless, indications or contraindications for resection are relative, and surgeons are safe to make their decision depending on individual patient's situation.

Pancreatic Endocrine Heterotopia Involving Meckel's Diverticulum: A Potential Mimic of Neuroendocrine Tumor

Pancreatic heterotopia most commonly occurs in the upper gastrointestinal tract, but can occur in other sites, including Meckel's diverticulum. When multiple histologic elements of the pancreatic tissue (acini, ducts, and endocrine cells) are present, the diagnosis is typically straightforward. In this article, we report a rare case of pure endocrine pancreatic heterotopia involving a Meckel's diverticulum, a potential mimic of a well-differentiated neuroendocrine tumor. Several features were useful in making the distinction, including lack of desmoplasia and mass forming lesion, and immunohistochemical staining in a physiological pattern similar to that of islets of Langerhans. It is important for pathologists to be aware of this entity and its features to avoid misdiagnosis of a neuroendocrine tumor.

Liver abscess caused by fish bone perforation of Meckel's diverticulum: a case report

Background

Liver abscess due to gastrointestinal perforation by foreign bodies is rare. Furthermore, there are few case reports of liver abscess via the portal vein caused by perforation of the lower gastrointestinal tract by a foreign body.

Case presentation

A 54-year-old man visited our hospital because of a fever that had lasted for 1 month. There were no physical findings except for the fever. Laboratory tests showed only elevated inflammatory markers. Abdominal contrast-enhanced computed tomography revealed an abscess in the right lobe of the liver and a high-density object in the small intestine. We diagnosed him with liver abscess secondary to intestinal perforation by a foreign body. The patient underwent drainage of the liver abscess and laparoscopic surgery for perforation of the small intestine. A fish bone had perforated the top of Meckel’s diverticulum, which had been covered by the ileal mesentery. We successfully performed diverticulectomy and removed the fish bone. The patient was discharged without complications on the 13th postoperative day.

Conclusions

Liver abscess caused by foreign bodies requires multidisciplinary treatment, so we must detect and remove the cause of the abscess earlier. Liver abscess can form via the portal vein secondary to lower gastrointestinal perforation, as in this case. When exploring the cause of liver abscess, we should investigate the whole body, including the lower gastrointestinal tract.

An internal hernia caused by Meckel's diverticulum: a case report

BACKGROUND

Meckel's diverticulum is a remnant of the omphalomesenteric duct. It can lead to intestinal perforation, obstruction and gastrointestinal bleeding. While the internal hernia caused by Meckel's diverticulum is rarely reported.

CASE PRESENTATION

We report a case of a 45-year old female patient who presented with intestinal obstruction and on laparotomy was found to have Meckel's diverticulum with internal hernia causing intestinal gangrene. Segmental bowel resection was performed and the patient had uneventful recovery.

CONCLUSIONS

In patients with acute intestinal obstruction without previous abdominal surgery, Meckel's diverticulum and its complications should be suspected.

A rare case of Meckel's diverticulum causing small bowel obstruction in a 50-year-old man

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Meckel’s diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract.

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Diagnosis of a Meckel’s diverticulum is difficult and often incidental due to the absence of symptoms in most patients.

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The complications of Meckel’s diverticulum should be considered by the treating clinician in the differential diagnosis of small bowel obstruction.

Introduction

Meckel’s diverticulum is the most common congenital anomaly of the small intestine. Common complications involving Meckel’s diverticulum include hemorrhage, intestinal obstruction, and inflammation.

Presentation of case

We present a rare case of a Meckel’s diverticulum causing small bowel obstruction. A 50-year old male presented to the emergency department (ED) with vomiting, abdominal pain and distension. Computed tomography (CT) of the abdomen showed dilated small bowel loops consistent with a small bowel obstruction. The patient was taken to the operating theatre for a laparotomy and was found to have a transition point from a mesodiverticular adhesion causing upstream dilatation which was released. The patient recovered with no postoperative complications and was discharged home.

Discussion

Meckel’s diverticulum is the most common congenital anomaly of the small intestine. Diagnosis of Meckel’s diverticulum is difficult to confirm preoperatively as most patients are asymptomatic. Frequent complications of Meckel’s diverticulum include hemorrhage, intestinal obstruction, and infection, with intestinal obstruction being the second most common complication.

Conclusion

The complications of Meckel’s diverticulum should be considered by the treating clinician in the differential diagnosis of small bowel obstruction.

Ileectomy performed on a case of adult intussusception due to inversion of Meckel's diverticulum

We report a rare case of adult intussusception caused by an inverted Meckel’s diverticulum with ectopic pancreatic tissue. A 43-year-old woman was referred to our hospital with complaints of abdominal distention, intermittent abdominal pain and nausea that she experienced 3 months ago. Abdominal computed tomography scans demonstrated ileo-ileal intussusception that contained a tumor with fat density as the lead point. Laparoscopic-assisted partial resection of the small intestine was performed. The surgical specimen showed an elongated polypoid lesion invaginated into the intestinal tract indicating an inverted Meckel’s diverticulum. Pathological findings showed a true diverticulum that ran antimesentrically, with tall columnar epithelium, a mucous gland and an islet of Langerhans. The postoperative period was uneventful, and she was discharged on the ninth postoperative day.

The Many Faces of Meckel's Diverticulum: Update on Management in Incidental and Symptomatic Patients

PURPOSE OF REVIEW

Meckel's diverticulum may be detected incidentally or present with symptoms from infancy and to old age. The presentation may be acute, with several complications associated with the condition. We aim to review the many faces with which a Meckel's diverticulum may present, either symptomatically or as an incidental finding.

RECENT FINDINGS

Due to its rarity, recent studies mainly include small retrospective series or case reports. Emphasis in the recent literature is on clinical presentation, the pathology of symptomatic cases, management options and risks of neoplasia. Symptoms are mainly caused by obstruction, bleeding or diverticulitis. Cross-sectional imaging is unspecific, although capsule endoscopy is reported of use in case series. Meckel's diverticulum presents with clinical features that are age-specific. Complicated Meckel's diverticulum is treated by resection. Optimal treatment of incidental cases remains debated. Meckel's diverticulum usually stays asymptomatic, and decision-making for management should be based on patient-specific factors. Use of minimal invasive techniques mandates refinement of the optimal treatment.

Torsion of Ileum Due To Giant Meckel's Diverticulum - A Case Report

BACKGROUND:

Meckel’s diverticulum (MD) is detected in approximately 2% of all individuals and only 2-4% MD patients may develop symptoms. Small intestinal obstruction is a frequent complication in adults.

CASE REPORT:

A 48-year-old male was admitted to emergency department for high intestinal obstruction symptoms. The imaging examinations were failed to detect the underlying causes. A median laparotomy revealed small bowel obstruction (SBO) due to a segment of ileum twisted around a giant MD axis.

CONCLUSION:

Thus, a giant MD generating torsion of ileum is an unusual complication. Preoperative diagnosis is challenging. Emergency surgery is preferred to make an accurate diagnosis and for treatment.