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PubMed1984

Radionuclide imaging of Meckel's diverticulum: cimetidine versus pentagastrin plus glucagon.

The aim of this study was to investigate the effects of prior administration of cimetidine in radionuclide imaging of Meckel's diverticulum. In three groups of seven rats with artificial Meckel's diverticulum, containing ectopic gastric mucosa, the effects of pentagastrin + glucagon plus 99mTc-pertechnetate, as well as cimetidine premedication plus 99mTc-pertechnetate, and 99mTc-pertechnetate alone were compared to attain improved radionuclide imaging of Meckel's diverticulum. This experimental model suggests that the use of cimetidine seemed to have some advantages: (a) nontarget (intestinal) radioactivity was diminished by cimetidine, (b) the target to nontarget (Meckel's diverticulum to intestinal activity) ratio increased with cimetidine pretreatment. This resulted in an enhanced accumulation of pertechnetate in the ectopic gastric mucosa, and reduced excretion of the radionuclide into the lumen. Consequently, better scintiphotograms and a low rate of false results added to the validity of this method.

Animals↗

PubMed1993

An adult case of bleeding Meckel's diverticulum diagnosed by preoperative angiography.

A 19-year-old woman in her 6th month of pregnancy was admitted to our hospital after passing a massive bloody stool. Romanoscopy and upper gastrointestinal panendoscopy revealed no abnormality, but a superior mesenteric arteriography demonstrated an embryonic artery with the extravasation of contrast medium in the distal end of the ileal artery. After the diagnosis of a bleeding Meckel's diverticulum had been established, an emergency operation was successfully performed. At laparotomy, a Meckel's diverticulum was found, about 70 cm toward the oral side from the ileocecal valve, and part of the ileum, including the diverticulum, was resected. Histological examination indicated that the diverticulum had a normal ileal layer with ectopic gastric mucosa and pancreatic tissue. Furthermore, multiple ulcers were observed in the adjacent ileum. Blood coagulation was observed at the site of one of these ulcers, and this was presumed to be the source of the hemorrhage.

Adult↗

PubMed1996

Successful application of an omental pedicle flap in delayed repair of a perforated esophageal diverticulum: report of a case.

Mediastinitis resulting from a perforated esophageal diverticulum is a potentially fatal complication and the surgical treatment of persistent esophagomediastinal fistula may be difficult. In this report, we describe the successful application of an omental pedicle flap in the delayed repair of a perforated esophageal diverticulum. A 53-year-old man presented with chest and back pain and a diagnosis of perforated esophageal diverticulum was subsequently confirmed. After receiving conservative treatment, he was referred to our department and underwent surgical repair 6 months following the onset of the perforation. Through a right thoracotomy, the mucosal layer of the esophagus around the diverticulum was sutured, and an omental pedicle flap was used to cover the suture line and obliterate the fistulous tract. His postoperative course was uneventful and the suture line healed well. The successful treatment of this patient reinforces our belief that wider application of the omental pedicle flap can be expected in the field of thoracic surgery.

Diverticulum, Esophageal↗

PubMed1983

[Meckel's diverticulum - results of 155 resections].

A total of 155 cases of Meckel's diverticulum were analyzed: 122 were uncomplicated as opposed to 33 that were complicated. Resection of all uncomplicated diverticula had a course free of difficulty, while there was one death in the cases with complicated diverticula as a result of peritonitis after perforation of the diverticulum. The diagnosis and differentiation of diverticulum from other abdominal clinical pictures, as well as from appendicitis, is usually not possible preoperatively, although differential diagnosis must always be kept in mind. If there are no special contraindications, Meckel's diverticulum is searched for instead and then resected.

Adolescent↗

PubMed1986

[When is a simultaneous operation of Meckel's diverticulum indicated: (always--never--or only in special circumstances?)].

Meckel's diverticulum causes in complications 4-16%. These appear, however, only in adolescents. Thus the simultaneous removal of a diverticulum without symptoms is only justified in adolescents. One should renounce to a search and removal in adults. In case of appendectomy indicated by suspected appendicitis with the appendix found to be normal and absent exudation in the abdomen, the search for a Meckel's diverticulum is superfluous. One should also renounce to a search and removal if there is a septic abdominal disease, because a removal in peritonitis is more complicated than the risk of complications a not-removed diverticulum will cause.

Appendectomy↗

PubMed1981

Unusual roentgenologic manifestations of Meckel's diverticulum.

Five cases illustrating rare roentgenographic manifestations of Meckel's diverticulum are presented. Small bowel studies in 2 patients demonstrated a mucosal pattern identifiable as heterotopic gastric rugae, and in 2 other cases peptic ulcers were seen within the diverticulum. In 1 patient the diverticulum located in the right upper quadrant contained calcified enteroliths, and in another patient the diverticulum had fistulous communication with the appendix.

Adult↗

PubMed1982

Angiographic evaluation of the ductus diverticulum.

The aortic isthmus in adults has a variable appearance on thoracic aortograms. Its configuration may show a concavity, a straightening or slight convexity, or a discrete focal bulge. The latter finding represents a ductus diverticulum and, in review of 103 aortograms, was found present in 9% of patients. At times a prominent ductus diverticulum may resemble, and be mistaken for, a traumatic pseudoaneurysm of the aortic isthmus. A traumatic pseudoaneurysm may be distinguished from a ductus diverticulum on aortography by demonstration of an intimal flap and/or delayed clearance of contrast material on subtracted films. However, a ductus diverticulum will exhibit neither of these features.

Aneurysm↗

PubMed1989

Spontaneous rupture of pyelocaliceal diverticulum.

One rare case of spontaneous rupture of pyelocaliceal diverticulum is reported in a 31-year-old Japanese man presented with a severe left flank pain. Intravenous pyelography and computerized tomography demonstrated extravasation of contrast medium from his diverticulum which contained numerous calculi. As a possible cause of spontaneous rupture of pyelocaliceal diverticulum in this case, we suggest that the paper-thin parenchyma covering the diverticulum was not strong enough to tolerate the minimum elevation of intrapelvic pressure due to the obstruction of delivered stones.

Adult↗

PubMed1997

The appearance of inverted Meckel diverticulum with intussusception on air enema.

This paper presents the appearances of inverted Meckel diverticulum with an irreducible intussusception on air enema in four children. The inverted Meckel diverticulum appeared as a bulbous (3) or triangular (1) filling defect in the air column projecting off the distal end of the soft tissue mass of the irreducible intussusceptum. The bulbous defect appears to be highly suggestive, and may be specific, for inverted Meckel diverticulum. Earlier recognition of the presence of the Meckel diverticulum as the lead point of the intussusception could have changed the management in two of the children.

Air↗

PubMed2004

Meckel's diverticulum: comparison of incidental and symptomatic cases.

Although Meckel's diverticulum is the commonest congenital gastrointestinal anomaly, there is still debate concerning the proper management of asymptomatic diverticula. Records of all patients whose Meckel's diverticulum was resected at our hospitals between 1990 and 2002 were reviewed. Clinical characteristics, mode of presentations, and management for all patients were analyzed. Meckel's diverticula were resected in 68 patients. Patients were divided into two groups: the incidental group included 40 patients (24 males) in whom the diagnosis of diverticula was incidental. The symptomatic group included 28 patients (20 males) who presented with diverticulum-related complications. Preoperative diagnosis was possible in only four cases. In four patients from the symptomatic group, Meckel's diverticula were found and left untouched during a previous laparotomy. There was no significant difference between the two groups with respect to gender (p = 0.48). Patients in the symptomatic group were significantly younger than patients in the incidental group (p = 0.002). The diverticula in the symptomatic group tended to be longer (p = 0.001) with a narrower base (p = 0.001) than the diverticula in the incidental group. A diameter of < or = 2 cm was significantly associated with more complications (p = 0.01). Heterotopic tissue was present more significantly in the symptomatic group than the incidental group (p = 0.01). There was no significant difference in the morbidity rate between the two groups (p = 0.71), and there was no mortality in either group. Preoperative diagnosis of Meckel's diverticulum is difficult and should be kept in mind in cases of acute abdomen. Resection of incidentally found diverticula is not associated with increased operative morbidity or mortality.

Adolescent↗

PubMed2005

An extremely rare case of symptomatic right hepatic duct diverticulum located outside the liver.

Symptomatic hepatic duct diverticulum located outside the liver is extremely rare, with only one reported case. We encountered this anomaly and present our experience, focusing on surgical management. A 17-year-old-girl was referred to our institute because of recurrent right upper quadrant pain. At presentation, serum amylase, lipase, bilirubin, and transaminases were normal. White blood cell count and C-reactive protein were slightly raised. Ultrasonography and magnetic resonance cholangiopancreatography (MRCP) revealed a diverticulum-like lesion on the right side of the bile duct system appearing to overlap the gallbladder. The provisional diagnosis was type II choledochal cyst. Pancreaticobiliary malunion (PBMU) could not be confirmed on MRCP. The origin of the lesion could not be identified initially at laparotomy, but after repeated intraoperative cholangiography (IC) studies, the lesion was found to originate from a normal-sized right hepatic duct via a narrow duct. It was relatively easy to ligate the narrow duct and treat the lesion smoothly. IC also showed that the common bile duct was not dilated and that PBMU was absent. Histopathology showed the lesion to be a diverticulum of the bile duct epithelium. This is only the second report of a symptomatic hepatic duct diverticulum located outside the liver. Based on our experience, IC is particularly useful for the complete understanding of anomalous hepatobiliary duct anatomy and for planning surgical treatment.

Adolescent↗

PubMed2004

Meckel's diverticulum complicating pregnancy. Case report and review of the literature.

INTRODUCTION: Symptomatic Meckel's diverticulum is a rare entity in pregnancy. The clinical presentation is variable and preoperative diagnosis is hampered by the various anatomical and physiological changes of pregnancy that can obscure serious underlying intra-abdominal pathology. CASE REPORT: We report a 14-year-old who presented at 32 weeks' gestation with worsening abdominal pain, distension, and leukocytosis. Abdominal computed tomography showed a pelvic fluid collection with extraluminal air suggestive of a perforated viscus and mechanical small bowel obstruction with features of a closed-loop obstruction. Explorative laparotomy revealed a perforated Meckel's diverticulum. Multiple adhesions between the appendix and the perforated diverticulum, and phlegmon sequelae led to the incarceration of an adjacent segment of ileum. DISCUSSION: Meckel's diverticulum in pregnancy can have serious consequences. There is a high rate of perforation due to delayed diagnosis and surgical intervention. Our report and review of the literature suggest that a high index of clinical suspicion can lead to earlier diagnosis and help to keep maternal and fetal morbidity and mortality to a minimum.

Adolescent↗

PubMed2003

The endoscopic stapler diverticulotomy for Zenker's diverticulum.

This paper describes the surgical procedure of the endoscopic stapler treatment of Zenker's diverticulum and analyzes the results of 24 consecutive operated patients. In three patients the endoscopic exposure of the diverticulum was not possible. Twenty-one patients underwent endoscopic stapler treatment without any peri- or postoperative complications. The follow-up period was 4 to 29 months (average 18 months). The average total time for surgery was 25 min. Postoperatively, a nasogastric feeding tube was not necessary: all patients resumed oral intake 12 h after surgery. Discharge from the hospital followed the 2nd postoperative day. All patients had complete or nearly complete resolution of symptoms at the 4-month follow-up. Recurrent complaints were an indication for repeat of the contrast barium esophagram. Two patients revealed a residual diverticulum 7 and 11 months after treatment. In comparison with results and complication rates in the literature of the external, transcutaneous techniques and endoscopic diverticulotomy procedures, the endoscopic stapler treatment of Zenker's diverticulum is a safe, (cost-)effective and minimally invasive method and to be considered as the initial treatment of choice.

Aged↗

PubMed2003

Epiphrenic diverticulum: clinical and radiographic findings in 27 patients.

The purpose of our study was to reassess the clinical and radiographic findings in patients with epiphrenic diverticula. A search of our radiology files revealed 27 patients with epiphrenic diverticula within 10 cm of the gastroesophageal junction. Medical records and radiographic reports and images were reviewed to determine the clinical and radiographic findings. Twenty-three patients had a solitary epiphrenic diverticulum, three had two diverticula, and one had three diverticula. The diverticula arose from the right side of the distal esophagus in 19 patients and the left side in eight. The diverticula had a mean width of 4.4 cm and a mean height of 3.7 cm. Other findings included prolonged retention of barium in the diverticula in 19 patients, preferential filling in 11, retained debris in 5, regurgitation of barium or debris in 5, compression of the esophagus in 5, pseudodiverticula formation in 3, and ulceration in 1. We found a significant correlation between the width of the diverticulum and preferential filling with barium. Twelve patients had abnormal esophageal motility, with diffuse esophageal spasm in two. Seventeen patients had symptoms attributable to the diverticulum (dysphagia in 11 and/or reflux symptoms in 12). We also found a significant correlation between the size or preferential filling of the diverticulum and the presence of symptoms. Conversely, we found no correlation between esophageal dysmotility and the presence of symptoms. Our experience suggests that the development of symptoms in patients with epiphrenic diverticula is more likely to be related to the morphologic features of the diverticula than to underlying esophageal motility disorders.

Aged↗

PubMed2003

Laparoscopic management of Meckel's diverticulum in adults.

BACKGROUND: Meckel's diverticulum is an uncommon entity. A high index of suspicion is necessary for opportune diagnosis and prompt treatment. Technetium (TC) 99m pertechnetate scintigraphy is a sensitive and specific test for Meckel's diverticulum. In adults, the scan contributes little to clinical decision making and often will not change the need for surgical intervention. We describe our experience with four patients. METHODS: Between August 2000 and August 2001, four patients were seen with Meckel's diverticula. Three were male and one was female. The mean age was 39 years (range, 18-64). Three patients presented with anemia and one with an acute abdomen. A 99mTc pertechnetate scan was performed at a cost of 900 dollars in the three anemic patients after other endoscopic and radiographic tests were nondiagnostic. Only one patient had a positive scan. All four patients underwent exploratory laparoscopy and small bowel resection. In one patient, a minilaparatomy had to be performed. RESULTS: All patients had a satisfactory outcome without complications. Three patients were discharged within 3 days of surgery. The remaining patient had a prolonged hospital stay because of ongoing chemotherapy for small cell lung cancer. In the three anemic patients who underwent enterectomy, ulcerated small bowel outside the diverticulum was found by the pathologist. CONCLUSION: Laparoscopy is safe, cost-effective, and efficient for the diagnosis and definitive management of Meckel's diverticulum. Technetium 99m pertechnetate scintigraphy scanning adds considerable time and expense to the care of the patient without significant benefits in adults. The practice of exploratory laparoscopy rather than scintigraphy is recommended.

Adult↗

PubMed2006

Spontaneous perforation of Meckel's diverticulum without peritonitis in a newborn: report of a case.

A case of a newborn male with a perforation of Meckel's diverticulum is reported. The clinical course consisted of progressive abdominal distention and pneumoperitoneum that formed within 29 h after birth. The perforation of Meckel's diverticulum was not associated with peritonitis because meconium did not contaminate the abdominal cavity. The histology of the diverticulum showed a nearly intact muscular layer but a focal muscular defect. Neither any inflammatory phenomena nor ectopic mucosa was found. A congenital focal muscular defect of the diverticulum and a sudden elevation of intraluminal pressure due to bowel movement after birth may thus be the pathogenesis of a spontaneous perforation. A search of the English literature did not reveal any similar case.

Diagnosis, Differential↗

PubMedDate not supplied

Adenomyoma arising in a meckel diverticulum: case report and review of the literature.

We report a case of adenomyoma of the small intestine arising in a Meckel diverticulum. The patient was a 22-month-old boy who presented with signs and symptoms of intussusception. At surgery, a Meckel diverticulum was found and removed. On histologic examination, a tumor consisting of dilated cystic glands and smooth muscle bundles was identified. A diagnosis of adenomyoma arising in a Meckel diverticulum was made. A review of the literature showed that only six other pediatric cases of adenomyoma of the small intestine have been reported. The presence of an adenomyoma in a young patient within a Meckel diverticulum favors the view that adenomyomas are a variant of pancreatic heterotopia.

Adenomyoma↗

PubMed2004

Perforated diverticulum of the caecum. A difficult preoperative diagnosis. Report of 2 cases and review of the literature.

BACKGROUND: Perforation of a solitary caecal diverticulum is a rare cause of acute abdomen and an uncommon differential diagnosis for acute appendicitis. Nine hundred cases have been described since Potiers' first description of perforated caecal diverticulum in 1912. METHODS: We describe 2 cases of perforated diverticulum of the caecum. The first patient was a 50-year-old man diagnosed by subsequent histology, and the second a 77-year-old woman diagnosed intra-operatively. Radiography, ultrasound and CT scan of the abdomen pointed at the diagnosis in the second case. A right hemicolectomy was performed. RESULTS: There were no complications, apart from a transient faecal fistula in the first patient managed conservatively. In both patients histology revealed a perforated caecal diverticulum. CONCLUSIONS: The surgeon must be familiar with the diagnosis and management of this rare, inflammatory benign caecal entity.

Aged↗