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We report an unusual case of small bowel strangulation due to long Meckel diverticulum. CT demonstration of the bundle-like segment contiguous with the distended fluid-filled loops of bowel contributed to the prompt preoperative diagnosis.
Meckel's diverticulum is a common developmental abnormality of the midgut which may present clinically because of complications. This report describes an unusual clinical presentation of a patient with a large leiomyoma of a Meckel's diverticulum.
Meckel's diverticulum is rarely seen on the standard small bowel follow-through and the diagnosis may be overlooked unless 99mTc -pertechnetate scanning or other complementary radiological examinations are performed. Three cases of bleeding Meckel's diverticulum with a negative barium sulphate meal examination and positive 99mTc -pertechnetate scanning are presented.
Meckel's diverticulum is a relatively uncommon cause of small bowel obstruction in the adolescent population. Here we discuss a patient with clinical and radiographic evidence of a complete bowel obstruction and describe the subsequent operative management. Finally, current literature concerning the diagnosis and management of Meckel's diverticulum is reviewed.
Meckel's diverticulum is a rare pathological condition with an incidence about 2%. We are presenting here a rare case report of a perforation of the terminal ileum caused by enterolithiasis of a Meckel's diverticulum. This patient has had repeated sub-occlusive states which was improved under conservative medical treatment. The operative decision was justified on bases of the evidence of an abdominal lesion discovered on barium follow-through and abdominal CT-scan.
Meckel's diverticulum occurs in 2% of the population. Of these, 4% may present as intestinal bleeding, intussusception, diverticulitis, volvulus, or perforation at any age, including neonates. We describe a 3-month-old baby whose giant Meckel's diverticulum had probably perforated in utero, leading to the formation of a large intra-abdominal pseudocyst.
Meckel's diverticulum usually presents as a diagnostic problem. Its most common clinical manifestations--lower GI bleeding, small bowel obstruction, and features suggesting acute appendicitis--are fairly well known. Other clinical presentations include a Meckel's diverticulum in an omphalocele, lower GI bleeding followed by perforation, perforation secondary to blunt trauma, and presentation as iron deficiency anemia with and without episodes of overt hemorrhage. Illustrative cases emphasize indications for and usefulness of abdominal scanning as a diagnostic aid.
Meckel's diverticulum, a relatively common congenital anomaly of the gastrointestinal tract, is present in approximately 2 percent of the population. When symptoms develop, they are usually the result of inflammation, hemorrhage or obstruction. Diagnosis is made by maintaining a high index of suspicion, carefully reviewing data from the history and physical examination, and performing a radionuclide scan. Surgical removal is usually indicated when symptoms occur. An asymptomatic Meckel's diverticulum that is discovered incidentally at surgery should usually be removed unless contraindications exist.
Meckel's diverticulum is the most prevalent anomaly of the gastrointestinal tract, found in about 2% of the general population. Most are asymptomatic; but most frequent complications are intestinal obstruction, diverticulitis and lower gastrointestinal bleeding. A 33-year-old man was operated on for mechanical small bowel obstruction caused by a large Meckel's diverticulum filled with a phytobezoar. This mechanism of obstruction is rare. When the history of a patient without previous intestinal operations, as in this case, raises the possibility of phytobezoar, the probability of congenital anomaly is high.
From 1992 to 2001 laparoscopic diagnosis and treatment of various pathologic changes of Meckel diverticulum were carried out in 58 children aged from 3 weeks to 14 years. Bleeding from the diverticulum was in 33 patients, diverticulitis--in 21, intestinal obstruction--in 4 patients. Diagnostic laparoscopy was performed carefully with trochars of small diameters (3-5 mm). Conversion to open operation was necessary in 2 patients due to inflammation in the diverticulum and adjacent parts of the intestine. Circulatory resection of the intestine with the diverticulum in the limits of healthy tissues was performed. All 33 patients with intestinal bleeding were examined with 99mTc before surgery. Only 15 (45.4%) patients demonstrated pathologic accumulation of radionuclide in the zone of the diverticulum. Laparoscopic resection of the diverticulum was performed in 56 patients. Three methods of endoscopic resection were used: with suture device Endo-Gia-30 (31 patients), with application of Roeder's loop on the base of the diverticulum when it was 1-1.5 cm wide maximum (23), with suturing of intestine with two-layer intracorporel endoscopic suture (2). All the started laparoscopic operations were finished successfully. There were no conversions to open surgery. Mean time of surgery was 45 min. There were no intraoperative complications. In postoperative period one patient showed acute adhesive intestinal obstruction which was treated with laparoscopy. Mean hospital stay was 6.1 bed-days. There were no lethal outcomes. Cosmetic effect was excellent in all the cases.
A 23-year-old male patient with giant Meckel diverticulum containing enteroliths is presented. Computed tomography (CT) and sonography were useful for correctly suggesting the diagnosis. The unique manifestations of this rare lesion are described.
We present two new cases of cancer in a Meckel's diverticulum, representing 3.3% of the complicated Meckel's diverticula encountered in our department. The first case was a carcinoid tumor encountered in a pathology study of an inflamed Meckel's diverticulum, and the second case was a leiomyosarcoma on a Meckel's diverticulum that presented as diverticular perforation. We emphasize the advanced age of the two patients and review the cases reported in Spain and in the Western literature.
A case of a primary lymphoma of Meckel's diverticulum in a 6-year-old Iraqi boy presenting clinically as acute appendicitis is reported. Exploration revealed a ruptured gangrenous Meckel's diverticulum with an ileo-ileal intussusception at the diverticulum origin. A fairly comprehensive search through the English language literature has failed to reveal any other report of a primary lymphoma of Meckel's diverticulum leading to acute intestinal obstruction.
This report describes the ultrasonic appearance of an ectopic pancreatic rest presenting as a mass within an intussusception due to an inverted Meckel diverticulum. Familiarity with the ultrasound appearance of this entity may be useful to obviate unnecessary imaging workup.
Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestinal tract. Two cases requiring emergency laparotomy due to massive gastrointestinal bleeding are presented. Only at laparotomy the correct diagnosis was established. In the first case a segment of small bowel was resected and diverticulectomy was performed in the second case. Both patients are free of complaints now at 2 and 3 years of follow-up respectively. The genesis of diverticular bleeding, the difficulties of the preoperative diagnosis of the complicated diverticulum and the uncertain indication for operation in cases of uncomplicated diverticulum are discussed and the literature is reviewed.
Meckel's diverticulum is an evolution of omphalomesentric channel one of the most frequent embryologic abnormality of digestive tract. It is observed in two circumstances: during a routine exploration or after a complication: intestinal obstruction, peritonitis, recurrent abdominal pain. Only open or laparoscopic explorations allow a diagnosis. Resection of the diverticulum is recommended in children because the complications are frequent and serious. The preferred therapeutic method is the bowel resection with immediate anastomosis.
Meckel's diverticula are the result of incomplete degeneration of the vitelline duct. It is generally believed that less than 5% of them become symptomatic, the frequency decreasing with age. Meckel's diverticula are most commonly manifested in children by painless lower gastrointestinal bleeding and in adults, as an inflammatory process or obstruction. Definitive diagnosis is usually made at surgery, though the Meckel's scan may suggest a diagnosis preoperatively, especially in the pediatric population. All symptomatic and pathologic Meckel's diverticula should be removed with a segment of ileum. The use of stapling devices, with their ease of use and low complication rate, make it reasonable to remove any Meckel's diverticulum that easily fits in the device. If a diverticulum found incidentally is so broad-based or short that stapling cannot be done without difficulty, it is unlikely to become symptomatic and should be left undisturbed.
Meckel's diverticulum can be detected with a high degree of accuracy by radionuclide scintigraphy using technetium-99m pertechnetate. The technique is without risk and should precede roentgenographic studies when the diagnosis is suspected. The method is described and the causes for false positive and false negative examinations are discussed. False negatives are rare and false positive are usually secondary to other surgical entities. Overall accuracy is 85 to 90%.