Complicated Meckel's diverticulum and therapeutic management

Abstract

Objective: This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckel's diverticulum at our clinics. Material and Methods:This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckel's diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012.Results: Fourteen patients with a diagnosis of Meckel's diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckel's diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%). Conclusion:Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckel's diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.

Obscure Gastrointestinal Bleeding Due to a Small Intestinal Gastrointestinal Stromal Tumor in a Young Adult

“…The MIB-1 labeling index was <1%. These features were compatible with those of low-risk GIST [8, 9, 10]. …”

“…Abdominal computed tomography revealed a well-delineated 45 × 40-mm mass in the jejunum (Fig 1). These findings indicated infected diverticulitis such as Meckel's diverticulitis with abscess [8]. …”

Diverse Presentation of Meckel’s Diverticulum in Pediatric Patients

“…2 Most of the cases of MD are clinically asymptomatic and isfound more commonly as an incidental findingin the operation theater but some cases can present to us as complications like gastrointestinal bleeding, intestinal obstruction, diverticulitis, umbilical fistula, diverticular perforation, and cecal or small bowel volvulus. 3 As there are low mortality and lifetime complication, there has been a controversy between resection of asymptomatic MD but for complicated cases resection has been recommended. 4 cases diagnosed as Meckel's diverticulum among the cases that were operated for different disease entity preoperatively were selected and analyzed.…”

Meckel’s diverticulum in adults and children

“…На основании обследования 14 взрослых пациентов с осложненным ДМ было показано, что КТ позволяет диагностировать механическую кишечную непроходимость, дивертикулит и перидивертикулярный абсцесс, а также пневмоперитонеум [53].…”

“…Подавляющему числу больных выполнялась частичная резекция тонкой кишки с дивертикулом, реже дивертикулэктомия [53].…”