Das Meckel-Divertikel: Sicherheit der Resektion symptomatischer und asymptomatischer Befunde und Literaturübersicht

Loh, Jan C.; Kruschewski, M.; Buhr, H. J.; Lehmann, Kai S.

doi:10.1055/s-0032-1327963

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…Giant Meckel's diverticula are defined as diverticula measuring more than 5 cm [11]. Complications of this anomaly comprise inflammation, obstruction, and bleeding [1,2,12]. Small bowel obstruction due to torsion of a giant Meckel's diverticulum is scarce [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative identification of a Meckel's diverticulum as the cause for an acute abdomen is achieved in 4% [14]. The most common suspected diagnosis in a patient with symptomatic Meckel's diverticulum is acute appendicitis [2]. While ultrasound and CT scan are frequent diagnostic tools, final diagnosis is often achieved during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…It is usually asymptomatic and is often found incidentally during surgery. Acute inflammation mimicking acute appendicitis and lower gastrointestinal bleeding are the most common complications of a symptomatic Meckel's diverticulum [2]. Gangrene secondary to axial torsion of a giant Meckel's diverticulum is seldom [3,4,5].…”

Section: Introductionmentioning

confidence: 99%

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Small Bowel Obstruction due to a Giant Meckel's Diverticulum

et al. 2016

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Background: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, with an average length of 3 cm. Complications occur in 6.4% and most commonly include inflammation and gastrointestinal bleeding. Preoperative diagnosis is demanding and achieved in 4%. Case Report: A 34-year-old otherwise healthy patient presented with an acute abdomen due to small bowel obstruction. Computed tomography scan could not identify the underlying cause. Emergency laparotomy was performed, and a torqued giant Meckel's diverticulum measuring 17 cm was found as the underlying cause for the small bowel obstruction. Resection of the affected ileum segment and ileo-ileal reconstruction were performed. The postoperative course was uneventful. Conclusion: In extremely rare cases, small bowel obstruction in an otherwise healthy patient might be caused by torsion of a symptomatic giant Meckel's diverticulum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Small Bowel Obstruction due to a Giant Meckel's Diverticulum

et al. 2016

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“…Indeed, few studies attempted to look at the Clavien-Dindo grading. 20,25 In most cases, the authors have specified that, in their considered opinion, the severe complications or the mortality were not directly attributable to the added procedure of IMD resection.…”

Section: Discussionmentioning

confidence: 99%

Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review

Yagnik,

Garg,

Dawka

2024

CEG

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Background: Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, poses a dilemma when incidentally encountered during surgery. Despite historical descriptions and known complications of symptomatic MD, the decision to resect an incidental MD (IMD) lacks clear guidelines. This study aims to assess whether resecting IMDs is justified by synthesizing evidence from studies published between 2000 and 2023. Factors influencing this decision, such as demographic risks, surgical advancements and complications, are systematically examined. Methods and Material: Following the PRISMA 2020 guidelines, this review incorporates 42 eligible studies with data on outcomes of asymptomatic MD management. Studies, both favoring and opposing resection, were analyzed. Results: Considering complications, malignancy potential, and operative safety, the risk-benefit analysis presents a nuanced picture. Some authors propose conditional resection based on specific criteria, emphasizing patient-specific factors. Of 2934 cases analyzed for short-and long-term complications, the morbidity rate was 5.69%. Of 571 cases where mortality data were available, all 5 fatalities were attributed to the primary disease rather than IMD resection. Conclusion:The sporadic, unpredictable presentation of IMD and the variability of both the primary disease and the patient make formulation of definitive guidelines challenging. The non-uniformity of complications reporting underscores the need for standardized categorization. While the balance of evidence leans towards resection of IMDs, this study acknowledges the individualized nature of this decision. Increased safety in surgery and anesthesia, along with better understanding and management of complications favor a judicious preference for resection, while taking into account patient characteristics and the primary disease.

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“…Therefore, benefits outweigh the risk in terms of morbidity and mortality and asymptomatic diverticulum should be resected [20]. Loh et al also support that resection of incidental MD had fewer complications compared to symptomatic resection [21].…”

Section: Recommends Resection For Incidental MDmentioning

confidence: 98%

Does an Incidental Meckel's Diverticulum Warrant Resection?

Rahmat¹,

Sangle²,

Sandhu³

et al. 2020

Cureus

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Meckel's diverticulum (MD) is the most common gastrointestinal malformation. The management of symptomatic Meckel's diverticulum has been undecidedly resection; however, the management of incidental Meckel's diverticulum has been fraught in comparison. As a systematic literature review, PubMed, PubMed Central (PMC), and MEDLINE were used. The search phrase utilized was "Meckel Diverticulum/Surgery [Mesh]" and resection incidental. The search was completed on July 18, 2020 and was limited to 1980 until the day of the search. Searches resulted in 62 initial articles on PubMed. On initial screening, 23 of these articles met the criteria. The references of these 23 articles were screened for relevant studies, yielding a total of 31 studies of which all were assessed for quality. Four articles made a recommendation for no resection. Twelve studies made a recommendation for resection. Ten studies concluded that resection should be completed in the presence of risk factors. Lastly, five studies made no clear recommendation. In recent literature, there has been a shift towards resection for all or in those with high-risk factors. In the future, it will be necessary for researchers to determine if resection is recommended for all patients with incidental MD or in those with risk factors. If only in those with risk factors, it will be important that research is completed to create evidence-based guidelines to support the risk factors.

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Das Meckel-Divertikel: Sicherheit der Resektion symptomatischer und asymptomatischer Befunde und Literaturübersicht

Abstract: Ectopic mucosa is more frequent in symptomatic MD, especially in bleeding MD. MD should always be considered in GIB of unknown origin. Resection of incidental MD can be recommended in patients without contraindications such as peritonitis, cancer, ascites or immunosuppression.

Cited by 7 publications

References 27 publications

Small Bowel Obstruction due to a Giant Meckel's Diverticulum

Small Bowel Obstruction due to a Giant Meckel's Diverticulum

Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review

Does an Incidental Meckel's Diverticulum Warrant Resection?

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