Emergency surgery for Meckel's diverticulum

Abstract

The current work attempts to highlight the various life threatening complications of Meckel's diverticulum and to present the surgical strategies used in the emergency conditions so far in the form of a review of the works presented in the literature. Our aim behind this presentation is to cover the possible indications, methods, their complications and the outcome of these surgical techniques. For this, we made an extensive literature search using Google and Pubmed with the words-"Meckel's diverticulum", "Complications", "Management" and "Emergency surgery". All the relevant articles containing the surgical aspects of symptomatic Meckel's diverticulum till May 2008 were collected and analyzed. Meckel's diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications.

Steroid Induced Perforation of Meckel's Diverticulum in an Adult

“…Symptomatic presentation of Meckel's diverticula is mostly seen in male pediatric population and include gastrointestinal haemorrhage, diverticulitis, obstruction, and perforation [3,4]. Perforation of Meckel's diverticulum is one of the uncommon complications with high morbidity and mortality, almost always preceded by diverticulitis [1][2][3]. The perforations can be NSAID induced [5], fish or chicken bone impaction [6,7].…”

A Rare Internal Herniation in Adult: Meckel’s Diverticulum

“…There are various mechanisms by which it can cause intestinal obstruction [7]: intestinal loops is usually impossible, even though CT is more specific than US. An invaginated Meckel's diverticulum, especially if it is associated with an intussusception, appears as an intraluminal mass composed of a central lesion with the attenuation of fat (representing the entrapped mesenteric fat of the inverted diverticulum) surrounded by a collar of soft tissue attenuation [8].…”

Meckel’s diverticulum with benign stricture: A very rare cause of intestinal obstruction

“…Meckel's diverticulum represents the most common congenital abnormality of the small intestine [2]. It represents the remnants of the omphalomesentric or vitelline duct, between the intestinal tract and the yolk sac and disappears between 5th to 7th weeks.…”

“…It represents the remnants of the omphalomesentric or vitelline duct, between the intestinal tract and the yolk sac and disappears between 5th to 7th weeks. Vitelline duct are known to harbour heterotopic gastric mucosa (50%), pancreatic mucosa (5%) and less commonly colonic, endometrial or hepatobiliary tissue which are mainly responsible for complications like gastrointestinal bleeding (31%), inflammation (25%), bowel obstruction (16%), intussusception (11%), hernial involvement (11%), umbilical sinus or fistula (4%), tumor (2%) [2,4]. In adults majority of patients with meckel's are discovered incidentally, at post-mortem, laparoscopy or laparotomy.…”

“…Hemorrhage is most common below 2 years while intestinal obstruction is a commoner presentation among adults [2]. A benign inflammatory stricture at the base of the Meckel's diverticulum is one of the rarest causes leading to small bowel obstruction [3].…”