Giant Meckel's diverticulum (33 ½ inches long)

Abstract

THIS case is noteworthy on account of its unusual clinical features during life and the anatomical abnormality found post mortem--namely, a very large diverticulum of the small intestine..HIs!roRY.-An infant, 5 months old, was admitted under the care of Dr. Vining for severe attacks of melmia. A first attack, sudden in onset, occurred two days after birth, a second hEmorrhage took place two months afterwards. and a third just before admission. W-hen admitted, the child appeared very blanched, and the blood-count showed a very severe type of secondary ansmia. Repeated small injections of blood taken from the father were given intramuscularly and improved the child's condition, and the patient was duly discharged from the hospital. The infant was, however, re-admitted two and a half months later for another severe attack of melena. This time a diagnosis of polypus of the intestine was suggested, and a laparotomy was performed which revealed free fluid in the abdomen and enlarged mesentcric glands. The condition was taken to be tuberculous, and the abdomen was closed. The child died a few days after the operation.POST-MORTEM ExAnIrNATIoN.-on opening the abdomen the peritoneal cavity was found to contain a few ounces of clear, straw-coloured fluid. The lower part of the ileum had a double-barrelled appearance which a t first was thought to be due to matting together of two coils of intestine, as 'seen in tuberculous peritonitis. On closer inspection, however, one of the two coils proved to be a very large diverticulum arising from the ileum two feet above the ileocaecal valve. The diverticulum showed all the layers of the small intestine, and communicated with the main channcl of the gut by a large opening about an inch in diameter, lying on the antiniesenteric border of the ileum. A t the junction of the diverticulum with the ileum were two chronic ulcers which probably had been the cause of bleeding during life.The diverticulum crossed over the ileum to become attached to its mesenteric border and thus accompanied the gut upwards for 334 in., terminating blindly. A well-marked stitch-work, very typical of physiological adhesions, bound the diverticulum to the gut, and blood-vessels, branches of the ileocolic artery, were seen coursing across the ileum to supply it. No communication between the two channels, other than the one described, was detected even after the water t e s t ; nor did the ileum present any breach of its

Giant Meckel’s diverticulum: An exceptional cause of intestinal obstruction

“…Compared to the overall incidence of 0.14%-4.50% (estimated by autopsy findings and retrospective studies) [4] , giant MD are rare [5] . The largest giant MDs reported have been > 100 cm long [6] , 96 cm long [7] , 85 cm long [8] , and 66 cm long [9,10] . In adult cases of MD, obstruction is the most frequently reporting presenting symptom [11][12][13][14] and can be caused by either the diverticulum's attachment to the umbilicus, abdominal wall or other viscera by a fibrous band or by interference due to the mobility of an unattached diverticulum [11] .…”

Littre Hernia: Surgical Anatomy, Embryology, and Technique of Repair

“…28 The diverticulum arises from the antimesenteric border of the ileum because of its ventral embryologic origin. Although it has been suggested that rotation in the position of a Meckel diverticulum is possible because of traction of fibrosed omphalomesenteric arteries, 29 diverticula found at the mesenteric border cannot be accepted as Meckelian. 30 A distinguishing feature is the terminal branch of the superior mesen- 17 teric artery (the persisting embryonic right omphalomesenteric artery), which crosses the ileum to supply the diverticulum (Fig.…”