Incidental finding of carcinoid tumor on Meckel’s diverticulum: case report and literature review, should prophylactic resection be recommended?

Abstract

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is caused by incomplete obliteration of the vitelline duct during intrauterine life. MD affects less than 2% of the population. In most cases, MD is asymptomatic and the estimated average complication risk of MD carriers, which is inversely proportional to age, ranges between 2% and 4%. The most common MD-related complications are gastrointestinal bleeding, intestinal obstruction and acute phlogosis. Excision is mandatory in the case of symptomatic diverticula regardless of age, while surgical treatment for asymptomatic diverticula remains controversial. According to the majority of studies, the incidental finding of MD in children is an indication for surgical resection, while the management of adults is not yet unanimous. In this case report, we describe the prophylactic resection of an incidentally detected MD, which led to the removal of an occult mucosal carcinoid tumor. In literature, the association of MD and carcinoid tumor is reported as a rare finding. Even though the strategy for adult patients of an incidental finding of MD during surgery performed for other reasons divides the experts, we recommend prophylactic excision in order to avoid any further risk.

Is an Incidental Meckel’s Diverticulum Truly Benign?

“…In the adult population, it is well accepted that a symptomatic MD should be resected; however, the operative management of an asymptomatic incidentally found Meckel's remains controversial. This controversy is largely resolved in the pediatric population where it is strongly recommended that both symptomatic and asymptomatic MD should be resected as it is recognized that most patients develop symptoms within the first two years of life and the incidence of MD-related complications is inversely proportional to age [ 7 ]. Review of current literature finds there to be several anecdotal operative findings, a narrow base, long length, and palpable mucosal heterotopia, which have been used by some as guidelines for resection [ 8 , 9 ].…”

Rare case of Meckel's diverticulum neuroendocrine tumour

“…Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract and is caused by incomplete obliteration of the vitelline duct during intrauterine life 1 . It is localized approximately 45–60 cm proximal to the ileocaecal valve on the antimesenteric side, on the projection of the terminal branch of the superior mesenteric artery.…”

Malignant neoplasms of Meckel's diverticulum; an evidence based review

“…The literature available on these rare histological sub –types remains scanty which mainly consist of case reports and case series with many researchers reporting on their own clinical experience and often disagree on not only its epidemiology, but more so on its surgical indications. The management to be followed in the case of malignant neoplasm of MD in adults is not yet unanimous [ 14 , 15 ].…”