Intestinal obstruction and ischemia by necrotic annular Meckel’s diverticulum: Case report and review of the literature

Evola, Giuseppe; Caramma, Sebastiano; G, Caruso; Schillaci, Riccardo; Reina, Carlo; Reina, Giuseppe Angelo

doi:10.1016/j.ijscr.2021.105897

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…Because of the unusual displacement of the abdominal viscera in SVI, the diagnosis of LSAA presenting with LLQ abdominal pain can be challenging. The main differential diagnosis of LLQ abdominal pain includes sigmoid diverticulitis, intestinal perforation or obstruction [14] , incarcerated or strangulated hernia, regional enteritis, Meckel's diverticulitis, acute pancreatitis, atypical right-sided appendicitis, LSAA, epiploic appendagitis, abdominal aortic aneurysm, mesenteric ischemia, renal colic, psoas abscess, testicular or ovarian torsion, ruptured ovarian cyst, ectopic pregnancy, pelvic inflammatory disease [1] . Imaging may be helpful for determining the correct diagnosis, as well as confirming SVIT or MM.…”

Section: Discussionmentioning

confidence: 99%

Left-sided acute appendicitis in a patient with situs viscerum inversus totalis: A case report

Evola

Ferrara

Fede³

et al. 2022

International Journal of Surgery Case Reports

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Introduction and importance Left-sided acute appendicitis (LSAA) is a very rare cause of acute abdomen, developing in association with two types of congenital anomalies like as situs viscerum inversus (SVI) and midgut malrotation (MM). Preoperative diagnosis of LSAA is a challenge because of its rarity and atypical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents the standard treatment of LSAA. Case presentation A 67-year-old Caucasian male with presented to the Emergency Department with a two-day history of left lower quadrant (LLQ) abdominal pain, nausea, vomiting, diarrhea and fever. Physical examination revealed LLQ abdominal rebound tenderness with guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography showed a LSAA with intraluminal appendicoliths, fat infiltration and pericecal fluid collection in a patient with SVI. The patient underwent laparoscopic appendectomy: a gangrenous and perforated appendicitis was sectioned and removed with drainage of pericecal abscess. The postoperative course of the patient was uneventful. Clinical discussion LSAA is characterized by anatomical variation of appendix and atypical presentation. Preoperative clinical diagnosis of LSAA is very difficult and imaging may be helpful for determining the correct diagnosis, as well as confirming SVIT or MM. Laparoscopic appendectomy represents the correct treatment of LSAA. Conclusion LSAA is a rare surgical emergency that should be considered in the differential diagnosis of patients with LLQ abdominal pain. Preoperative diagnosis of LSAA needs a high index of suspicion and is facilitated by imaging. Surgery represents the appropriate treatment of LSAA.

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Section: Discussionmentioning

confidence: 99%

Left-sided acute appendicitis in a patient with situs viscerum inversus totalis: A case report

Evola

Ferrara

Fede³

et al. 2022

International Journal of Surgery Case Reports

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“…This management of intussusception secondary to Meckel’s diverticulum having a definite indication for diverticulectomy or segmental resection has gained consensus throughout the literature and in clinical application at this time in practice. 13,15…”

Section: Discussionmentioning

confidence: 99%

Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum

Zorn

Zhang

Brandt

et al. 2022

SAGE Open Medical Case Reports

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Small bowel obstruction (SBO) secondary to intussusception of Meckel’s diverticulum (MD) is a rare cause of acute abdominal pain that may warrant urgent surgical treatment. Volvulus or intussusception of the small bowel with presence of MD as the lead point is the most commonly reported etiology of Meckel’s related obstructions. We report an interesting case of a small bowel obstruction caused by the intussusception of an MD within its own lumen. The case involves a 30-year-old male who presented to the emergency room with acute, severe abdominal pain with an abdominal computed tomography (CT) showing a distal high-grade SBO. Decision was made to take the patient to the operating room urgently due to his clinical examination and radiologic imaging, specifically CT scan. Diagnostic laparoscopy was performed and subsequently converted to an exploratory laparotomy, which revealed the intussuscepted MD with focal necrosis into the distal small bowel causing an SBO. A segmental small bowel resection with hand sewn primary anastomosis was performed. The case presents an interesting challenge in deciding when to take a patient with an SBO to the operating room versus initial conservative management and what the treatment should be if an MD is encountered. In addition, the case emphasizes the importance of history and physical exam findings in coordination with radiologic imaging in helping to make appropriate decisions in a timely manner for operative vs conservative management of an SBO. It reminds us that, Meckel’s diverticulum, although less commonly the cause of a small bowel obstruction in the adult population, needs to be on the differential diagnosis and we need to have a high clinical suspicion for this possibility to ensure appropriate treatment in a timely manner.

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“…Symptoms and signs of AA may be caused not only by the inflammation of the appendix but also by rare appendiceal neoplasms [14] . The main differential diagnosis of typical AA includes Crohn ileitis, mesenteric adenitis, right-sided colitis, intestinal perforation or obstruction [15] , [16] , incarcerated or strangulated hernia, regional enteritis, Meckel's diverticulitis, epiploic appendagitis, abdominal aortic aneurysm, mesenteric ischemia, renal colic, psoas abscess, testicular or ovarian torsion, ruptured ovarian cyst, ectopic pregnancy and pelvic inflammatory disease. SHAA, generally presenting with right upper abdominal pain, may be clinically indistinguishable from acute cholecystitis, liver abscess, perforated duodenal ulcer.…”

Section: Discussionmentioning

confidence: 99%

Intestinal obstruction and ischemia by necrotic annular Meckel’s diverticulum: Case report and review of the literature

Cited by 8 publications

References 11 publications

Left-sided acute appendicitis in a patient with situs viscerum inversus totalis: A case report

Left-sided acute appendicitis in a patient with situs viscerum inversus totalis: A case report

Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum

Subhepatic perforated acute appendicitis in a patient with midgut malrotation: A case report and review of the literature

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