Laparoscopy and Complicated Meckel Diverticulum in Children

Abstract

Background and Objectives:Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy.Methods:A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum.Results:Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications.Conclusions:Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.

Optimizing surgical resection of the bleeding Meckel diverticulum in children

“…19, 20 Several prior studies have also shown successful resection of a Meckel diverticulum via diverticulectomy-only for children presenting with symptoms of bleeding. 13, 15 There are advantages of this approach, including the ease of diverticulectomy with laparoscopy and elimination of the need for an enterectomy. Diverticulectomy-only can be accomplished through laparoscopy, using endostapling devices, as was performed in 11 children of our cohort who presented with bleeding.…”

Laparoscopic resection for Meckel’s diverticulum causing intestinal obstruction

“…Ding et al (9) reported the role of laparoscopy on the surgical treatment of perforated MD, and they found it to be safe and effective for diagnosis and the therapeutic role. Alemayehu et al (10) reported a retrospective analysis of laparoscopically treated complicated MD in patients. Eight of these patients had intestinal obstruction and were laparoscopically treated without complication.…”

Peanut as a cause of torsion Meckel's diverticulum

“…The risk of death in the case of Meckel's diverticulum is 0.001%, but with complications (bleeding, perforation or obstruction) can reach 4-6% (6,7,8). For these reasons, many surgeons believe that it is necessary to surgically treat diverticulum at incidental findings, while some studies suggest that it does not need to be touched in case of the elderly people if it has a wide lumen (9)(10)(11)(12)(13)(14)(15)(16)(17). We believe that it is necessary to surgically treat Meckel's diverticulum always in order to prevent any complications.…”