Meckel's Diverticulum with Small Bowel Obstruction Presenting as Appendicitis in a Pediatric Patient

Mohiuddin, Sultan; González, Adolfo Hidalgo; Corpron, Cynthia A.

doi:10.4293/108680811x13176785204553

Cited by 22 publications

(37 citation statements)

References 18 publications

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“…Internal hernia and Meckel's diverticulum related BO [Table/ Fig-4] is rare but important. Meckel's diverticulum can be overlooked in many cases hence, it is recommended that the small bowel be assessed in all cases of appendectomy [30]. 16.4% of children and adolescents undergoing operative management require bowel resections [ Table/Fig -5].…”

Section: Age Related -Decision Making In Newborn Young and Oldmentioning

confidence: 99%

Decision Making in Bowel Obstruction: A Review

Pujahari

2016

JCDR

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IntRoductIonOver the last 100 years, the anatomical location of Bowel Obstruction (BO) has remained unchanged; however, the aetiological factors in small and large BO have changed significantly. With advance of time more and more elderly patients are presenting with BO [1]. But still, BO continues to be one of the most common surgical emergencies [2] encountered in general surgery units and it continues to be a major cause of morbidity and financial expenditure [3]. Peritoneal adhesions and hernia were the most common causes of BO and contributing 42.3% [4]. All patients of BO are potential candidates for major abdominal surgery with long term morbidity and possible mortality. Hence, the decision of surgery and its timing is vital.Various factors are considered for taking the decision on operative or non-operative management. The factors considered are age of the patients, duration of obstruction, volume of nasogastric aspirate, findings on the radiological imaging, previous abdominal surgeries and malignancy. decision in Small Bowel obstruction (SBo)Clinical presentation of pain, vomiting, distension and constipation, laboratory and radiographic factors should all be considered when making a decision about treatment of BO [5]. One must rule out an abdominal wall hernia as a cause of BO, which is seen in 26.8% of cases in virgin abdomen [4]. Plain radiograph should be an integral part of management of patients with clinical suspicion of BO and gastrointestinal perforation [6] [Table/ Fig-1]. The diagnosis in most cases will be confirmed by further imaging studies such as ultrasound, contrast studies or most commonly in contemporary practice, the Computed Tomography (CT) [7].The CT scan, besides confirming the diagnosis of BO, it gives information on partial or complete obstruction, it location, it also provides specific type like closed loop type and helps in deciding early surgery. Contrast Enhanced Computed Tomography (CECT) give enough information on ischemic bowel and bowel oedema, which requires emergency surgery and luminal gastrograffin helps in relieving the BO [8,9].Surgeons find coronal images more helpful than axial images for management [10]. The radiographic transition zone alone does not increase the likelihood of surgical intervention or identify patients who will fail non-operative management [11]. The four cardinal features -intra peritoneal free fluid, mesenteric oedema, presence of the "small bowel faeces sign" and history of vomiting -are predictive of requiring immediate emergency operative intervention [5]. decision in large bowel obstructionIn Indian scenario, two common types of Large Bowel Obstructions (LBO) are seen. They are: (a) Acute obstruction due to Sigmoid volvulus (SV); and (b) Sub-acute or chronic obstruction due to cancer of colon. In suspected volvulus, plain X-rays may help with diagnosis but MRI is more reliable. However, flexible endoscopy is always diagnostic as well as therapeutic [12]. Once diagnosed flatus tube, hydrostatic enema or colonoscopic reduction attempt is th...

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Section: Age Related -Decision Making In Newborn Young and Oldmentioning

confidence: 99%

Decision Making in Bowel Obstruction: A Review

Pujahari

2016

JCDR

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“…However, a blind-ending fluid- or gas-filled structure in continuity with the small bowel may be seen [17]. It may yield a high rate of diagnosis when small bowel obstruction is present (81-96%), but a Meckel's etiology is difficult to identify as a cause due to the inability of distinguishing a diverticulum amongst loops of small bowel [5]. Abdominal CT seems to be a reliable modality to facilitate a preoperative diagnosis in complicated cases such as intussusception [18].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of Meckel's diverticulum, whose prevalence is ranging from 1 to 4% of the population, is clinically silent and is incidentally identified at surgery or during autopsy [4]. Bleeding and intussusception tend to occur more often under the age of 2 years, while obstruction and inflammation is more common in adults [5]. The frequent complications of Meckel's diverticulum are hemorrhage, intestinal obstruction, and diverticulitis.…”

Section: Introductionmentioning

confidence: 99%

Mesodiverticular Band of Meckel's Diverticulum as a Rare Cause of Small Bowel Obstruction: Case Report and Review of the Literature

et al. 2013

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Background: Meckel's diverticulum, which was first described by Johann Friedrich Meckel, is a congenital anomaly. It results from incomplete obliteration of the most proximal portion of the vitelline or omphalomesenteric duct. Its prevalence is ranging from 1 to 4% of the population. The lifetime risk of complications is estimated at 4-6%. One of them is intestinal obstruction which is a more common presentation among adults. Mesodiverticular band, as presented in this case report, is a rare cause of small bowel obstruction in Meckel's diverticulum. Case Report: We report the case of a 17-year-old male who had intestinal obstruction caused by a mesodiverticular band of Meckel's diverticulum. He presented with severe abdominal pain, nausea, and vomiting. The established diagnosis was mechanical intestinal obstruction. Laparotomy revealed an internal herniation and obstruction caused by a mesodiverticular band of Meckel's diverticulum. There was no evidence of necrosis or ischemia. The mesodiverticular band was released from the ileal mesentery and the Meckel's diverticulum was resected. The postoperative period was uneventful and the patient was discharged after 6 days. Conclusion: The incidence of an internal hernia caused by a mesodiverticular band of Meckel's diverticulum is rare. It may be overlooked in the case of intestinal obstruction because of nonspecific symptoms. Delay in the diagnosis can lead to significant morbidity and mortality. In the case of small bowel obstruction, Meckel's diverticulum should therefore be kept in mind.

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“…Untersuchungen zeigen jedoch, dass nach der Aufhebung der Anastomose nur die Hälfte der Patienten im weiteren Verlauf eine Wiederherstellung der Darmkontinuität erhält [20]. Prinzipiell können diese operativen Revisionen auch laparoskopisch durchgeführt werden [50]. …”

Section: Therapie Bei Anastomoseninsuffizienzen Nach Kolorektaler Resunclassified

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

Werner¹,

Sauer

2013

Visc Med

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Hintergrund: Anastomoseninsuffizienzen stellen die schwerwiegendste septische Komplikation nach viszeralchirurgischen Eingriffen dar. Neben der chirurgischen Therapie sind zunehmend endoskopische Behandlungsoptionen möglich. Methode: Literaturübersicht. Ergebnisse: Therapieoptionen von Anastomoseninsuffizienzen sind abhängig von der klinischen Symptomatik, der Art der Anastomose, der Defektgröße, den lokalen Gewebeverhältnissen sowie dem Zeitpunkt der Diagnose. Bei einer Nekrose oder Minderdurchblutung der Viszeralorgane müssen diese operativ reseziert werden. Prinzipiell sind alle operativen Revisionseingriffe auch laparoskopisch durchführbar. Bei erhaltener Gewebeperfusion können die Leckagen lokal übernäht oder endoskopisch verschlossen werden. Die Ergebnisse für die Stenttherapie nach Ösophagus- und Magenresektionen sind für moderne Stents sehr Erfolg versprechend. Im Gegensatz dazu sind die Ergebnisse der endoskopischen Stenttherapie bei Insuffizienz nach kolorektalen Eingriffen enttäuschend; dafür steht hier mit der Schwammtherapie eine vielversprechende endoskopische Alternative zur Verfügung. Schlussfolgerung: Die aktuellen Daten zeigen, dass neue laparoskopische und endoskopische Optionen zur Therapie von Anastomoseninsuffizienzen bestehen, die jedoch noch in prospektiven und randomisierten Studien evaluiert werden müssen.

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Meckel's Diverticulum with Small Bowel Obstruction Presenting as Appendicitis in a Pediatric Patient

Abstract: The authors suggest that the small bowel be assessed in all appendectomy cases for a pathological Meckel's diverticulum.

Cited by 22 publications

References 18 publications

Decision Making in Bowel Obstruction: A Review

Decision Making in Bowel Obstruction: A Review

Mesodiverticular Band of Meckel's Diverticulum as a Rare Cause of Small Bowel Obstruction: Case Report and Review of the Literature

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

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