Optimizing surgical resection of the bleeding Meckel diverticulum in children

Robinson, Jamie R.; Correa, Hernán; Brinkman, Adam S.; Lovvorn, Harold N.

doi:10.1016/j.jpedsurg.2017.03.047

Cited by 31 publications

(30 citation statements)

References 21 publications

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“…Furthermore, operative times and hospitalization are shortened significantly without increasing risk of continued bleeding, with lower overall complication rate and eliminates the contaminated surgical field. 9,11 Postoperative morbidity is reported to be 5,3%, with wound infections and adhesive intestinal obstruction being some of the most common complications, which we also observed in our series; both resolved with conservative treatment. 4,7 This study is associated with some limitations.…”

Section: Discussionsupporting

confidence: 82%

“…2,8 As MD is the most common cause of small intestinal bleeding in children, Tc99m is specially indicated in cases of painless intestinal bleeding although has a false negative rate of 33,3%, like the result of our series (36%). 11 False-negative diagnosis may be due to ulcers and hemorrhage without ectopic gastric mucosa to capture Tc-99m or if the area of ectopic gastric mucosa is very small and can be missed on the Meckel's scan; 7 alternatively, if there is profuse bleeding or an accentuated intestinal transit, the radioisotope can be washed out. 3,7 Several techniques have been introduced to increase the sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively advocates of diverticulectomy-only contend that the ulcerated intestinal mucosa is immediately adjacent to the heterotopic gastric mucosa, which itself originates in the diverticulum and that removal of this acid-producing source is enough to prevent further bleeding. 4,9,11 In fact, some recent studies showed that in children presenting with a bleeding MD, diverticulectomy-only is safe and completely resects gastric heterotopia. Furthermore, operative times and hospitalization are shortened significantly without increasing risk of continued bleeding, with lower overall complication rate and eliminates the contaminated surgical field.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical manifestations of Meckel Diverticulum in children: a review of 11-years

Lima¹,

Knoblich²,

Borges³

et al. 2020

GHOA

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical manifestations of Meckel Diverticulum in children: a review of 11-years

Lima¹,

Knoblich²,

Borges³

et al. 2020

GHOA

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“…When residual ectopic tissue is histologically confirmed after simple diverticulectomy for bleeding MD, reoperation for segmental resection is necessary only after bleeding remission as simple diverticulectomy does not increase the risk of postoperative bleeding (17, 18). …”

Section: Managementmentioning

confidence: 99%

Meckel's Diverticulum in Adults: Surgical Concerns

et al. 2018

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Since Meckel's diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Treatment of symptomatic MD is definitive surgery, including diverticulectomy, wedge, and segmental resection. The type of procedure depends on: (a) the integrity of diverticulum base and adjacent ileum; (b) the presence and location of ectopic tissue within MD. The presence of ectopic tissue cannot be accurately predicted intraoperatively by palpation and macroscopic appearance. When present, its location can be predicted based on height-to-diameter ratio. Long diverticula (height-to-diameter ratio >2) have ectopic tissue located at the body and tip, whereas short diverticula have wide distribution of ectopic tissue including the base. When indication of surgery is simple diverticulitis, diverticulectomy should be performed for long and wedge resection for short MD. When indication of surgery is complicated diverticulitis with perforated base, complicated intestinal obstruction and tumor, wedge, or segmental resection should be performed. When the indication of surgery is bleeding, wedge and segmental resection are the preferred methods for resection. Regarding management of incidentally discovered MD, routine resection is not indicated. The decision making should be based on risk factors for developing future complications, such as: (1) patient age younger than 50 years; (2) male sex; (3) diverticulum length >2 cm; and (4) ectopic or abnormal features within a diverticulum. In this case, diverticulectomy should be performed for long and wedge resection for short MD.

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“…Moreover, diverticulectomy appears to have a lower overall complication rate. 10,11 Diverticulectomy can be performed either intracorporeally or extracorporeally. Intracorporeal diverticulectomy can be performed laparoscopically without the need to enlarge the umbilical wound.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Management of Mechanical Small Bowel Obstruction Secondary to Meckel's Diverticulum with a Double Basis. A Rare Anatomic Presentation

Mariani

Siddiqui

Boulard

et al. 2020

European J Pediatr Surg Rep

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Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. Intestinal occlusion due to MD is a commonly observed consequence of intussusception or volvulus. Here, we report a case of an 11-year-old boy who presented to the emergency department with acute abdominal pain, bilious vomiting, and abdominal rebound tenderness. Computed tomography scan concluded a diagnosis of intestinal occlusion with no apparent cause. The patient was submitted to diagnostic laparoscopy, and mechanical occlusion by the permeable Meckel with double base was identified. A diverticulectomy by staplers was performed, and occlusion was alleviated. MD is a rare disease (for only 0.3–2.9% of the general population), and only 4.2 to 9% of patients diagnosed with MD have associated complications. MD can be a large base or a narrow base, with a mesodiverticular band but the diverticulum is usually a blind recess. In our case, the tube connected two intestinal segments. To the best of our knowledge, we have reported the first case of an MD-like permeable tube with a double basis.

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Optimizing surgical resection of the bleeding Meckel diverticulum in children

Cited by 31 publications

References 21 publications

Clinical manifestations of Meckel Diverticulum in children: a review of 11-years

Clinical manifestations of Meckel Diverticulum in children: a review of 11-years

Meckel's Diverticulum in Adults: Surgical Concerns

Laparoscopic Management of Mechanical Small Bowel Obstruction Secondary to Meckel's Diverticulum with a Double Basis. A Rare Anatomic Presentation

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