Surgical Management and Complications of Meckel's Diverticulum in 90 Patients

Piñero, A.; Martínez‐Barba, Enrique; Canteras, Manuel; Rodríguez, José Manuel ́Ramírez; Castellanos, Gregorio; P, Parrilla Paricio

doi:10.1080/110241502317307508

Cited by 43 publications

(17 citation statements)

References 15 publications

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“…Therefore, many methods, including high-resolution ultrasound scan, laparoscopy, and CT have been tried for diagnosis of MD at an early stage [20]. In this study, Meckel's scan was performed for 36.4% of patients, while diagnostic laparoscopy was performed for 42.4% of patients, as was the most used diagnostic method.…”

Section: Discussionmentioning

confidence: 99%

“…Ileal resection is performed for a patient with hemorrhage who has a broad-based diverticulum in order to avoid a situation in which ectopic mucosa remains after surgery. However, Piñero et al [20] reported that ileal resection showed a higher frequency of post-operative complications, such as infection or intestinal obstruction (stenosis or band) in junction than diverticulectomy. In particular, if the diameter of the diverticulum base is larger than that of the intestine, a child is likely to have stenosis of the ileum after diverticulectomy.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis

Rho

Kim

et al. 2013

Pediatr Gastroenterol Hepatol Nutr

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PurposeMeckel's diverticulum (MD) has various clinical manifestations, and diagnosis or selectection of proper diagnostic tools is not easy. This study was conducted in order to assess the clinical differences of MD diagnosed by scintigraphic and non-scintigraphic methods and to find the proper diagnostic tools.MethodsWe conducted a retrospective review ofthe clinical, surgical, radiologic, and pathologic findings of 34 children with symptomatic MD, who were admitted to Gachon University Gil Medical Center, Inha University Hospital, and The Catholic University of Korea, Incheon St. Mary's Hospital between January 2000 and December 2012. The patients were evaluated according to scintigraphic (12 cases; group 1) and non-scintigraphic (22 cases; group 2) diagnosis.ResultsThe male to female ratio was 7.5 : 1. The most frequent chief complaint was lower gastrointestinal (GI) bleeding in group 1 and nonspecific abdominal pain in group 2, respectively. The most frequent pre-operative diagnosis was MD in both groups. Red blood cell (RBC) index was significantly lower in group 1. MD was located at 7 cm to 85 cm from the ileocecal valve. Four patients in group 1 had ectopic gastric tissues causing lower GI bleeding. The most frequent treatment modality was diverticulectomy in group 1 and ileal resection in group 2, respectively.ConclusionTo diagnose MD might be delayed unless proper diagnostic tools are considered. It is important to understand indications of scintigraphic and non-scintigraphic methods according to clinical and hematologic features of MD. Scintigraphy would be weighed in patients with anemia as well as GI symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis

Rho

Kim

et al. 2013

Pediatr Gastroenterol Hepatol Nutr

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“…[67891011121314] None out of these nine studies contained cases of multiple ectopic tissues. The meta-analysis shown in Figure 1 includes data from these nine case series plus the data from our own case series.…”

Section: Resultsmentioning

confidence: 99%

Meckel′s diverticulum and ectopic epithelium: Evaluation of a complex relationship

Burjonrappa

Khaing

2014

J Indian Assoc Pediatr Surg

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Introduction:Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. Currently, for any incidentally discovered Meckel's diverticulum, the management approach is based on weighing the statistical odds of future complications against the risks of a diverticulectomy.Materials and Methods:The temporal relationship between age at Meckel's diverticulectomy and the presence of ectopic epithelium was evaluated in our series. A meta-analysis of all reported recent literature on this condition was subsequently performed to evaluate the strength of the relationship between ectopic epithelium and symptomatic Meckel's diverticulum.Results:There was a paucity of ectopic epithelium in Meckel's diverticulectomy specimens in infants operated on at less than 1 year of age. Having two or more ectopic epithelia in a diverticulum does not appear to carry an additive risk for complications. The meta-analysis confirmed that ectopic epithelium was the most significant factor that influenced surgical intervention in all series of Meckel's diverticulum.Conclusion:The relationship between ectopic epithelium and the development of symptomatic Meckel's diverticulum is complex. Further understanding of the development of ectopic rests in the diverticulum will facilitate elucidating the pathophysiology in symptomatic cases.

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“…[ 3 ] The incidence of Meckel diverticulum in the general population has been estimated at approximately 2%, but reports from autopsy and retrospective studies range from 0.14% to 4.5%. [ 4 – 6 ] Meckel diverticulum is more common in males than females, with the previously reported male to female ratio ranging from 2:1 to 4:1. [ 7 – 9 ] In children, large proportion of Meckel diverticulum cases occur in those younger than 2 years of age (almost 50%).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of Meckel diverticulum in children

et al. 2017

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Meckel diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract in children. The aim of this study was to review and analyze clinical data on the diagnosis and management of Meckel diverticulum in pediatric patients. The records of 102 pediatric patients (<14 years old) who underwent surgery for Meckel diverticulum at our institute between 2001 and 2015 were reviewed. Clinical, imaging, laboratory, surgical, and pathological data were recorded. The series comprised 65 males and 37 females with a median age of 5.6 years. Lower gastrointestinal bleeding was the most frequently identified clinical manifestation of Meckel diverticulum, and this manifestation was observed in 41 patients. Intussusception secondary to Meckel diverticulum was identified in 32 patients. Twelve patients presented clinical features of peritonitis; of these patients, 8 had perforated Meckel diverticulum and 4 had Meckel diverticulitis. In 10 patients, Meckel diverticulum was incidentally diagnosed during other surgeries, including appendectomy and neonatal enterostomy. Seven patients were diagnosed with intestinal obstruction. Technetium-99m pertechnetate imaging offered high diagnostic yield. Open surgery was performed on 59 patients, while a laparoscopic approach was employed in 35 patients. The remaining 8 patients did not undergo resection of the Meckel diverticulum. Histology revealed ectopic gastric mucosa in 42 patients (44.7%), ectopic pancreatic tissue in 35 patients (37.2%), mucosa of the small intestine in 15 patients (16.0%), and both gastric and pancreatic ectopic tissue in 2 patients (2.1%). All patients recovered uneventfully except 2 patients in whom an intestinal adhesion obstruction was identified after discharge. Meckel diverticulum had various clinical manifestations in children. Technetium-99m pertechnetate imaging may be useful for diagnosing Meckel diverticulum. Surgical excision of the Meckel diverticulum may be safe and effective in symptomatic patients, and relatively better outcomes can be achieved using this approach.

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Surgical Management and Complications of Meckel's Diverticulum in 90 Patients

Abstract: Meckel's diverticulum should be suspected particularly when there are symptoms of obstruction or gastrointestinal bleeding in children. The presence of both ectopic gastric mucosa and ulcers is related to the symptoms and we found no H. pylori in any of the cases.

Cited by 43 publications

References 15 publications

Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis

Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis

Meckel′s diverticulum and ectopic epithelium: Evaluation of a complex relationship

Clinical characteristics of Meckel diverticulum in children

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