The Significance of Meckel’s Diverticulum in Appendicitis — A Retrospective Analysis of 233 Cases

Abstract

Conflicting reports are found in the literature concerning whether to remove an incidentally discovered Meckel's diverticulum (MD). Between 1.1.1974 and 31.12.2000, at a single center, the perioperative data associated with appendectomy (AE) were recorded consecutively and analyzed retrospectively. All patients in whom an MD was discovered during an AE were included in the study. The clinical presentation, postoperative course, and follow-up in all MDs left in place were analyzed. During the course of 7927 AE, 233 MD (2.9%) were detected. Of these 80.7% (n = 188) were removed and 19.3% (n = 45) were left untouched. In 9% (n = 21) of all detected diverticula pathological changes were found. Ectopic tissue was seen in 12.2% (n = 23) of the MDs removed. The postoperative complication rates did not differ significantly between patients in whom the MD was removed (9.5%; n = 18) and those in whom it was not (17.7%; n = 8); in the latter group the appendicitis was of the more acute type (gangrenous or perforated) (24.4% vs. 4.3%). In 18 patients (40.0%) with non-removed MDs, a follow-up period of 14.1 5.8 years was achieved. Complications associated with a non-removed MD were not observed. If during the course of an AE a MD is detected, the present data, as well as those in the literature, suggest that an individualized approach should be taken. Meckel's diverticulum with obvious pathology should always be removed. In cases of gangrenous or perforated appendicitis, an incidentally discovered MD should be left in place, whereas in an only mildly inflamed appendix it should be removed.

Perforated Meckel’s Diverticulum- A Rare Case Presentation

“…In one study, 11% of children with complicated MDs were initially diagnosed with appendicitis 6 . Ueberrueck et al found that 5 MDs were found incidentally in a series of 311 appendicectomies performed at one institution over 3 year 10 .…”

Postoperative intestinal obstruction caused by Meckel’s diverticulitis after appendectomy

“…Mortality in elective diverticulectomy is close to zero and mortality in complicated cases is 1% -10% [6,8]. The generally accepted approach is neither to search for a diverticulum nor to excise the diverticulum if it contains ectopic mucosa or the appendix shows lowgrade inflammation and to leave it in place in case of a perforated or gangrenous appendicitis presence but the experience and preference of the operating surgeon are an important factor [2]. The two cases presented in this study are relevant to this discussion.…”

“…The most important factors in making this decision are whether the appendix is perforated or inflamed and the macroscopic appearance of the Meckel's diverticulum [2]. Appendectomy is the main reason for laparotomy application in children and the incidence of intestinal obstruction occurring in the early period after appendectomy is 1.3% -8.3% with higher rates in complicated appendicitis [3,4].…”

“…Whether a Meckel's diverticulum found incidentally during appendectomy should be simultaneously excised or not is a controversial issue [1,2]. The most important factors in making this decision are whether the appendix is perforated or inflamed and the macroscopic appearance of the Meckel's diverticulum [2].…”

A Rare Case Od Meckel’s Diverticulum Perforation Caused By a Toothpick Mimicking Acute Appendicitis

“…This study concluded in establishing the importance of exploring the bowel in all appendectomy cases. [13] In patients with the preoperative workup that raises suspicion for, but without an intraoperative verification of, an acute appendicitis, an exploration of 180 cm of the small bowel from the ileocecal valve is advocated. Both pathologies being present, is very rare, and therefore little is to be gained by searching for a diverticulum where acute appendicitis is present and dealt with.…”