Meckel's diverticulum mimicking acute appendicitis in children: a retrospective cohort study.

BACKGROUND: The aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children. MATERIALS AND METHODS: We retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel's diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded. RESULTS: A total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1-13 years). Perforated Meckel's diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix. CONCLUSIONS: The most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.

Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study.

OBJECTIVE: Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. METHODS: We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. RESULTS: The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. CONCLUSIONS: Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.

Extraskeletal myxoid chondrosarcoma metastasis to a Meckel's diverticulum adenocarcinoma.

Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumour with a high local and distant metastasis rate and limited response to chemotherapy. Meckel's diverticulum is the most frequent congenital anomaly, and it is associated with a considerable risk of malignant transformation. In this case report, we describe a 50-year-old female patient with a history of extraskeletal myxoid chondrosarcoma of the lower limb and metastasis to the forearm who went to the emergency department with abdominal pain. The investigations revealed a caecal volvulus. A lesion in the middle third of the ileum was incidentally discovered and removed during surgery. Pathology examination revealed a Meckel's diverticulum adenocarcinoma, with metastasis of extraskeletal myxoid chondrosarcoma. Resection was complete; however, the patient had diffuse metastatic pulmonary disease and died eight months later due to disease progression. This mechanism of tumour-to-tumour metastasis is described in other locations, but, regarding the Meckel's diverticulum, this is a unique situation, previously unreported in the literature.

Incarcerated Littre's Umbilical Hernia: A Case Report.

Littre's hernia is an extremely rare type of hernia which has Meckel's diverticulum as its content. A 63-year-old male, presented to the emergency department with chief complaints of swelling and pain around the umbilicus. The patient was diagnosed with an incarcerated umbilical hernia. Following the emergency laparotomy, the intraoperative finding depicted an umbilical Littre's hernia. The patient underwent open Meckel's diverticulectomy with mesh repair. Preoperative diagnosis of Littre's hernia is unlikely due to its low incidence and lack of specific radiological and clinical findings, but the role of computed tomography scan and ultrasound are important in differentiating between strangulated or incarcerated bowel and omentum and in guiding the urgency of operative management. Keywords: case reports; hernia; Meckel diverticulum.

Occult bleeding from a false-in-true non-Meckelian ileal diverticulum.

Ileal diverticula can be congenital or acquired and are rare even among the already rare entity of small bowel diverticula. What has never been reported, as far as we know, is false diverticula arising within the true non-Meckelian diverticulum with mesenteric erosion causing an occult gastrointestinal bleed. We present a patient with occult gastrointestinal bleeding from a false-in-true ileal diverticulum. Multiple investigations were required to localise the bleeding site after which the patient was taken to the operating room for a laparoscopic ileocaecectomy with complete resolution of symptoms. Preoperative localisation of the bleeding site may be difficult but is critically important in occult gastrointestinal bleeding. Procedure choice for a bleeding ileal diverticulum is dictated by the distance from the ileocaecal valve and the etiopathology of the bleed.

Meckel's diverticulum is a rare cause of mechanical ileus in adults.

Meckel's diverticulum is the most common congenital gastrointestinal defect with a prevalence of 2%. It is mostly asymptomatic and it rarely causes acute abdomen in adults. In this case report, a 28-year-old male with no previous abdominal surgery presented with clinical symptoms of small bowel obstruction. Surgery revealed a Meckel's diverticulum adherent to the abdominal wall, causing internal herniation with small bowel obstruction. The diverticulum was openly resected and no post-operative complications occurred. Laparoscopy seems safe, and surgical removal of the symptomatic Meckel's diverticulum is recommended.

Laparoscopic management of small bowel obstruction secondary to a mesodiverticular band of a Meckel's diverticulum in an adult: A case report and literature review.

RATIONALE: The mesodiverticular band (MDB) of a Meckel's diverticulum (MD) is a rare, yet notable etiology of small bowel obstruction (SBO) in adults. Due to the nonspecific symptoms and challenging diagnosis thereof, preoperative clinical suspicion and strategic management are crucial for achieving optimal outcomes. Therefore, we presented a case in which laparoscopic surgery was strategically performed to alleviate ileus, due to a preoperative diagnosis of SBO, suspected to be secondary to an MD with a concomitant MDB. PATIENT CONCERNS: A 32-year-old male patient presented with a half-day's duration of epigastric pain, abdominal distension, and tenderness, resulting in the working diagnosis of SBO. DIAGNOSES: Initial non-contrast computed tomography (CT) revealed SBO without signs of strangulation, postulated to be caused by an MD and concomitant MDB, resulting in conservative management. The symptoms persisted, necessitating contrast-enhanced CT. However, the dilated bowel loop suggestive of an MD that had been observed on non-contrast CT could not be confirmed on contrast-enhanced CT. INTERVENTIONS: Decompression therapy using a long tube provided minimal relief, prompting laparoscopic surgery on the 5th day post-admission for diagnostic and therapeutic purposes. OUTCOMES: An MD resection effectively relieved the SBO. The histopathological analysis revealed a true diverticulum with ectopic pancreatic tissue, confirming the diagnosis of an MD. At the band site, vascular and neural structures were encased in a sheath, consistent with the remnants of the vitelline duct mesentery; and histopathologically diagnosed as an MDB. The postoperative course was uneventful, and the patient was discharged on the 9th day, postoperatively. LESSONS: Decompression therapy and strategic laparoscopic surgery based on the preoperative working diagnosis of SBO yielded favorable outcomes, highlighting the importance of the early clinical suspicion of an MD and a concomitant MDB, as the etiology of SBO. The imaging variability and rarity of an MD in adults emphasizes the need for a heightened awareness and an accurate diagnosis for optimal management. Early intervention should be deliberated for patients with suspected intestinal ischemia. However, this case accentuates the clinical implications of strategic planning and employing minimally invasive techniques in the management of an MD-related SBO in adults.

Application of small bowel capsule endoscopy in children with Meckel's diverticulum.

BACKGROUND: Meckel diverticulum (MD) is an important cause of gastrointestinal bleeding in children. Small bowel capsule endoscopy (SBCE) is a first-line examination method applied to patients with obscure gastrointestinal bleeding, but there are few studies on its application in children with MD. This article aims to provide evidence in favor of the auxiliary diagnosis of MD in children by analyzing its characteristics using SBCE. METHODS: We retrospectively collected the clinical data of patients with suspected MD. RESULTS: A total of 58 children were included in this study. All 58 children presented overt gastrointestinal bleeding (bloody stool or melena). Capsule endoscopy identified protruding lesions in 2 cases, double-lumen changes in 30 cases (all considered as MD), vascular lesions in 7 cases, intestinal mucosal inflammatory lesions in 3 cases, ulcers or erosion in 3 cases, and no obvious abnormalities in SBCE in 12 cases. Both SBCE and technetium-99 scans were performed for 24 cases, 22 of which were diagnosed MD by their combined results, giving a diagnostic coincidence rate of 91.7%. Eight cases were highly suspected as MD but were negative for the technetium-99 scan and positive for SBCE. CONCLUSION: SBCE has high accuracy in the diagnosis of MD in children, especially when performed in combination with a technetium-99 scan, which can greatly improve the diagnostic rate of MD in children.

Persistent Vitello-Intestinal Duct Masquerading as Acute Appendicitis: A Case Report.

The vitello-intestinal duct normally regresses with the development. But, in certain cases, it could persist and present as Meckel's diverticulum. Here we report a case of an eight-year-old boy presenting with peri-umbilical abdominal pain, vomiting and loose stool. He was initially diagnosed and managed as acute appendicitis but did not improve, rather developed features of intestinal obstruction. Exploratory laparotomy was done which revealed persistent vitello-intestinal duct and was managed surgically. This case report highlights that in any case of suspected acute appendicitis, the complications of persistent vitello-intestinal duct should be considered as one of the differentials. Keywords: appendicitis; case reports; intestinal obstruction; laparotomy; omphalomesenteric duct.

Divertículo de Meckel complicado. Experiencia de 15 años en un hospital interzonal / Complicated Meckel's diverticulum. Fifteen years of experiencein an interzonal hospital in the Province of Buenos Aires

Introducción: el divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Puede presentarse con hemorragia, obstrucción intestinal o diverticulitis, complicaciones que disminuyen con la edad, por lo que en el adulto el diagnóstico suele ser incidental. El tratamiento de las complicaciones es quirúrgico, mediante diverticulectomía o resección segmentaria del intestino delgado, dependiendo de sus características morfológicas. Objetivo: analizar nuestra experiencia en el manejo del divertículo de Meckel complicado en un período de 15 años. Diseño: estudio descriptivo, observacional, transversal, retrospectivo. Material y métodos: se revisaron las historias clínicas de los pacientes operados por divertículo de Meckel complicado en el Servicio de Cirugía General del Hospital San Roque durante el periodo 2007-2022. Se registraron datos demográficos, presentación clínica, diagnóstico preoperatorio, tratamiento quirúrgico, complicaciones postoperatorias y hallazgos histopatológicos. Resultados: se incluyeron 25 pacientes, 21 (84%) hombres, 3 menores de 18 años. La presentación clínica fue un síndrome de fosa iliaca derecha en el 80% de los casos, obstrucción intestinal en el 16% y hemorragia en el 4%. En solo 2 casos se realizó el diagnóstico preoperatorio, confirmado mediante tomografía computada. Se realizó diverticulectomía en el 68% de los pacientes y resección segmentaria el 32%. El abordaje fue laparotómico en el 64%, principalmente en el periodo inicial y laparoscópico en el 36%. Hubo una complicación IIIb de Clavien-Dindo en un paciente pediátrico tratado con drenaje percutáneo. En un solo paciente (4%), que se presentó con hemorragia digestiva masiva, se encontró epitelio de tipo gástrico y páncreas ectópico en el divertículo. Conclusiones: En nuestra experiencia el divertículo de Meckel complicado se presentó predominantemente en hombres. La complicación más frecuente en el adulto fue la diverticulitis. El diagnóstico preoperatorio fue infrecuente y realizado por tomografía computada. La diverticulectomía es suficiente en la mayoría de los casos. Actualmente, la laparoscopia es una herramienta segura, rentable y eficiente que permite el diagnóstico y tratamiento oportunos de esta entidad. (AU)

Introduction: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can present with bleeding, intesti-nal obstruction or diverticulitis, complications that decrease with age, so in adults the diagnosis is usually incidental. Treatment of complications is surgical, through diverticulectomy or segmental resection of the small intestine, depending on its morphological characteristics. Objective: to analyze our experience in the management of complicated Meckel's diverticulum over a period of 15 years. Design: descriptive, observational, cross-sectional, retrospective study. Materials and methods: the medical records of patients operated on for complicated Meckel's diverticulum in the General Surgery Service of the San Roque Hospital during the period 2007-2022 were reviewed. Demo-graphic data, clinical presentation, preoperative diagnosis, surgical treatment, postoperative complications, and histopathological findings were recorded. Results: twenty-five patients were included, 21 (84%) men, 3 under 18 years of age. The clinical presentation was a right iliac fossa syndrome in 80% of cases, intestinal obstruction in 16% and hemorrhage in 4%. In only 2 cases was the preoperative diagnosis made, confirmed by computed tomography. Diverticulectomy was performed in 68% of patients and segmental resection in 32%. The approach was by laparotomy in 64%, mainly in the initial period, and by laparoscopy in 36%. There was a Clavien-Dindo IIIb complication in a pediatric patient treated with percutaneous drain-age. In only one patient (4%), who presented with massive gastrointestinal bleeding, gastric-type epithelium and ectopic pancreas were found in the diverticulum. Conclusions: In our experience, complicated Meckel's diverticulum occurred predominantly in men. The most frequent complication in adults was diverticulitis. Preoperative diagnosis was infrequent and was made by computed tomography. Diverticulectomy is sufficient in most cases. Currently, laparoscopy is a safe, profitable and efficient tool that allows for the timely diagnosis and treatment of this entity. (AU)

Divertículo de Meckel con tumor neuroendocrino: presentación inusual / Meckel's diverticulum with neuroendocrine tumor: unusual presentation

El divertículo de Meckel es una malformación congénita que suele presentarse como un hallazgo incidental asintomático. Puede complicarse por procesos inflamatorios o tumores, cursando con sintomatología abdominal sumamente inespecífica, lo que complica su diagnóstico oportuno. Aunque la incidencia de neoplasias malignas en estos divertículos es baja, los tumores neuroendocrinos son los más representativos. Presentamos el caso de una paciente de 72 años que consultó por dolor abdominal y deposiciones melénicas, con múltiples nódulos intrahepáticos sugestivos de tumores neuroendocrinos y hallazgo intraoperatorio incidental de diverticulitis aguda de Meckel con metástasis peridiverticular de un tumor neuroendocrino. (AU)

Meckel's diverticulum is a congenital malformation that usually presents as an incidental finding. It can be complicated by inflammatory processes or tumors, with non-specific abdominal symptoms which delay its timely diagnosis. Although the incidence of malignant neoplasms in these diver-ticula is low, neuroendocrine tumors are the most representative. We present the case of a 72-year-old female patient who consulted for abdominal pain and melenic bowel movements, with multiple intrahepatic nodules suggestive of neuroendocrine tumors and an incidental intraoperative finding of acute Meckel's diverticulitis with peridiverticular metastasis of a neuroendocrine tumor. (AU)

Intestinal malrotation, mesocolic hernia, and Meckel diverticulum - differential diagnosis of abdominal pain in adults: case report and literature review

Intestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923. Intestinal malrotation is a rare condition among adults - prevalent in a mere 0.0001% to 0.19% of the population -, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptomsmay appear later in life,making diagnosis in adults difficult on account of non-specific symptoms. In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina. (AU)

Vólvulo y necrosis de divertículo de Meckel gigante: reporte de un caso / Volvulus and necrosis of giant Meckel's diverticulum: a case report

El divertículo de Meckel complicado es poco frecuente en el adulto. Presentamos un paciente de 19 años de edad, con dolor abdominal de 11 horas de evolución, encon­ trando al realizar la laparotomía exploradora un divertículo de Meckel gigante, necrosa­ do y volvulado. Las presentaciones más frecuentes del divertículo de Meckel son la obstrucción intestinal y la diverticulitis, esta última da una sintomatología similar a la apendicitis aguda, por lo que al realizar la exploración quirúrgica y encontrar el apéndi­ ce cecal normal, se debe visualizar los últimos 180 cm de íleo terminal.

Meckel's diverticulum is rare in adults. We present a 19­year­old patient with abdominal pain of 11 hours of evolution, finding a giant Meckel diverticulum, necrotic and volvula­ ted, when performing the exploratory laparotomy. The most frequent presentations of Meckel's diverticulum are intestinal obstruction and diverticulitis, the latter being a symptomatology similar to acute appendicitis, surgical surgery and the normal cecal ap­ pendix, the last 180 cm of terminal ileum should be visualiz

Actualización en diagnóstico de divertículo de Meckel como causa de hemorragia gastrointestinal / Update in diagnosis of Meckel's diverticulum as a cause of gastrointestinal hemorrhage

El Divertículo de Meckel es la malformación congénita más común del sistema gastrointestinal1 , se produce al obliterarse el conducto onfalomesentérico a nivel proximal formando un divertículo verdadero en el borde anti mesentérico a nivel del íleon, el cual debería cerrarse entre la 5ta y 6ta semana de gestación normalmente. Sus alteraciones pueden dar lugar a pólipos ductales, bandas fibrosas, quistes ductales, fístulas íleoumbilicales o más frecuentemente al Divertículo de Meckel; estas variaciones pueden asociarse a otras malformaciones en el sistema nervioso o cardiovascular2 . Los remanentes onfalomesentéricos son más frecuentes en hombres que en mujeres, con una relación 2:1, siendo la incidencia general de un 2%3 . La mayoría de los casos se mantienen asintomáticos, pero algunos pacientes, sobre todo en edades pediátricas, pueden presentar síntomas como hemorragia gastrointestinal, torsión intestinal, obstrucción o infección4 . Dada su escasa e inespecífica sintomatología, es que podría llevar al clínico a confundirlo con otros diagnósticos diferenciales tales como la Enfermedad Inflamatoria Intestinal, Úlceras u otras patologías. Esta una de las razones por las que nos parece relevante realizar una revisión de las técnicas diagnósticas disponibles en la actualidad con el fin de determinar las mejores opciones diagnosticas dependiendo del medio en que se desenvuelva el clínico.

Meckel Diverticulum is the most common congenital malformation of the gastrointestinal system1 , it occurs when the omphalomesenteric duct is obliterated proximally, forming a true diverticulum in the anti-mesenteric border at the level of the ileum, which should be closed usually between the 5th and 6th week of gestation. Its alterations can give rise to ductal polyps, fibrous bands, ductal cysts, ileo-umbilical fistulas or more frequently to Meckel's diverticulum; These variations can be associated with other malformations in the nervous or cardiovascular system2 . Omphalomesenteric remnants are more frequent in men than in women, with a 2: 1 ratio, with a general incidence of 2% 3 . Most cases remain asymptomatic, but some patients, especially at pediatric ages, may present symptoms such as gastrointestinal bleeding, intestinal torsion, obstruction or infection4 . Given its scarce and unspecific symptomatology, it could lead the clinician to confuse it with other differential diagnoses such as Inflammatory Bowel Disease, Ulcers or other pathologies. This is one of the reasons why it seems relevant to review the diagnostic techniques currently available to determine the best diagnostic options depending on the environment in which the clinician operates

Divertículo de Meckel. A propósito de un caso / Meckel's diverticulum. Apropos of a case

RESUMEN El divertículo de Meckel es una evaginación en dedo de guante del borde antimesentérico del íleon, constituido por sus capas, debido a una persistencia embriológica del extremo proximal del conducto onfalomesentérico. Forma una bolsa a manera de tubo y que puede extenderse hasta la región umbilical, su inflamación (diverticulitis) produce un cuadro clínico semejante al de la apendicitis aguda, por lo que su diagnóstico preoperatorio es raro. Por lo infrecuente, los médicos no piensan seriamente en esta patología y su diagnóstico definitivo se realiza durante el transoperatorio. Se presentó un caso por lo infrecuente que resulta lo cual aporta conocimiento a la comunidad médica sobre el tema. Paciente de 68 años, acude al centro con dolor tipo cólico, taquicardia y fiebre de 38.5C°, con 24 h de evolución. Refiere que el dolor se le hizo fijo hacia fosa iliaca derecha, el cual se fue intensificando. Se decidió su ingreso para tratamiento quirúrgico. Se realizó apendicectomia y resección y anastomosis en la zona del divertículo. Se recibió biopsia informando diverticulitis de Meckel.

ABSTRACT Meckel's diverticulum is an evagination resembling a glove finger of the ileum anti-mesenteric edge, formed by layers due to an embryologic persistence of the proximal end of omphalo-mesenteric duct. It forms a sac like a tube that may extend up to the umbilical region; its inflammation (diverticulitis) has clinical characteristics similar to the acute appendicitis ones, making its pre-surgery diagnosis very unusual. Due to its frequency, doctors often do not take this disease into account, and it is definitely diagnosed during the trans-operative. The case was presented due to its infrequency, bringing knowledge on the theme to medical community. A patient aged 68 years assisted the hospital with a colic-like pain, tachycardia and fiver of 38.5oC after 24 hours of evolution. He refers that the pain became fixed in the right iliac fosse and got more intensity. The decision was entering him for surgical treatment. Appendectomy, resection and anastomosis were carried out in the area of the diverticulum. The received biopsy informed Meckel's diverticulum.

Anemia ferropénica severa asintomática como presentación inusual de divertículo de Meckel / Severe asymptomatic iron deficiency anemia as an unusual presentation of a Meckel diverticulum

El divertículo de Meckel es un diagnóstico poco frecuente dentro de la práctica clínica diaria. Sin embargo, debe ser considerado dentro del diagnóstico diferencial de todo paciente que acude por hemorragia digestiva oscura, tanto manifiesta como oculta. Anteriormente, el intestino delgado era inexplorable; en la actualidad, su evaluación es posible gracias a nuevos métodos diagnósticos: cápsula endoscópica, enteroscopía, enterotomografía y enteroresonancia. La cápsula endoscópica no permite tomar biopsias, es un examen sin insuflación, no controlado y depende mucho de la interpretación del evaluador. Sin embargo, dentro del algoritmo diagnóstico de todo paciente con hemorragia digestiva oscura, la cápsula endoscópica suele ser el estudio inicial, por ser mínimamente invasiva y por permitirnos definir la mejor ruta de abordaje para realizar procedimientos posteriores, como la enteroscopía asistida por balón (simple o doble) que nos permite profundizar la evaluación del intestino delgado, tomar biopsias y hacer medidas terapéuticas. Como veremos, la cápsula endoscópica y la enteroscopía asistida por balón son complementarios y no excluyentes en todo paciente con hemorragia oscura. En este reporte presentamos el caso de un paciente adulto joven, asintomático, deportista, que en un examen de rutina evidenció anemia severa por deficiencia de hierro, sin historia de pérdidas gastrointestinales manifiestas. La evaluación del intestino delgado, mediante cápsula endoscópica y enteroscopía asistida por balón, nos permitió demostrar la presencia de un divertículo de Meckel ulcerado, y una laparoscopia orientada por los hallazgos nos permitió un tratamiento efectivo y una evolución favorable de esta presentación poco frecuente.

Meckel's diverticulum is a rare clinical entity in clinical practice. However, it should be considered as an important differential diagnosis in patients with both obscure overt and occult gastrointestinal bleeding. Years ago, the evaluation of the small bowel was impossible without surgery, nowadays the development of new diagnostic methods has changed this horizon. Capsule endoscopy cannot take biopsies, has not bowel insufflation, and its final report depends a lot on the interpretation of the evaluator. However, capsule endoscopy is usually the first procedure in all patients with obscure gastrointestinal bleeding, because is minimally invasive, and it has a main role in predicting the better route to perform a balloon assisted enteroscopy (single or double) that allows us to explore the small bowel, take biopsies and do therapeutic procedures. Capsule endoscopy and balloon assisted enteroscopy are complementary procedures in every patient with obscure gastrointestinal bleeding. In this report, we present a case of young adult without history of gastrointestinal bleeding who had severe asymptomatic iron deficiency anemia, in which the evaluation of small bowel with capsule endoscopy and balloon-assisted enteroscopy allow us to diagnosis ulcerated Meckel diverticulum.

Divertículo de Meckel en adultos / Meckel´s diverticulum in adults

Introducción: El divertículo de Meckel es el remanente de la porción proximal del conducto vitelino y representa la anomalía congénita más frecuente del aparato gastrointestinal. Objetivo: Definir el valor de los métodos de diagnóstico actuales, las complicaciones y sus causas y el tratamiento apropiado del divertículo de Meckel. Métodos: Se realizó la revisión de la literatura en PubMed/Medline y en Infomed con las palabras clave Meckel´s diverticulum, diagnosis, complicaciones, tratamiento y las correspondientes en español, publicados en los últimos 5 años. Se incluyeron, de preferencia, los artículos dedicados a series de casos. Se excluyeron los dedicados a casos pediátricos. Resultados: Se encontraron 4260 artículos en Medline/Pubmed y 17 en Infomed. No se encontraron ensayos clínicos, metanálisis, ni revisiones sistemáticas. La mayoría de los artículos revisados hacen referencia a presentación de casos y algunos fueron estudios retrospectivos. Conclusiones: El divertículo de Meckel es raro en adultos y, regularmente, se diagnostica durante una laparotomía por otras causas. El diagnóstico preoperatorio es difícil porque los síntomas simulan los de otras afecciones del cuadrante inferior derecho; apendicitis aguda la más frecuente. La imaginología, principalmente la TAC, juega un rol importante en el diagnóstico preoperatorio. El tratamiento quirúrgico del divertículo de Meckel encontrado incidentalmente, es controversial. El divertículo sintomático debe ser extirpado conjuntamente con una porción del íleon adyacente, por la posibilidad de mucosa ectópica gástrica o pancreática, además de tumores asociados. Los índices de mortalidad en estos pacientes son altos. El diagnóstico temprano evita complicaciones adicionales y la hospitalización prolongada(AU)

Introduction: Meckel's diverticulum is the remnant of the proximal portion of the vitelline duct and represents the most frequent congenital abnormality in the gastrointestinal tract. Objective: To define the value of current diagnostic methods, complications and their causes, and the appropriate treatment for Meckel's diverticulum. Methods: Literature review was carried out in PubMed/Medline and Infomed, with the keywords Meckel's diverticulum, diagnosis, complications, treatment and the corresponding Spanish words, published in the last 5 years. Preferably, we included the articles about case series. We excluded those dedicated to pediatric cases. Results: 4260 articles were found in Medline/Pubmed and 17, in Infomed. No clinical trials, meta-analyzes or systematic reviews were found. Most of the articles reviewed refer to case presentations and some were retrospective studies. Conclusions: Meckel's diverticulum is rare in adults and is regularly diagnosed during a laparotomy for other causes. The preoperative diagnosis is difficult because the symptoms simulate those for other conditions of the right lower quadrant, acute appendicitis being the most frequent. Imaging techniques, mainly CAT, play an important role in the preoperative diagnosis. The surgical treatment for Meckel's diverticulum incidentally found is controversial. The symptomatic diverticulum must be removed together with a portion of the adjacent ileum, due to the possibility of gastric or pancreatic ectopic mucosa, as well as associated tumors. Mortality rates in these patients are high. Early diagnosis avoids additional complications and prolonged hospital stay(AU)

Persistencia de conducto onfalomesenterico permeable / Patent onfalomesenteric conduct / Persistência do ducto onfalomesentérico permeável

La persistencia del conducto onfalomesentérico permeable es una de las formas de presentación menos frecuente, dentro de la patología, de los restos embrionarios derivados de este conducto. Se presenta el caso de un lactante de 30 días de vida a quien se le hace un diagnóstico de conducto onfalomesentérico permeable y se realiza cirugía resectiva, con una buena evolución postoperatoria inmediata y con alta a domicilio a los 8 días. Se revisan los datos de embriología así como de patología, la presentación clínica, los diagnósticos diferenciales y las opciones terapéuticas.

The persistence of permeable omphalosenteric duct is one of the less frequent forms of presentation, within the pathology, of the embryonic remnants derived from this duct. We present the case of a 30-day-old infant who is diagnosed with permeable omphalomesenteric duct, and resective surgery is performed, with a good postoperative evolution and with home discharge at 8 days. The embryology data as well as the pathology, the clinical presentation, the differential diagnoses and the therapeutic options are reviewed.

A persistência do ducto onfalossentérico permeável é uma das formas menos freqüentes de apresentação, dentro da patologia, dos remanescentes embrionários derivados desse ducto. Apresentamos o caso de um lactente de 30 dias que é diagnosticado comducto oncomumentérico permeável, sendo realizada cirurgia ressectiva, com boa evolução pós-operatória e com descarga domiciliar aos 8 dias. Os dados da embriologia, bem como a patologia, a apresentação clínica, os diagnósticos diferenciais e as opções terapêuticas são revisados.

Diverticulo de meckel: reporte de casos / Meckel's diverticulum. Case reports

El divertículo de Meckel es el defecto congénito más frecuente del tracto gastrointestinal. Se trata de un remanente del conducto onfalome- sentérico, una estructura que conecta el saco vitelino primitivo al intestino medio durante el desarrollo del feto. El conducto onfalomesenté- rico se oblitera entre la quinta y séptima sema- nas de gestación. Generalmente se encuentra localizado en el último metro de intestino delga- do en el borde antimesentérico. Puede ser asintomático o manifestarse como un cuadro de abdomen agudo. Las complicaciones en un escaso número de pacientes pueden ser: infección, sangrado digestivo, obstrucción y raramente transformación maligna. A continuación, se presentan 4 casos de pacien- tes pediátricos con diagnóstico postoperatorio de divertículo de Meckel del Instituto Hondure- ño de Seguridad Social de San Pedro Sula, durante el período 2012-2014. El presente artículo se realizó con la nalidad de brindar una lección clínica a los colegas y permitir ampliar sus conocimientos sobre esta entidad...(AU)

Divertículo de Meckel: revisão de literatura / Meckel's diverticulum: a literature review

O divertículo de Meckel (DM) é considerado a anormalidade congênita mais comum do trato gastrintestinal. Resulta de falha na obliteração do ducto onfalomesentérico (ducto vitelino) e, geralmente, apresenta-se como divertículo curto, de base larga, localizado na borda antimesentérica do íleo a aproximadamente 90 cm da válvula ileocecal. É assintomático na maioria dos casos e diagnosticado acidentalmente em laparotomia/laparoscopia indicadas por outras causas. Manifesta-se em crianças pela hemorragia digestiva e nos adultos pelo desenvolvimento de processos abdominaisobstrutivos ou inflamatórios. Suas principais complicações são: hemorragia, intussuscepção, volvo, formação de enterólitos, inflamação, perfuração, obstrução e neoplasia. A confirmação diagnóstica é definida por exames de imagem como a ultrassonografia abdominal, tomografia computadorizada, cintilografia e angiografia. A conduta em pacientes assintomáticos é controversa, entretanto, em pacientes sintomáticos, a indicação cirúrgica é consenso. Sua abordagem requer a diverticulectomia simples ou a enterectomia segmentar com reconstrução pela anastomose primária término-terminal.

Meckel's diverticulum (MD) is considered the most common congenital abnormality of the gastrointestinal tract. It results from a failed obliteration of the omphalomesenteric duct (vitelline duct), and generally presents as short diverticulum of wide base, located in the antimesenteric border of the ileum, about 90cm from the ileocecal valve. It is asymptomatic in most cases and diagnosed accidentally by laparotomy/laparoscopy indicatedfor other causes. It manifests as gastrointestinal bleeding in children and in adults by developing abdominal obstructive or inflammatory processes. Its main complications are bleeding, intussusception, volvulus, enterolith formation, inflammation, perforation, obstruction, and neoplasia. Diagnostic confirmation is defined by imaging studies such as abdominal ultrasound, computed tomography, scintigraphy, and angiography. Clinical conduct in asymptomatic patients is controversial; however, in symptomatic patients,surgical indication is a consensus. The approach requires simple diverticulectomy or segmental bowel resection with primary reconstruction by end-to- end anastomosis.