Laparoscopic reduction of an ileoileal intussusception and resection of an inverted Meckel's diverticulum in an adult.

Intussusception occurs commonly in children, but rarely is observed in adults. Whereas the hydrostatic pressure of a contrast enema often proves diagnostic as well as therapeutic in infants and children, resection usually is required for an underlying bowel pathology in older children and adults. Conventionally, the resection is accomplished at laparotomy. We report the case of a 20-year-old woman who presented with diarrhea and vomiting of 1 week duration. She was found unexpectedly to have intussusception on abdominal ultrasonography. The intussusception was laparoscopically reduced, and a segment of the middle small bowel that harbored an inverted Meckel's diverticulum was resected laparoscopically, after which an intracorporeal anastomosis was fashioned. The ileus resolved on postoperative day 4, and the patient was discharged from hospital on postoperative day 5. The role of the laparoscopic approach in the management of intussusception is discussed.

Meckel's diverticulum in adults: retrospective analysis of 119 cases and historical review.

OBJECTIVE: To publish our experience in the management of Meckel's diverticula in adults, and compare our results with those published elsewhere. DESIGN: Retrospective investigation of casenotes. SETTING: Multicentre study, Switzerland. SUBJECTS: 119 patients aged over 16 years who had Meckel's diverticula resected between 1980 and 1997. MAIN OUTCOME MEASURES: Assessment of the usefulness of various investigations and the criteria for removing asymptomatic diverticula. RESULTS: 67 diverticula (56%) were resected during laparotomy for another cause, and 52 (44%) for symptoms caused by the diverticula. In both groups the condition was more common in men, and most likely to present during the fourth decade. The most common investigation in the 52 symptomatic cases was a plain film of the abdomen (n = 47, 90%), and in none was a Meckel's diverticulum suggested as the cause of the symptoms. The success rates of other investigations were: small bowel enema 4/9, 99mTc scan 3/4, angiography 1/3, and computed tomography 1/14. No ultrasound scans were done. Our results compared favourably with those reported elsewhere, with no deaths in either group, 2 complications that required reoperation in the incidental group, and 1 in the symptomatic group. CONCLUSIONS: The criteria to be taken into account when deciding to resect an asymptomatic diverticulum are: male sex, age <40, ASA score, the operation being done, the size and position of the diverticulum, whether it is palpable, and whether there are other reasons for the patient's complaints.

Ectopic gastric mucosa presenting as a polypoid mass within a Meckel's diverticulum.

A 32-year-old man presented with severe abdominal pain located in the mesogastrium and right hemi-abdomen. A barium transit study showed a tubular structure of 6 cm arising from a bowel loop in the distal ileum, with an intraluminal polypoid mass near the bottom. Diagnosis of a benign lesion within a Meckel's diverticulum was made. Anatomopathology confirmed a Meckel's diverticulum and demonstrated that the polypoid mass was caused by an unusual great ectopic island of gastric mucosa.

[Diagnosis of Meckel diverticulum, containing ectopic gastric mucosa", by studying small bowel passage]. / Ectopiás gyomornyálkahártyát tartalmazó Meckel-diverticulum felismerése vékonybél-passage vizsgálattal.

Radiological diagnosis of Meckel diverticulum is a difficult task. Here we report a patient with hereditary sphaerocytosis who complained of a chronic periumbilical pain and in whom antegrade barium enema suggested Meckel diverticulum. The diagnosis had been proven both surgically and histologically. This observation indicates that so called traditional x-ray still has its role even in the era of modern (and expensive) radiology.

Pseudolipoma of inverted Meckel's diverticulum: clinical, radiological and pathological correlation.

Three cases of isolated inverted Meckel's diverticulum are described. In two cases an initial pathological diagnosis of small bowel lipoma was suggested. In a third case central fat was demonstrated on CT and peristalsis of the intraluminal polypoid mass was observed during US examination. In all three cases small bowel enema examination demonstrated the lesion. Correlation of the clinical, radiological and pathological features is emphasised, as this will allow the correct diagnosis.

Inverted Meckel diverticulum: clinical, radiologic, and pathologic findings.

PURPOSE: To determine the clinical, radiologic, and pathologic findings of inverted Meckel diverticulum by retrospectively reviewing a large series of cases. MATERIALS AND METHODS: Among 84 cases of Meckel diverticulum, 18 (21%) were found at surgery to be inverted into the lumen of the bowel. Thirteen of these 18 (72%) cases were associated with small bowel intussusception and five (28%) were not. RESULTS: All 18 patients (median age at time of diagnosis, 32 years) were symptomatic, but the symptoms were subacute or chronic in 14 (78%). At barium examination in 15 cases, inverted diverticulum was depicted in 10 (67%) as a solitary, elongated, smoothly marginated, often club-shaped intraluminal mass in the distal ileum. At computed tomography (CT) in three cases, a central area of fat attenuation was surrounded by a thick collar of soft-tissue attenuation. At ultrasound (US) in two cases, a target-like mass contained a central area of increased echogenicity. At pathologic examination in all cases, the inverted sac contained mesenteric fat. CONCLUSION: Inverted Meckel diverticulum occurs more commonly than previously recognized and is associated with characteristic findings at barium examination, CT, and US.

[Atopic stomach polyp as the cause of invagination of Meckel's diverticulum]. / Dystoper Magenpolyp als Ursache der Invagination eines Meckel'schen Divertikels.

We report a 16 year old boy with suspected appendicitis. Besides leucocytosis a roll was palpable in the right lower quadrant. The enema with water soluble contrast medium revealed an invagination. Intraoperatively, reduction was possible. The cause was an inverted Meckel's diverticulum. In this diverticulum we found a large perpendicular hyperplasiogenic gastric polyp as the cause of inversion and invagination.

Vesico-diverticular fistula: a rare complication of Meckel's diverticulum.

Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can also result in an vesico-diverticulum fistula, as noted in three previously reported cases. In all three cases, bladder or bowel disease was associated with the fistula. Herein, the authors describe a previously healthy, 23-year-old man who presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue and that the perforation was secondary to an enterolith. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike any of the three previously reported cases, the authors' patient had no coexisting bowel or bladder disease occurring with his vesico-diverticular fistula. To the authors' knowledge, this is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum that did not contain ectopic tissue. It represents the first case where the perforation was secondary to an enterolith.

[Value of barium transit of the small intestine in research on Meckel's diverticulum]. / Intérêt du transit baryté du grêle dans la recherche du diverticule de Meckel.

Twelve children were diagnosed as having a bleeding Meckel diverticulum upon laparotomy. Before surgery, barium small bowel examination was performed according to the Bret technique (J Radiol Paris [1980] 61, 753-758) in 8 cases; the Meckel diverticulum being apparent in all 8 cases. By contrast, a classical technique of barium small bowel examination used in 4 cases, and 99m TC pertechnate scan performed in 7 cases, yielded only negative results. We conclude that barium small bowel examination, when performed according to the Bret's technique, is a very effective method for the diagnosis of Meckel diverticulum.

Intussuscepted Meckel diverticulum: radiologic-pathologic correlation.

Nine cases of Meckel diverticulum presenting with intussusception were reviewed and correlated clinically, radiologically and pathologically. The appearance of intussuscepted Meckel diverticulum by small bowel series is not specific. However, by CT, a central fat density surrounded by a thick collar of soft tissue was noted in one case correlating well with the gross pathologic appearance. The pathologic material in all our cases suggests that this CT appearance is characteristic of an inverted Meckel diverticulum.

[A case of intestinal occlusion caused by a Meckel' diverticulum (etiopathogenetic, diagnostic and clinical considerations)]. / Su di un caso di occlusione intestinale da diverticolo di Meckel (Considerazioni etiopatogenetiche, diagnostiche e cliniche).

The authors show a case of acute intestinal stoppage due to Meckel's diverticulum. After some notices about embryogenesis, pathological anatomy and symptomatology of Meckel's diverticula, they point out the difficulty to reach the diagnosis of such disease, which almost always is only done subsequent to the appearance of complications, such as: intestinal stoppage, inflammation, ulceration, perforation, neoplasms, bleeding. In fact, the diagnosis of Meckel's diverticulum is exceptionally preoperative and difficult on the basis of the symptomatology only, for which the disease can be responsible, whereas it can be more easily placed thanks to the contribution of instrumental methods, such as: barium meal, opaque enema, scintigraphy with 99mNa pertechnetate, selective arteriography of upper mesenterial artery. The diagnosis is more frequently interoperative, in course of explorative laparotomy or performed for other indications. Then the Authors state their orientation about the treatment, which is surgical in all the complex cases of Meckel's diverticulum, with a mention of the different operative techniques, and, as a conclusion, confirm the necessity for the systematic research of the asymptomatic diverticulum, the removal of which represents the only prophylactic measure against a permanent possibility and dreadful complicative evolution of same.

[Meckel's diverticulum in the adult. Double-contrast study of 7 cases]. / Le diverticule de Meckel de l'adulte. Etude en double contraste de 7 observations.

The authors report 7 cases of Meckel's diverticulum on a series of 500 double contrast small bowel enema (1,4%). In two cases, the diverticulum is not recognized by repletion study. So, they find that the double contrast small bowel enema is the most accurate method to detect a Meckel's diverticulum.