Obscured Meckel's Diverticulum by the Urinary Bladder: The Value of Lateral View and Post Void Images.

We describe a case of a 5-year-old boy with a history of intermittent melena underwent TcO4 scintigraphy. On dynamic images, no abnormal activity was noted. After voiding and also in the lateral view, the focus of activity was noted in the superior and anterior aspect of the urinary bladder, compatible with a Meckel's diverticulum, which was confirmed pathologically as well.

[Rare Clinical Case of a Small Intestine Ileus Following an Invaginated Meckel's Diverticulum]. / Seltener klinischer Fall eines Dünndarm-Ileus in Folge eines invaginierten Meckel'schen Divertikels.

MEDICAL HISTORY AND CLINICAL FINDINGS: A 43-year old male patient was admitted because of diffuse abdominal discomfort for two days, which had started in the upper abdomen; medical history, no previous surgical interventions at the abdomen. INVESTIGATIONS: Gastroscopy and abdominal ultrasound revealed only a mild gastritis. Laboratory parameters: showed only a slight leucocytosis (10 610/µL). On the 1st day of the hospital stay, the patient developed a worsening of the abdominal symptoms with distended abdomen, sounding bowel movements and recurrent vomiting, which were interpreted as acute abdomen by the surgeon on call leading to the indication of a surgical intervention. CT scan revealed an intraluminal tumor. DIAGNOSIS: Suspicion of a mechanical ileus by an obstructing tumor of the small intestine. THERAPY: Median laparotomy of the lower abdomen revealed an invagination at the terminal ileum - after devagination, an invaginated Meckel's diverticulum was found. This was resected at its basis and the ileal wall was transversally sutured. COURSE: The postoperative course was uneventful. DISCUSSION (CONCLUSION): An invaginated Meckel's diverticulum belongs rather to the less frequent causes of an ileus of the small intestine and an unclear / acute abdomen in adults.

Clinical characteristics of Meckel diverticulum in children: A retrospective review of a 15-year single-center experience.

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.

Meckel's diverticulum in the adult.

Meckel's diverticulum (MD) is the most common gastro-intestinal congenital malformation (approximately 2% in the overall population). The lifetime risk of related complications is estimated at 4%. These include gastro-intestinal bleeding, obstruction or diverticular inflammation. Diagnosis is difficult and rarely made, and imaging, especially in the case of complicated disease, is often not helpful; however exploratory laparoscopy is an important diagnostic tool. The probability of onset of complication decreases with age, and the diagnosis of MD in the adult is therefore often incidental. Resection is indicated in case of complications but remains debatable when MD is found incidentally. According to an analysis of large series in the literature, surgery is not indicated in the absence of risk factors for complications: these include male gender, age younger than 40, diverticulum longer than two centimetres and the presence of macroscopically mucosal alteration noted at surgery. Resection followed by anastomosis seems preferable to wedge resection or tangential mechanical stapling because of the risk of leaving behind abnormal heterotopic mucosa.

Divertículo de Meckel. Actualización / Meckel's diverticulum. Up dateinformations

Se realizó una revisión bibliográfica sobre el divertículo de Meckel (DM); enfermedad no frecuente que se presenta generalmente en niños, aparece de forma asintomática y obedece a una malformación congénita. Se abordaron aspectos de su anatomía, fisiología, frecuencia, clínica, complicaciones, diagnóstico diferencial e incidencia. Se realizan consideraciones finales al respecto(AU)

A bibliographical review was done on the Meckel diverticulum topic. It is an uncommon disease that usually occurs in children, asymptomatically due to congenital malformations. It dealt with aspects of its anatomy, physiology, frequency, clinical, complications, differential diagnosis and incidence. Final considerations are made(AU)

Many faces of Meckel's diverticulum and its complications.

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is a true diverticulum containing all layers of the intestinal wall and identified as a saccular, blind-ending structure located on the antimesenteric border of the distal ileum. Most patients remain asymptomatic during their lifetime. Symptomatic cases are nonspecific and can present as small-bowel obstruction, diverticulitis, perforation, gastrointestinal bleeding, and rarely, a neoplasm. Therefore, the radiological diagnosis is of paramount important for proper patient management.

Colonic cyst in a cat presenting recurrent constipation and abdominal pain.

A 5-year-old domestic short-haired spayed female cat was presented for abdominal pain and suspended defecation. Abdominal radiographs confirmed constipation; abdominal ultrasonography showed a cystic oval structure attached to the colon. The structure exhibited a well-defined wall, composed of three layers. Its content was mildly echogenic and inhomogeneous. Laparotomy was performed and complete resection of the structure, and of part of the colon, was required (end-to-end anastomosis). Histopathology confirmed the structure to be a cystic formation of the colon with some areas of mucosal metaplasia. However the question whether the cystic structure was consistent with an intestinal duplication cyst - which is the most likely type of cyst in this particular case - a Meckel's diverticulum remnant, a vitelline duct cyst or a cystic diverticulum of the colon could not be resolved. Postoperatively, no further other episode of constipation occurred.

[Giant Meckel's diverticulum in an adult]. / Divertículo de Meckel gigante en un adulto.

Meckel's diverticulum results from a partial persistence of the omphalomesenteric duct and is the most common congenital anomaly of the gastrointestinal tract, affecting about 2% of the general population. Its presentation as a giant Meckel's diverticulum (>5 cm) is rare and is associated with major complications. We report a case of a 53 year-old woman with constipation for at least ten years. A colonoscopy from eight years ago suggested megacolon. The patient consults in the last month for abdominal pain associated with anorexia. The computed tomography scan image suggested an ileal megadiverticulum. An exploratory laparotomy revealed a saccular dilatation of the distal ileum of 6 x 15.5 cm, located 20 cm away from the ileocecal valve. We resected the involved segment of distal ileum and performed a manual ileo-ascendo anastomosis. The biopsy showed a saccular dilatation of the wall, lined by small intestinal mucosa with areas of gastric metaplasia, supporting the diagnosis of giant Meckel's diverticulum.

El divertículo de Meckel corresponde a la persistencia parcial del conducto onfalomesentérico, representa la anomalía congénita más frecuente del tracto gastrointestinal y afecta alrededor del 2% de la población general. La presentación como divertículo de Meckel gigante (>5 cm) es infrecuente y está asociada a una mayor tasa de complicaciones. Se presenta el caso de una mujer de 53 años que refiere constipación de al menos diez años; una colonoscopía de hace ocho años sugiere un megacolon y en el último mes la paciente ha presentado dolor abdominal asociado a anorexia. Se realiza una tomografía computarizada con imagen que sugiere la presencia de megadivertículo ileal, por lo que se decide realizar una laparotomía exploradora que evidencia una dilatación sacular del íleon distal a 20 cm de la válvula ileocecal de 15,5 x 6 cm aproximadamente. Se reseca el segmento comprometido del íleon distal, que queda cerrado a nivel de la válvula ileocecal, y se realiza una íleo-ascendo anastomosis manual. La biopsia informa dilatación sacular de la pared, revestida por mucosa de intestino delgado con áreas de metaplasia gástrica, hallazgos compatibles con un divertículo de Meckel gigante.

Massive gastrointestinal bleeding from Meckel diverticulum with ectopic pancreatic tissue.

Meckel diverticulum (MD), a congenital gastrointestinal anomaly, is often involved in pediatrics, but less in the adult population. The patient in this report was a 69-year-old female presented with massive gastrointestinal bleeding causing hemorrhagic shock due to MD containing ectopic pancreatic tissue. A review of the literature revealed that gastrointestinal bleeding from MD containing ectopic pancreatic tissue is rare in adults and difficult to be identified preoperation. MD should be considered as one of the differential diagnosis for lower gastrointestinal bleeding, although scarce in adults, especially when the patient has massive painless bleeding.

Utility of SPECT/CT with Meckel's scintigraphy.

Meckel's diverticulum is a relatively common source of gastrointestinal tract morbidity in children. Individuals may present with symptoms of lower gastrointestinal tract bleeding, bowel obstruction or diverticulitis. Technetium-99 m pertechnetate scintigraphy is used to demonstrate those Meckel's diverticula that contain heterotopic gastric mucosa. We present a case of an adolescent male patient with rectal bleeding and suspected Meckel's diverticulum where the use of SPECT/CT fusion imaging provided valuable diagnostic information and prevented a false-negative study.

Meckel's diverticulum masked by a long period of intermittent recurrent subocclusive episodes.

Meckel's diverticulum (MD) is the most frequent congenital abnormality of the small bowel and it is often difficult to diagnose. It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. The authors report a case of a 7-year-old boy with a one-year history of recurrent periumbilical colicky pain with associated alimentary vomiting, symptoms erroneously related to a cyclic vomiting syndrome but not to MD. The clinical features and the differential diagnostic methods employed for diagnosis of MD are discussed.

Torsion and gangrene of a Meckel's diverticulum.

A 19-year-old woman presented to the emergency department with intermittent and progressively worsening abdominal pain, nausea, and vomiting. A computed tomographic scan revealed findings consistent with distal small bowel obstruction of unknown etiology. In the operating room, a torsed and gangrenous Meckel's diverticulum with extension of ischemia to adjacent small bowel was discovered and immediately resected. Pathology confirmed the diagnosis of gangrenous Meckel's diverticulum. Torsion and gangrene of a Meckel's diverticulum is a rare complication and often presents with vague and poorly localized signs and symptoms. The preoperative diagnosis is often difficult and presumed to be appendicitis or small bowel obstruction of unclear etiology. Complications of Meckel's diverticulum should be considered in patients with lower abdominal pain and acute abdomen.

Estrangulação de intestino delgado devido a divertículo de Meckel e banda mesodiverticular em égua gestante – relato de caso / Strangulation of the small intestine by Meckel´s diverticulum and mesodiverticular band in a pregnant mare – Case Report

O objetivo deste trabalho é descrever a ocorrência de cólica por estrangulação intestinal ocasionada por banda mesodiverticular (BMD) e divertículo de Meckel (DM) em uma égua no terço final de gestação com histórico de 20 horas de cólica moderada contínua sem resposta à administração de analgésicos. Pela celiotomia constatou-se a presença de BMD e DM medindo 15cm a partir da borda anti-mesentérica, ocasionando estrangulação intestinal distante 150cm do orifício ileocecal. Realizaramse enterectomia de 290cm de alça necrosada, drenagem do conteúdo enegrecido e fétido do intestino remanescente, seguida de by pass do ceco por jejuno-colonostomia. Durante o pós-operatório, o quadro se manteve refratário à terapia intensiva instituída. O animal voltou a ter refluxo pela sonda nasogástrica e ocorreu abortamento após seis dias, sendo praticada a eutanásia após 24 horas. A BMD e o DM são estruturas remanescentes dos componentes onfalomesentéricos vitelinos, e sua ressecção deve ser considerada sempre que essas estruturas forem diagnosticadas durante a cirurgia abdominal em equinos. A égua deste relato viveu cinco anos sem consequências aparentes, até que tais alterações provocaram a estrangulação intestinal.

The objective of this report is to describe the occurrence of intestinal strangulation caused by mesodiverticular band (MDB) and Meckel´s diverticulum (MD) in a mare at the latter third of gestation with a 20 hours history of moderate colic unresponsive to analgesic medication. The celiotomy revealed the presence of 5.9 inches long MD and MDB causing intestinal strangulation 59 inches from the ileocecal valve. It was performed an enterectomy of 115 inches of necrotic loop, drainage of the dark and fetid content of the remaining intestine, followed by cecum bypass through jejunocolostomy. Despite the intensive therapy established during postoperative, the gastric reflux through the nasogastric tube came back, the mare suffered abortion after six days, and the euthanasia was performed after 24 hours. MDB and MD are remaining structures of vitelline omphalomesenteric components and their resection should be considered whenever these structures are diagnosed during abdominal surgery in equines. The mare on this report lived five years without apparent consequences; until the moment these alterations caused intestinal strangulation.

Is incidental Meckel's diverticulum resected safely?

AIM: Meckel's diverticulum (MD) is the most common congenital anomaly of the small intestine. The majority of MD cases are discovered incidentally. On the other hand, there is disagreement about the management of incidentally discovered asymptomatic MD. The aim of the study was to compare the clinicopathologic characteristics of incidentally found and symptomatic cases of MD, and to compare morbidity and mortality in symptomatic and asymptomatic patients. PATIENTS AND METHODS: Records of patients whose MD was resected at our institution between 1989 and 2004 were reviewed and 76 patients were found. The patients were divided into two groups. The incidental group included patients in whom the MDs were found incidentally during the course of laparotomy performed for reasons not related to the diverticular complications. The symptomatic group included patients who presented with complications related to the MDs. We compared the clinicopathologic characteristics of the patients between the two groups RESULTS: The incidental group included 40 patients (34 males) and the symptomatic group included 36 patients (30 males). There was no significant difference between the two groups with respect to age, gender, APACHE scores, postoperative complications, and hospital stay. There were two deaths in the symptomatic group. There was a significant correlation between operative mortality and APACHE II scores. CONCLUSIONS: Resection of incidentally found MD is not associated with increased operative morbidity or mortality.

Intestinal malrotations: a review and report of thirty cases.

Intestinal malrotation is a developmental anomaly affecting the position and peritoneal attachments of the small and large bowels during organogenesis in foetal life. It has been defined as absent or incomplete rotation and fixation of the embryonic gut around the superior mesenteric artery. In the present paper, we review the definition, history, embryology/aetiology, epidemiology, symptoms and signs, diagnosis and treatment of intestinal malformations. Moreover, we report the records of 30 cases of malrotation admitted to our department over a period of five years. The final intraoperative diagnosis of the cases presented was 53.3% pure malrotation, 33.3% malrotation with mid-gut volvulus, 6.7% malrotation with duodenal atresia, 3.3% malrotation with Meckel's diverticulum and duodenal atresia, and 3.3% malrotation and biliary atresia. Preoperative imaging studies were performed for 27 cases and surgical management was successfully conducted without any mortality among the cases studied. This article provides an overview of basic and clinical aspects of intestinal malrotation. In addition, the signs and symptoms, imaging findings, and final intraoperative diagnoses presented by the subjects reported on are of potential use and clinical interest.

Invaginación intestinal secundario a linfoma no hodgkin: a propósito de un caso / Intestinal invagination secondary to non-hodking`s lymphoma: a purpose of a case

La invaginación se define como la penetración de una porción del intestino, en otro generalmente distal, puesto que la misma sigue los movimientos peristálticos enterales. Es una causa frecuente de obstrucción intestinal. En lactantes y preescolares. La mayor parte de las intususcepciones son ileocólicas, seguidas por la ileoileal y colococólica. Se pueden identificar un punto guía específico en aproximadamente el 5 por ciento de los pacientes, más comúnmente en las invaginaciones ileoileales. Un divertículo de Meckel es el punto guía más común y en orden de frecuencia los pólipos, las duplicaciones intestinales, los linfomas, la hemorragia submucosa secundaria a púrpura de Henoch y los hemangiomas. Es más común durante el primer año de vida. La mayor incidencia ocurre en lactantes entre 5 y 10 meses de edad, con una relación 4:1, hombres: mujeres. La incidencia varía de 1,5-4 por 1000 nacimientos vivos. El diagnóstico puede realizarse por el cuadro clínico, examen físico, coadyuvado con los signos radiológicos y ecosonográficos. El tratamiento puede ser de tipo médico o quirúrgico. Presentamos el caso de un paciente preescolar femenino de 4 años de edad quien ingresa con cuadro clínico de obstrucción intestinal siendo llevada a mesa operatoria teniendo como hallazgos intususcepción con punto guía un linfoma intestinal no Hodgkin.

The walking blood bank: an alternative blood supply in military mass casualties.

Planning health care for unknown situations is inevitably difficult. This case demonstrates how the US Navy used the WBB to provide blood replacement in a hemorrhaging patient when no other source of blood was available. Although transfusion at sea is a rare event, the availability of a well-planned blood transfusion program prevented a fatality and ultimately returned a sailor to his ship. It was an excellent test of materials, process, and personnel.

Vólvulo de divertículo de Meckel. Complicación poslaparoscopia. A propósito de un caso / Volvulus of a Meckel´s diverticulum. As a post-laparoscopic complication. A case study

Describimos un interesante caso de un vólvulo de divertículo de Meckel ocurrido tras una laparoscopia, para un bloqueo tubárico bilateral. Realizando una posterior revisión de la escasa bibliografía actual existente. (AU)