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Intussusception due to an inverted Meckel's diverticulum is considered a rare occurrence. We present a case of a 37-year-old male with anemia and melena due to an inverted Meckel's diverticulum at the base of an ileoileal intussusception. To our knowledge, this is the first case in which small bowel enema, computed tomography, and magnetic resonance imaging showed the pathology.
The autopsy incidence of internal hernia has been reported to be between 0.2% and 0.9%, and these hernias are usually diagnosed on imaging due to their complications or at surgery. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 1% to 3% of the population according to autopsy studies. The condition also is usually diagnosed at surgery, by barium studies or scintigraphy, or on cross-sectional imaging due to complications. We present an unusual case of a large Meckel diverticulum in a right paracolic hernia diagnosed on multidetector computed tomography. This diagnosis was made after attacks of subacute intestinal obstruction with the aid of multiplanar reconstructions. This case emphasizes the role of multidetector computed tomography and postprocessing techniques such as multiplanar reconstruction in the diagnosis of bowel pathology.
We report a case of intraluminal duodenal diverticulum with special reference to its magnetic resonance imaging findings. An intraluminal duodenal fluid collection surrounded by a hypointense rim on T2-weighted or magnetic resonance cholangiopancreatographic images, the shape of which is changed by peristalsis, is considered to be almost diagnostic for intraluminal duodenal diverticulum.
A meckel's diverticulum is a congenital abnormality of the GI tract seen in approximately 3% of the population. Tumor arising within this entity is a rare, although know complication. We report a gastrointestinal tumor arising within a Meckel's diverticulum in a 28-year-old male.
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.
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.
Colonic amyloidosis is frequent, although rarely radiographically evident. The radiological findings are varied and unspecific. We report a case of perforated giant colonic diverticulum (GCD) diagnosed by helical CT in which amyloid deposition was pathologically demonstrated. The patient was a renal transplant recipient who previously had undergone hemodialysis for 10 years. A possible role of amyloidosis in the pathogenesis of this case is discussed. Giant colonic diverticulum must be included in the spectrum of gastrointestinal manifestations of amyloidosis.
We report a case of a giant Meckel's diverticulum containing numerous enteroliths. A correct diagnosis was made preoperatively by means of CT, by demonstrating a connection between the diverticulum, containing multiple peripherally calcified stones, and the small intestine.
Congenital diverticulum of the ventricle is a rare cardiac abnormality that is characterized by local embryologic development failure of the ventricular muscle. It can be found as an isolated form or associated with other cardiac abnormalities. Clinically, it has been reported that it can lead to heart failure, arrhythmia, or chest pain, although frequently the course is asymptomatic. We present a patient who was referred to our clinic with chest pain due to isolated left ventricular diverticulum mimicking myocardial ischemia.
A symptomatic Meckel's diverticulum (MD) may manifest as an intestinal obstruction secondary to a volvulus. We describe a case of a meconium-impacted MD associated with inflammatory adhesions to adjacent viscera that presented as an intestinal obstruction in a 4-h-old infant secondary to an ileal volvulus with resultant infarction of the diverticulum and ileal segment.
Meckel's diverticulum occurs in 2% of the population. Of these, 4% may present as intestinal bleeding, intussusception, diverticulitis, volvulus, or perforation at any age, including neonates. We describe a 3-month-old baby whose giant Meckel's diverticulum had probably perforated in utero, leading to the formation of a large intra-abdominal pseudocyst.
In the era of laparoscopic surgery, the resection of a Meckel's diverticulum is a good indication for a laparoscopic procedure. In this paper, the relationship between the distribution of gastric heterotopia (GH) and the external appearance of the diverticulum was studied for the proper choice of the laparoscopic procedure. Symptomatic diverticula containing GH in eight patients were analyzed with regard to the distribution of gastric mucosa and the external appearance. While the long diverticula had the GH at the distal end, in the short diverticula it occurred in almost any area. For long diverticula, simple transverse resection with a stapling device is recommended. However, in short diverticula ileal resection with end-to-end anastomosis or wedge resection after exteriorization is recommended.
Tracheal diverticulum is a rarely encountered entity. It may be congenital or acquired, the difference residing mainly in the histologic features of the wall. Most cases are asymptomatic, but when symptoms are present they are usually nonspecific. Congenital diverticulum is not normally detected in infancy unless it is suggested by recurrent episodes of tracheobronchial infection or in associated with other malformations. Imaging techniques are useful for diagnosis because the point of communication with the trachea is difficult to detect with bronchoscopy. In the absence of symptoms, management should be conservative. We review the entity and report two new cases, one a casual finding in a 49-year-old man and the other in a 63-year-old woman who presented with occasional bloody sputum.
UNLABELLED: Funnel-type intraluminal duodenal diverticulum (windsock web) is a rare congenital malformation. A 4-year-old boy with vomiting and abdominal pain for several weeks was referred to the hospital. A plain abdominal X-ray on admission disclosed a double bubble sign. Abdominal echography and CT disclosed a foreign body lodged in the alimentary tract. After the foreign body was removed with a fibrescope, endoscopy showed a stenotic descending portion where the foreign body was located. An upper gastro-intestinal contrast study demonstrated a post-bulbar duodenal stenosis with a barium-filled pear-shaped sac in the descending portion of the duodenum. Surgical exploration was done under the diagnosis of windsock web of the duodenum. A simple excision of the web at its base was carried out. A hole 7 mm in diameter was found at the edge of the web. The microscopic appearance of the resected specimen was characterized by the duodenal mucosa with an extensive chronic inflammation lining both sides of the diverticulum and the lack of muscular layer of mucosa. CONCLUSION: If an ingested material is not excreted in the stool, possible clogging in the intestinal tract should always be considered and a further intensive examination is warranted.
Patients with Zenker's diverticulum (ZD) underwent surface electromyography (sEMG) evaluation to determine sEMG patterns specific for ZD. Group 1 comprised patients with proven long-standing ZD that refused surgical treatment (n = 11, age mean = 55.7 years). Group 2 comprised surgically operated on patients with ZD (n = 6, age mean = 61 years). The timing, amplitude, and graphic patterns of activity of the masseter, submental, and laryngeal strap muscles were examined during voluntary single water swallows ("normal"), single swallows of excessive amounts of water (20 ml, "stress test"), and continuous drinking of 100 cc of water. The muscle activity in pharyngeal and initial esophageal stages of swallowing was measured, and graphic records were evaluated in relation to timing and voltage. The data were compared with the previously established normative database. The main sEMG patterns of ZD are (1) duration of swallowing and drinking is longer than normal (p < 0.05), (2) electric amplitude of laryngeal strap muscles during swallowing activity is higher than normal (p < 0.05), and (3) regurgitation peaks immediately after swallow followed by secondary swallow of the regurgitated portion of a bolus as seen at the sEMG records are specific graphic patterns for the ZD. Zenker's diverticulum has its own specific sEMG patterns. Surface EMG, being an important screening method for patients with dysphagia, is a valuable additional diagnostic tool for ZD. Because it is noninvasive and nonradiographic, it can be used for monitoring of long-standing cases of the disease as well as monitoring of postsurgical recovery.
We report the laparoscopic resection of a perforated Meckel's diverticulum (MD) found in a 14-year-old boy who presented with abdominal pain and nausea. There was rebound tenderness in the right lower quadrant of the abdomen, which appeared suspicious for acute appendicitis. The patient was referred to the operating room, and laparoscopic appendectomy was performed. With the appendix showing no macroscopic signs of inflammation, laparoscopy was continued and a perforated MD was identified 50 cm proximal to the ileocecal valve. The findings included pus and localized peritonitis between the ileal loops adjacent to the perforation site. The diverticulum was longitudinally resected with an Endo-Gia stapler. The histopathologic workup confirmed the diagnosis of a perforated MD. The patient completely recovered and was discharged 8 days after the procedures. At this writing, he is completely asymptomatic 6 months later. We conclude from our observation that laparoscopic resection of a perforated MD can be performed safely even when localized peritonitis is present. Inspection of the small intestine should be performed to exclude a symptomatic or perforated MD when the appendix does not show any signs of acute appendicitis.
Laparoscopy is being used more and more often in pediatric surgery for diagnostic and therapeutic indications. We report the successful laparoscopic excision of a congenital bladder diverticulum in a 6-year-old child. The minimally invasive approach allowed for easy identification and dissection of the diverticulum and surrounding vital structures with minimal postoperative pain and a good cosmetic result.
The true incidence of epiphrenic esophageal diverticulum is unknown. Traditionally, diverticulectomy via a left thoracic approach has represented the gold standard. Trans-hiatal esophageal dissection under laparoscopy is feasible, but has not, to our knowledge, been applied before in the treatment of epiphrenic esophageal diverticulum.