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Meckel's diverticulum (MD) is the most frequent congenital abnormality of the small bowel and it is often difficult to diagnose. The authors report a case of a patient with long-term symptoms erroneously not related with MD disease and developing a diverticulum perforation.
A case of pneumatosis cystoides intestinalis (PCI) associated with perforated duodenal ulcer and Meckel's diverticulum is presented. The patient was managed with direct suturing of the perforation and reinforcement with an omental patch. Meckel's diverticulum was excised. PCI was followed up and disappeared postoperatively in the 4th week.
Lower gastrointestinal bleeding after aspirin intake was reported in a 64-year-old woman. Gastroscopy, colonoscopy and selective mesenteric angiography failed to reveal the source of hemorrhage; only a midgut malrotation was suggested by angiography. Small bowel enema finally demonstrated a blind sac on the antimesenteric border of the ileum, corresponding to a Meckel's diverticulum. This embryological remnant of the vitelline duct was associated with a mesenterium commune. Laparoscopy confirmed the small bowel study, and resection of the diverticulum was easily carried out. It is, to our knowledge, the first time that these developmental abnormalities have been preoperatively diagnosed together.
The use of diagnostic laparoscopy in acute abdominal pain, especially when patients have been admitted for acute pain in the lower abdominal quadrants, improves the accuracy of diagnosis and leads to improvements in treatment procedures. A case is reported of a 24-year-old woman admitted under suspicion of appendicitis. The appendix was found to be normal, and a perforation caused by a fishbone was discovered in a Meckel's diverticulum. The diverticulum was resected by a combined laparoscopic and open procedure. Diagnostic laparoscopy should be performed routinely in cases of acute abdominal pain in the lower quadrants of suspected appendiceal origin to avoid overlooking other causes of the symptoms.
We report an unusual case of acute abdomen due to axial torsion and infarction of a Meckel's diverticulum in a 13-year-old boy and illustrate the versatility of laparoscopy in the diagnosis and management of acute surgical abdomen in children. We believe that this is only the third case reported in a child of torsion of a Meckel's diverticulum and the first to be managed by laparoscopic resection.
OBJECTIVE: The aim of this paper is to demonstrate that laparoscopy can successfully diagnose otherwise elusive Meckel's diverticuli and at the same time offer a therapeutic access for successful resection. MATERIALS AND METHODS: Two patients with anemia of unknown cause and a further patient with acute small bowel obstruction underwent diagnostic laparoscopy. A Meckel's diverticulum was identified in each case and successfully resected through a minilaparotomy. RESULTS: All three patients were successfully investigated and treated with laparoscopy with no morbidity or mortality. CONCLUSION: Laparoscopy is a safe and effective surgical modality for diagnosis of atypically presenting Meckel's diverticulum and has a therapeutic role that results in an excellent cosmetic result.
Cecal diverticulitis is an uncommon disorder that, unlike sigmoid diverticular disease, usually involves a solitary true diverticulum. The resulting pain is hard to distinguish from that of appendicitis or perforating carcinoma. The typical patient is male, Asian, and in the fourth decade of life. The following case is unusual in that the patient was a 50-year-old Caucasian woman, and the diverticulum was excised laparoscopically. To the author's knowledge, this is the first case in which laparoscopy has been used for this purpose.
Neoplasia is the least common complication of Meckel's diverticulum. A case of partial obstruction of the small intestine due to adenocarcinoma arising in a Meckel's diverticulum is presented. The noteworthy feature of this case is the presence of neoplastic Paneth cells in the tumor.
Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct, which is rarely affected by neoplasia. The authors report the first case of malignant melanoma in Meckel's diverticulum in a middle-aged man without skin or ocular lesions. Five other Meckel's diverticuli were evaluated histologically and by immunoperoxidase technics for neural crest elements, which could have given rise to this lesion.
In two patients with a symptomatic posteroseptally localized accessory atrioventricular pathway, but with distinct electrocardiographic patterns, a coronary sinus diverticulum appeared to be the site of this connection. Radiofrequency catheter ablation in the diverticulum was implemented to interrupt the pathway in both cases. This study demonstrates the necessity to perform coronary sinus angiography when ablation attempts in the posteroseptal region are not immediately successful, or optimal signals are not detected.
Cardiac diverticula have been documented in approximately 80 patients. In over 70% of cases, this lesion is associated with midline thoracoabdominal defects or other congenital malformations of the heart. The diverticulum is thought to occur early in embryogenesis from an outpouching of the endomyocardium through a weak region in the left ventricular wall, but its exact etiology is uncertain. The case of a 6-year-old white boy who died suddenly while playing is presented. Autopsy revealed a ruptured diverticulum of the left ventricular apex with massive hemopericardium and cardiac tamponade. No other abnormalities were found. The pertinent literature is reviewed.
Four patients with intraluminal diverticulum of the duodenum are presented and compared with those reported previously. This lesion is a rare congenital disorder that usually becomes symptomatic in adult life. It is located in the second portion of the duodenum within the lumen, extending distally. It has the appearance of a "thumb of a glove" and it is lined by mucosa on both surfaces. It develops betweeen the fourth and eighth week of the embryo's life, but it increases in size during adult life. It usually presents with typical or atypical symptoms of peptic ulcer disease, but sometimes manifestations such as gastrointestinal bleeding, duodenal obstructions or pancreatitis may predominate and may be severe and life-threatening. The diagnosis is best made with hypotonic duodenography, which demonstrates the lesion as a barium coated pouch within the air filled duodenal lumen. The treatment of choice is duodenotomy and excision of the lesion. Proper identification of the papilla of the ampulla of Vater is important since this structure is often adjacent to the diverticulum. No recurrences have been noted in the three patients operated upon.
OBJECTIVE: The authors determined whether Meckel's diverticulum, discovered incidentally at operation, should be removed. SUMMARY BACKGROUND DATA: It is not clear from the medical literature whether the risk of an incidental Meckel's diverticulectomy is greater than the risk of leaving the diverticulum in place. METHODS: The authors used the medical experience of Olmsted County, Minnesota residents for the period 1950 to 1992 to answer the question. RESULTS: During the period, 58 residents developed Meckel's complications that required diverticulectomies. The incidence of complications was 87 per 100,000 person-years, and the lifetime risk (to 80 years of age) of developing them was 6.4%. The risks were similar throughout the period and at all ages of life, but were greater among men (124 per 100,000 person-years) than women (50 per 100,000 person-years, p < 0.05). Diverticulectomies for complications carried an operative mortality and morbidity of 2% and 12% and a cumulative risk of long-term postoperative complications of 7%, whereas incidental diverticulectomies done in 87 residents during the period carried corresponding rates of only 1%, 2%, and 2%, respectively. CONCLUSIONS: Meckel's diverticula discovered incidentally at operation should be removed for most patients, regardless of age.
PURPOSE: To report a rare cause of epiphora and chronic discharge: lacrimal canalicular diverticulum. METHODS: Case report. RESULTS: A distended left lower eyelid canaliculus was associated with chronic epiphora and discharge. A suspected canalicular diverticulum was noted on dacryocystogram. CONCLUSIONS: Canalicular diverticula should be considered in the differential diagnosis in patients that present with epiphora and discharge with a patent nasolacrimal system. Dacryocystography is diagnostic.
Fifty-eight children were studied for the presence of Meckel's diverticulum by scintigraphy with 99mTc-pertechnetate. Meckel's diverticulum was found at surgery in 6 of 6 patients with positive radionuclide studies and in 2 of 48 patients with negative studies. Four studies could not be interpreted because of widespread intestinal activity. Using the criteria described in this paper, false-positive readings did not occur.
Administration of cimetidine prior to pertechnetate imaging in two patients with Meckel's diverticulum resulted in demonstrating the abnormality with unusual clarity. This is presumed due to the cimetidine-mediated retention of pertechnetate in the gastric mucosa. Pertechnetate imaging in two normal subjects with and without cimetidine administration disclosed a marked difference in retention of the radionuclide in the gastric mucosa and its subsequent transit into the intestinal tract. Pertechnetate imaging in conjunction with cimetidine administration appears to result in markedly improved identification of Meckel's diverticulum.
The usual scintigraphic presentation of a Meckel's diverticulum is progressive accumulation of Tc-99m pertechnetate within the ectopic gastric mucosa that parallels uptake in the stomach. The authors present a case of an adult with acute gastrointestinal bleeding, negative endoscopic and radiologic evaluation, and atypical scintigraphy. An abnormal focus of uptake appeared at the same time as the stomach but faded away in the 15-minute image before reappearing while the stomach was still progressively accumulating the radioisotope. Meckel's diverticulum was confirmed by surgery. This case emphasizes the importance of scintigraphy in the evaluation of gastrointestinal bleeding, and it further emphasizes that any uptake that cannot be physiologically related is suspicious, even in a young adult.
The evaluation of gastrointestinal hemorrhage may include a Meckel's scan, particularly in children. Typically, a Meckel's diverticulum shows discrete, focal uptake in the right lower abdomen. The authors describe an adult whose bleeding Meckel's diverticulum manifested as brisk, intermittent intraluminal tracer extravasation.