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A case of Meckel's diverticulum is presented in a 17-month-old girl following technetium pertechnetate radioisotope scan. The patient had presented 10 months earlier with the first episode of passing bloody stools. A Meckel's diverticulum was resected during surgery. Reasons for the original false-negative examination are presented.
Meckel's diverticulum is rarely seen on the standard small bowel follow-through and the diagnosis may be overlooked unless 99mTc -pertechnetate scanning or other complementary radiological examinations are performed. Three cases of bleeding Meckel's diverticulum with a negative barium sulphate meal examination and positive 99mTc -pertechnetate scanning are presented.
This study reports the results and complications of operation for 85 patients with diverticulum of the urethra. The technique for surgical excision and the factors necessary for successful repair are described. The follow-up period was from 2 to 15 years. Seventy patients (82%) experienced immediate and complete relief. A clinically significant postoperative complication--urethrovaginal fistula--occurred in one patient; clinical evidence of urethral stricture was not encountered. Delayed complications eventually occurred in 14 patients: recurrent urinary tract infection (2), urethral pain syndrome (2), urinary incontinence (2), and recurrent diverticulum (8). Many of these were continuations or recurrences of the chronic infectious entity rather than complications related to urethral diverticulectomy.
The records of 70 patients with a suburethral diverticulum were reviewed. Cases were classified according to their anatomic site of origin in an attempt to rationalize the appropriate therapeutic approach. It is suggested that suburethral diverticulum arising in the lower third of the urethra be preferably treated by marsupialization with tissue excision for histologic confirmation, and those diverticula arising in the upper two thirds of the urethra be treated by excision. In those cases in which multiple diverticula are suspected, an anterior vaginoplasty should be carried out in an attempt to reduce the morbidity associated with excision only.
In 18 of 27 cases a duodenal diverticulum, which usually occurs at "weak" spots in the bowel wall, penetrated the pancreas. Of these, 14 cases (77.8%) extended along the embryological fusion line of the ventral and dorsal components, which is considered to be the so-called "locus minoris resistantiae." In four cases the diverticulum penetrating the ventral pancreas was in close approximation to the locus minoris resistantiae.
A case of carcinoma in urethral diverticulum is herein reported. The patient was a 58-year-old housewife presenting with the complaint of dysuria. Physical examination revealed a hen-egg-sized cystic mass at the anterior vaginal wall. Complete excision of the diverticulum was performed transvestibulary. Pathologically, it was described as papillary adenocarcinoma. The patient's postoperative course was uneventful and she was discharged. She was readmitted because of recurrence of tumor 9 months after the first operation. Forty-five cases including this case are reviewed and discussed.
The presentation of a rare case of leiomyoma of Meckel's diverticulum in a boy of 5 yr forms the starting point for a discussion of such cancers. In adult age, the complication is not so rare as the sporadic publications would suggest, incidence of tumoral forms being around 1 : 50 M.D. with a high malignancy frequency. In paediatric age, on the other hand, the tumoral degeneration of a M.D. is an exceptional occurrence: a review of more than 1,200 reported cases and personal experience (48 cases of M.D. in 15 yrs) confirm the rarity of the observation. The need to seek M.D. on each occasion and remove it to prevent the risk of tumoral degeneration in adult age is stressed. M.D. surgical removal tecniques are commented on and emphasis laid on the desirability of ample intestinal resection in cases of cancer of the diverticulum.
Anatomopathological, clinical, therapeutical aspects of intraluminal duodenal diverticulum are analyzed. This is an illness of which are described in all literature of world about 47 to 70 cases. On intraluminal duodenal diverticulum is described with x rays examinations. The diagnosis of this illness is made by radiological and endoscopical examinations. The clinical symptoms are very poor, but many illness of duodenum, pancreas, cholecystis are associated with this.
Diverticula of the right ventricle are extremely rare malformations of the heart. Nearly always they are congenital in origin and represent distinct anomalies from diverticula of the left ventricle both embryologically and clinically. Symptoms are caused by associated heart disease. Complications may arise from endocarditis, heart insufficiency or from rupture of the diverticulum which event almost always leads to death. Therapy consists in surgical removal of the diverticulum if the indication is given, at any rate in antibiotic prophylaxis for infective endocarditis. The prognosis of this malformation depends largely on the coexisting heart disease.
After a short introduction aiming at outlining the etiopathogenesis of fore thorax acute pain occurring in quite healthy individuals, the authors describe two cases of individuals who complained of retrosternal pains to be related, in their opinion, to acute neoformation of a diverticulum of the esophagus. The Authors conclude by remarking how such newly formed diverticulum of the esophagus is to be included among the etiopathogenetic causes of both fore and back thoracic pains and they underline the necessity of an X-ray examination of the esophagus on subjects where the cause of acute thoracic pain in uncertain.
A 54-year old man with abdominal pain and fever was found to have perforated a diverticulum of the ileum. Resection of the involved bowel and reanastomosis proved to be successful therapy. Five previously reported cases of perforated ileal diverticulum are reviewed. The need for prompt resection of the involved bowel segment is emphasized.
Solitary diverticula of the large bowel are comparatively rare respect the much more frequent multiple diverticula. Such diverticula are found mainly in the caecum and ascending colon and are true diverticula, i.e. their wall is made up of all the layers of the bowel wall. When a solitary diverticulum of the caecum undergoes inflammation of the patients generally present with symptoms suggestive of acute appendicitis. A case of solitary diverticulum of the caecum in a 51 years old woman is described and discussed from the diagnostic and clinical as well as from the morphological and pathogenetic point of view.
An elderly patient with an acute small bowel obstruction due to an enterolith that evolved within a duodenal diverticulum is reported. Twenty-four prior instances of small bowel obstruction due to an enterolith formed within a small bowel diverticulum have been culled from the world literature and tabulated. In toto, 18 subjects are female and seven are male. The median age is 68 yr. Optimal surgical management is either to break up the enterolith and milk the components into the cecum without an enterotomy or, as is more often necessary, to milk the enterolith orad removing the concretion through an enterotomy made in less edematous small intestine. As in managing gallstone ileus, the bowel should be "run" seeking additional enteroliths. The diagnosis can be established only by documenting the normalcy of the gallbladder and the presence of duodenal and/or jejunal diverticula.
The opinions of surgeons on their management of an incidentally found Meckel's Diverticulum under various circumstances is obtained and analysed. The literature is reviewed. It is concluded that no guidelines can be given to the junior surgeon that will be acceptable to all his seniors. Further studies have to be undertaken to ascertain where the actual complication rate of a Meckel's Diverticulum lies in the 1% to 33% range quoted in current publications, before an objective decision can be taken on whether to resect or not, with a view to reducing morbidity and mortality.
A Meckel's diverticulum (M.d.) was seen in 70 children. Among 3233 appendectomies 58 M.d. (1.79%) were observed, in 12 cases the laparotomy was necessary for other reasons. 6 of 70 children (8.5%) with M.d. had complications due to the diverticulum. Ectopic tissue was found in 4 cases. Postoperative complications were not observed at the own patients.
A 10-month-old infant was treated for life-threatening rectal bleeding caused by a perforated ulcer in Meckel's diverticulum. Radionuclide imaging with 99mTc-pertechnetate was used to demonstrate the diverticulum preoperatively. Early intervention is desirable to avoid uncontrollable bleeding or complications such as perforation in cases of Meckel's diverticula. Routine 99mTc-pertechnetate imaging as recommended today requires prolonged fasting, and its use in emergency situations may be questioned. This case, however, illustrates the usefulness of radionuclide imaging on an emergency basis as well as in the daily routine.
A 31 year-old man was seen with acute gastrointestinal bleeding. Superior mesenteric angiography revealed a vascular blush. This corresponded to an area of narrowing seen on the small bowel series. A diagnosis of malignant neoplasm was made preoperatively. At laparatomy, however, a Meckel's diverticulum with ulceration and stricture formation extending into the ileum was found. The histology showed gastric mucosa with ulceration. This report depicts small bowel narrowing secondary to Meckel's diverticulum.
In a four-year-old boy perforation of a peptic ulcer occurred in a Meckel's diverticulum located on a duplication of the small intestine. Complications in connection with Meckel's diverticulum and intestinal duplication are discussed, and also the indications for surgery. If the duplication is too large for resection, continuity of passage must be ensured.