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Meckel's diverticulum (MD) results from incomplete involution of the proximal portion of the vitelline (also known as the omphalomesenteric) duct during weeks 5-7 of foetal development. Although MD is the most commonly diagnosed congenital gastrointestinal anomaly, it is estimated to affect only 2% of the population worldwide. Most cases are asympt...
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... 23-year-old male patient presented at the Emergency Department with a complaint of abdominal pain, nausea, and vomiting that had persisted for 5 d and increased in severity over the last 24 h. The patient reported no faecal or gas discharge during the previous 48 h. History taking upon admission revealed that the patient had visited hos- pitals frequently for many years with similar gastrointesti- nal complaints as well as bloating. The patient's abdomen was remarkably distended and initial clinical assessment indicated hypovolemia. Physical examination revealed sig- nificant bowel sounds and substantial abdominal rebound pain, both more robust in the periumbilical area. Labo- ratory testing showed increased white blood cell count (11.8 × 10 3 /μL; normal range: 4.1 × 10 3 -11.2 × 10 3 ), haemoglobin (17.0 g/dL; 12.5-16.0), haematocrit (49.6%; 37.0-47.0) and creatinine (1.4 mg/dL; 0.4-1.2), but nor- mal blood urea nitrogen (27 mg/dL; 10-50). Abdominal X-ray indicated remarkably high air-fluid levels ( Figure ...
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Introduction
Meckel's diverticulum is a congenital anomaly that is often detected incidentally. When it presents symptomatically, it causes painless gastrointestinal bleeding. Nevertheless, in rare instances, it can cause acute intestinal obstruction, often obscuring the true clinical picture.
Case presentation
A 31-year-old male presented to the...
Citations
... Other major causes reported for per rectal bleeding are colitis (ulcerative, infectious, and nonspecific), colorectal polyps, hemorrhoids, intussusception, and inflammatory bowel disease [12]. Abdominal pain, gastrointestinal bleeding, and anemia are common symptoms observed in MD, often accompanied by complications such as intussusception, intestinal obstruction, and, infrequently, hernia or perforation [1,3,13,14]. MD-related intestinal obstruction is the cause of 20-25% of the presenting cases [13]. ...
... Meckel's diverticulum derived from an anomaly of incomplete obliteration of the Vitelline duct which occurred during embryonic development [1]. This issue remains the most common anomaly in congenital gastrointestinal maturity [2,3]. The diagnosing of Meckel's diverticulum relatively challenging due to vague presentation (constipation, perforation, gastrointestinal bleeding, or inflammation) [4]. ...
Introduction
and Importance: Meckel's diverticulum is a rare congenital condition often detected incidentally. Meckel's diverticulum, a rare disease, may result in acute intestinal obstruction and is frequently misdiagnosed. This study aims to report a case of acute intestinal obstruction due to Meckel's diverticulum.
Case presentation
A 61-year-old Javanese man was admitted to the emergency room with a history of constipation, nausea, vomiting, and abdominal pain. Physical examination showed abdomen distention, tenderness in the lower quadrant, and hyperactive bowel sound. Rectal examination found that the rectal ampulla was collapsed. A plain abdominal Radiograph showed small bowel dilatation and air-fluid levels. The patient was diagnosed with small bowel obstruction due to suspected left-sided colon cancer and taken up for exploratory laparotomy.
Clinical discussion
On exploration, Meckel's diverticulum measuring 3.5 cm in length and with a 2 cm base was found about 70 cm proximal to the Bauhin valve; the thin part formed a band that entangled the small bowel. Ileo-ileal resection anastomosis was performed.
Clinical discussion
Meckel's diverticulum is an intestinal pouch caused by incomplete obliteration of the vitelline duct during gestation. This condition affects 2 % of the population and is within 2 feet of the Bauhin valve. The mesodiverticular band was found to be the source of the bowel obstruction. Surgical resection is required for complicated diverticulum.
Conclusion
Meckel's diverticulum can be difficult to diagnose and require a higher level of suspicion. Although Meckel's diverticulum is uncommon in adults, it should be considered a cause of small bowel obstruction.
... Giant MDs are defined by a length superior to 5 cm. It is a rare condition, and possibly more exposed to complications [11]. Throughout history, some factors have been identified as risk factors for developing symptomatic MD, such as male sex, age < 50 years, a diverticulum's length superior to 2 cm, a diverticulum containing ectopic mucosa, and the presence of a band on the abdominal wall [12,13]. ...
Introduction:
Meckel's diverticulum (MD) is the most common congenital malformation of the digestive tract, but the odds of stumbling on MD exceeding 10 cm are rare. Although obstruction is described in the literature, its occurrence due to an internal hernia caused by a fibrous band generated from a gigantic diverticulum is exceptional. This presentation aims to illustrate an exceptionally rare case of a gigantic MD responsible for a bowel obstruction due to the constriction caused by a fibrous band.
Case presentation:
A 45-year-old patient was admitted with symptoms of small bowel obstruction. On Examination, the abdomen was distended with rebound tenderness in the right iliac fossa. A CT scan showed a small bowel volvulus without signs of appendicitis. During emergency laparotomy, we found a 25 cm-long MD. The tip of the diverticulum was linked to the adjoining mesentery through a fibrous band, forming a narrow internal ring responsible for the strangulation of a part of the ileum, leading to gangrene.
Discussion:
Small bowel obstruction caused by a gigantic MD is rare. Diagnosis can be challenging due to its unspecific features. Management of complicated MD is surgical. Nevertheless, the management of asymptomatic MD continues to be a topic of significant disparity among authors, as there are no definitive guidelines that unequivocally dictate whether resection is warranted or not.
Conclusion:
A gigantic MD causing small bowel obstruction is rare. Emergency doctors and surgeons should maintain a high index of suspicion for complicated MD in the preoperative phase to reduce morbidity and mortality.
... [9] "The rule of the two" is defined for Meckel's diverticulum; i) it is present in 2% of the population, ii) it is seen within 2 feet from the ileocecal valve, iii) it is usually 2 inches in diameter, iv) it usually contains two kinds of ectopic mucosae (gastric and pancreatic). [10,11] The lifetime risk for Meckel's diverticulum to develop complications is nearly 7%. [12,13] The defined risk factors for occurrence of complications are male gender, age less than 40-50 years of age, diverticulum length longer than 2 cm and presence of ectopic mucosa. ...
... Bleeding is more common in children and obstruction is more common in adults. [11,16] Perforation due to diverticulitis is a very rare event in all age groups and in all populations and it is not only specific for liver transplant recipients. ...
... In cases of a complicated Meckels with such presentations as obstruction, perforation, bleeding or tumour, wedge resection or segmental resection anastomosis is to be done. [13] The presentation in our reported case is consistent with the clinical picture of other reported cases of obstruction in case of meckels diverticula, [6,14,15] of an young adult male with a short acute history of colicky abdominal pain , vomiting and abdominal distention, and with no prior positive history. The patient was vitally stable, which allowed us to obtain a CT imaging, avoid a diagnostic dilemma and take early decision for surgery. ...
Meckels diverticulum is a persistent remnant of the vitellointestinal duct, and is one the most commonly diagnosed congenital surgical conditions. It occurs in 2% of the population, is usually two inches long, two feet proximal from the ileocaecal junction and in approximately 20% cases it is seen to contain heterotropic epithelium. Its most common clinical presentations are usually in the form of haemorrhage, diverticulitis and rarely may complicate causing intestinal obstruction. We hereby present one such case of intestinal obstruction in a young adult male, secondary to small bowel volvulus around a vitellointestinal band extending from a meckels diverticulum to the anterior abdominal wall. The presentation and management of this case, which had presented to the Emergency Department of our hospital, is elaborated in detail.
... It should be noted that this rule applies primarily to the pediatric age group. Adults have much longer small bowel than children and their Meckel's diverticulum can be 3-4 feet proximal to the ileocecal valve, and much larger in size to over 4 inches (10 cm) in diameter to be called giant Meckel's diverticulum [11][12][13]. They contain heterotopic gastric mucosa in 40-60% and pancreatic or other tissues in up to 10% of cases. ...
The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel’s diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.
... Conveniently, when using the imperial measurements, the recurring theme of the same number has led to the clinical "rule of twos" (4). However, diverticula have been reported up to 100 cm long; therefore, once >5 cm in length, they are classified as giant Meckel's diverticula, with 90% of cases falling between 1 and 10 cm in size (4). A giant Meckel's diverticulum is more prone to complications (3,4). ...
... However, diverticula have been reported up to 100 cm long; therefore, once >5 cm in length, they are classified as giant Meckel's diverticula, with 90% of cases falling between 1 and 10 cm in size (4). A giant Meckel's diverticulum is more prone to complications (3,4). ...
Meckel's diverticulum is the most common congenital gastrointestinal abnormality. Clinical presentation is normally in childhood with either hemorrhage or an acute surgical abdomen. The much rarer giant Meckel's diverticulum is associated with a more varied clinical presentation. In this case report, we provide a unique example of presentation with isolated faltering growth related to a giant Meckel's diverticulum in a young boy. We discuss the diagnostic process, imaging modalities, and subsequent surgical procedure.
... Several studies have also shown that only up to 5% of paediatric cases of symptomatic MD have been found to be giant MD at surgery, with a higher incidence of symptoms expected in such cases, which lends to the rarity of this case [2,9,10]. Complications of torsion and inflammation are more commonly seen with narrow-based, long MD while intestinal obstruction particularly by intussusception, is more frequently seen with wide-based, short MD [2,11,12]. ...
... Surgical management of MD typically includes resection of the MD with possible resection of adjacent bowel, the extent of which is determined by the degree of inflammation seen at surgery [2]. Giant MD requires resection even if found incidentally at surgery given the high risk of more severe forms of complications, particularly obstruction, and low risk of morbidity associated with resection [11,14]. In the case presented, the decision was made to perform a wedge resection of the giant MD together with primary ileo-ileal anastomosis, based on the viability of the bowel seen after manual reduction of the RINT. ...
Retrograde intussusception (RINT) and giant Meckel’s diverticulum (MD) are both rare pathologies and are seldom encountered in surgical practice. Thus, it is exceptional for both conditions to be seen in the same patient, with very few published case reports in the paediatric population.
This case describes a three-month-old male who was referred to our paediatric surgery unit following a diagnosis of intussusception on an ultrasound scan. The patient presented to the paediatric emergency department one day prior with a clinical history of fever, cough, vomiting and irritability. After resuscitation, the patient was admitted for overnight observation in the paediatric ward. However, the patient’s symptoms persisted with notable abdominal distension. Abdominal X-ray (AP erect) showed features of small bowel obstruction, while abdominal ultrasound showed a concentric mass in the right upper quadrant consistent with intussusception. Following this diagnosis of intussusception, pneumatic enema reduction under ultrasound guidance was attempted but proved unsuccessful. The patient was then taken for emergency laparotomy. At surgery, an ileo-ileal RINT with a proximal giant MD was discovered. Successful manual reduction of the RINT and wedge resection of the giant MD with primary ileo-ileal anastomosis was performed. The postoperative recovery and follow-up were uneventful.
... monly exhibits as gastrointestinal bleeding in pediatric population and as intestinal obstruction in adults [6] . Although Meckel's diverticulum is most commonly diagnosed congenital gastrointestinal tract anomaly, it affects only 2% of population worldwide [7] . Surgical treatment of Meckel's diverticulum by both open and laparoscopic procedures has led to the clinical "rule of 2" for symptomatic cases, by which the anatomical deformity is most often located 2 feet from the ileocecal junction and is 2 inches long [8] . ...
... The obstruction allied with a free or unattached diverticulum or having only one attachment to the intestine represent first Meckel's diverticulum type and obstructions allied with an attached diverticulum, including through its terminal ligament, to the abdominal wall or intestinal viscus represents the second type. Between these two types, former is much rarer [7] . In our case, it was Giant Meckel's diverticulum and can be categorised into first type, as it was unattached diverticulum to the abdominal wall. ...
Meckel's diverticulum is the most common congenital anomaly of gastrointestinal tract, which results from incomplete involution of the proximal part of the vitelline duct during weeks 5-7 of fetal development. Giant Meckel's diverticulum more than 5 cm in length is relatively rare and may be associated with small bowel obstruction. Here we report Giant Meckel's diverticulum in 11 year old male who presented with the symptoms of acute abdomen with intermittent subacute small bowel obstruction. Patient presented with muscle guarding and tenderness. CT abdomen revealed a large outpouching round lesion in distal ileum intermittently compressing the small bowel that was suggestive of Giant Meckel's diverticulum. The morphology, pathology and complications of Giant Meckel's diverticulum is important for radiologist and surgeons for successful management of patient.
... Also, MDs typically measure less than 5 cm and bigger diverticula are referred to as "giant' diverticula [1]. These large diverticula are relatively uncommon and usually associated with more severe complications [5]. ...
