Laparoscopic Management of Perforated Meckel's Diverticulum in Adults

Department of General Surgery, The Second Hospital of Shandong University, Shandong 250033, China.
International journal of medical sciences (Impact Factor: 1.55). 05/2012; 9(3):243-7. DOI: 10.7150/ijms.4170
Source: PubMed

ABSTRACT To determine the role of laparoscopy in diagnosis and surgical treatment of perforated Meckel's diverticulum (MD) in adults.
Between July 2003 and July 2011, fifteen patients were seen with perforated MD. Eleven were male and four were female. The median age was 38 years (range, 21-68). All patients presented with a sudden onset of pain. Among them 9 had a past medical history of bloody stools and /or chronic recurrent abdominal pain. 2 were preoperatively diagnosed with perforated MD confirmly and 4 suspiciously, 9 with perforated acute appendicitis. All 15 patients underwent exploratory laparoscopy.
4 patients with broad-base(≧ 2 cm) and 2 patients with narrow-base(<2 cm) whose perforative site was near the base underwent laparoscopically assisted extracorporal bowel segment resection, the other 9 patients with narrow-base(<2 cm) underwent laparoscopically intraabdominal wedge resection of the MD. No intraoperative or postoperative complications occurred. The median hospital stay was 4 days (range, 2-7 days). The histopathologic studies showed heterotopic gastric mucosa (HGM) in 10 cases (66.7%). All patients recovered uneventfully.
To patients with sudden abdomen pain mimic acute appendicitis accompanied by a past medical history of bloody stools and/or chronic recurrent abdominal pain, proferated MD should be kept in mind as a differential diagnosis. Laparoscopy is a safe and effective surgical modality for diagnosis of proferated MD and has a therapeutic role that results in an excellent cosmetic result.

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    ABSTRACT: Meckel diverticulum (MD) is the most common congenital gastrointestinal malformation found in approximately 2% of the general population. MD manifests in adults as gastrointestinal bleeding, bowel obstruction, intussusception, or perforation in <5% of cases. There is no consensus on the ideal management strategy in symptomatic MD. Therefore, we searched the literature to highlight the role of laparoscopy in diagnosing and treating symptomatic MD. We used PubMed, Medline, Google Scholar, Ovid, and Cochrane data search engines looking for articles containing terms such as Meckel diverticulum, ectopic gastric mucosa, laparoscopic, technetium 99m pertechnetate, and acute management. We included articles reporting on case series in the English language on adult patients only and reporting on laparoscopic approach in the management of symptomatic MD. A total of 5 articles reporting on 35 cases were found. We report on the pooled data from these series with emphasis on number of patients, age, male to female ratio, length of stay, conversion to open procedure, method of resection, complications, first presentation, and confirmation of diagnosis preoperatively. We also compare the results of laparoscopic versus open approaches mentioned in the literature. The laparoscopic approach was found to be effective as a diagnostic and therapeutic modality in patients with symptomatic MD; however, its adoption as the gold standard still needs further studies with larger patient numbers.
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    ABSTRACT: Complications aroused from Meckel's diverticulum tend to developed in children. Children presented with abdominal pain, intestinal obstruction, intussusception or gastrointestinal bleeding may actually suffered from complicated Meckel's diverticulum. With the advancement of minimally invasive surgery (MIS) in children, the use of laparoscopy in the diagnosis and subsequent laparoscopic excision of Meckel's diverticulum has gained popularity. Recently, single incision laparoscopic surgery (SILS) has emerged as a new technique in minimally invasive surgery. This review offers the overview in the development of MIS in the management of children suffered from Meckel's diverticulum. The current evidence in different laparoscopic techniques, including conventional laparoscopy, SILS, the use of special laparoscopic instruments, intracorporeal diverticulectomy and extracorporeal diverticulectomy in the management of Meckel's diverticulum in children were revealed.
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    ABSTRACT: Aim-Background This article presents the case of a young man with gangrenous Meckel’s diverticulum, and reviews the literature in depth for relative references. Meckel’s diverticulum is the most frequently encountered congenital anomaly of the gastrointestinal tract that results from persistence of the omphalomesenteric duct due to developmental failure or arrest of the yolk sac. This case report summarizes data on the incidence, symptoms and possible complications of Meckel’s diverticulum. Furthermore, it touches on contemporary issues raised in the international scientific community involving both differential diagnosis and surgical or non-surgical treatment of diverticulum of Meckel, when this is an accidental intraoperative finding. Case Report A 16-year-old male presented to the emergency department of our hospital with symptoms of an acute abdomen. Initial clinical examination pointed to acute appendicitis. After undergoing the necessary laboratory and imaging investigations, the patient was taken to the operating theatre. Acute peritonitis prompted by a gangrenous Meckel’s diverticulum was identified intraoperatively. Complete resection of the diverticulum was performed, accompanied by a standard appendectomy. The patient made a good recovery and was discharged from the hospital on the seventh postoperative day. No problems were observed at follow-up. Conclusion Meckel’s diverticulum presents in approximately in 1–4% of the population. It is a true diverticulum and is typically located on the antimesenteric border of the terminal ileum. Ectopic tissue may be detected in the diverticulum; more specifically, heterotopic gastric mucosa or pancreatic tissue is found in the majority of symptomatic cases. The discovery of the diverticulum as an accidental intraoperative finding gives rise to controversy as to whether, in theory, surgical or non-surgical treatment is more appropriate. Developments in modern laparoscopic surgery offer new opportunities, not only in terms of establishing differential diagnosis but also in achieving treatment.
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