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A walled-off ruptured Meckel's diverticulum in an infant

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Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.
Article
We report a review of 208 cases of Meckel's diverticulum among pediatric patients from one single institution. One of the aims of this report is to highlight the different diagnostic modalities of Meckel's diverticulum since a majority of cases is undiagnosed prior to surgery. Our review shows 58 cases containing gastric and/or pancreatic heterotopic tissue, including two unique cases. The first case reported is a desmoid tumor arising at the tip of diverticulum, a case that, to our knowledge, has not been previously reported. The second case involves a female patient appearing with an acute abdomen thought to be appendicitis, instead surgery revealed a diverticulum arising from the ileum. The cause of acute abdomen was due to gonococcal infection. In conclusion, we hope that this large series of Meckel's cases will enrich our readers on the differential diagnosis and preoperative diagnostic techniques of Meckels' diverticulum.
Article
A total of 600 cases, comprising 4 of our cases and 596 others in Japan, was analyzed, and the diagnosis of Meckel's diverticulum was made in only 34 of them. The rate of diagnosis was 5.7 per cent, which is very low. The most common complication of this disease was intestinal obstruction, the second most common was intussusception, the third was inflammation, and the fourth was rectal bleeding. Ectopic tissue, present in ninety-three patients, consisted of ectopic gastric mucosa in fifty-eight. 99mTc-P scanning was performed on fifteen patients. In twelve of them ectopic gastric mucosa was observed. However, it was not found in three, all of whom had false-positive scans.
Article
A total of 600 cases, comprising 4 of our cases and 596 others in Japan, was analyzed, and the diagnosis of Meckel's diverticulum was made in only 34 of them. The rate of diagnosis was 5.7 per cent, which is very low. The most common complication of this disease was intestinal obstruction, the second most common was intussusception, the third was inflammation, and the fourth was rectal bleeding. Ectopic tissue, present in ninety-three patients, consisted of ectopic gastric mucosa in fifty-eight. 99mTc-P scanning was performed on fifteen patients. In twelve of them ectopic gastric mucosa was observed. However, it was not found in three, all of whom had false-positive scans.
Article
Meckel's diverticulum (MD) is the most common congenital anomaly of the small intestine, occurring in up to 4 percent of the population. The majority of MD cases are discovered incidentally; however, they can occasionally cause serious bleeding or obstructive or inflammatory complications. We reviewed the charts of 58 patients with MD from 1984 to 1994 collecting data on age, sex, presentation, therapy, pathology, and surgical complications to try to identify factors suggestive of the need for surgical therapy and the associated morbidity and mortality of resection. There was a 1.3:1 male:female ratio, and although patients with MD were found at all ages, the majority were found in patients in the 4th and 5th decade of life. Forty-five of 58 were incidental, and 13 of 58 were symptomatic. The most common symptom was bowel obstruction (10 of 13). Forty-five of 58 MD cases were managed surgically, 71 percent by diverticulectomy and the remainder by segmental resection, with no associated morbidity or mortality. Symptomatic patients were more often male (77 vs 23%; P 0.06, Fisher's exact test), more often had ectopic mucosa (31 vs 16%; P, not significant), and were evenly distributed over all ages. These data suggest that, with the possible exception of male sex, there is no factor predictive of the development of symptoms in incidentally found MD. In light of this finding, the low operative morbidity and mortality, and the even age distribution in patients with complications of their MD, we recommend that MD be resected when found incidentally in the absence of an absolute contraindication.
Meckel’s diverticulum: Investigation of 600 patients in the Japanese Literature
  • Yamaguchi
Robbins and Cotran Pathologic Basis of Disease
  • RT Jerrold