scholarly journals Management of Intussusceptions Secondary to Pathological Lead Points in Infants and Children

2021 ◽  
Vol 57 (01) ◽  
pp. 53-57
Author(s):  
Rajendra K. Ghritlaharey
Keyword(s):  
Surgical Procedures ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Infants And Children ◽  
Paediatric Surgery ◽  
Single Institution ◽  
The Mean ◽  
Terminal Ileostomy ◽  
Gangrenous Bowel ◽  
In Infants And Children

Abstract Objectives This study was undertaken to investigate and review the age, sex, clinical presentation, surgical procedures done, major postoperative complications, and the final outcome of infants and children operated for intussusceptions secondary to pathological lead points (PLPs). Materials and Methods This is a single-institution, retrospective study and included infants and children below the age of 12 years who were operated for the secondary intussusceptions. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results During the study period, 200 infants and children were operated for the intussusceptions, and 23 (11.5%) of them were operated for the intussusceptions secondary to PLPs. This review comprised 18 (78.26%) boys and 5 (21.73%) girls, and consisted of infants (n = 9, 39.13%) and children of 1 to 5 years of age (n = 7, 30.43%) and 6 to 12 years of age (n = 7, 30.43%). The age at presentation ranged from 3 months to 10 years, with the mean age of 41.47 ± 40.06 months. Clinically, all the children presented with features of acute intestinal obstruction. Ultrasonography (USG) examination of the abdomen revealed the diagnosis of intussusception in all of them but not able to document the PLPs as a cause for it. During the exploratory laparotomies, gangrenous bowel was detected in 15 (65.21%) cases. PLPs causing intussusceptions were Meckel’s diverticulum (n = 17, 73.91%), begin ileal growth (n = 4, 17.39%), benign ileal polyp (n = 1, 4.34%), and caecal lymphoma (n = 1, 4.34%). Surgical procedures were executed in the following order of frequency: (1) resection of segment of ileum including PLP, and ileoileal anastomosis (n = 13, 56.52%); (2) resection of segment of ileum including PLP, caecum and part of ascending colon, and ileoascending anastomosis (n = 5, 21.73%); (3) Meckel’s diverticulectomy (n = 3, 13.04%); and (4) resection of segment of ileum including PLP and terminal ileostomy (n = 2, 8.69%). This study documented two (8.69%) deaths in postoperative period. Conclusion Meckel’s’ diverticulum was the commonest pathology for the secondary intussusceptions in infants and children and documented most frequently during infancy. Half of the secondary intussusceptions occurred within 24 months of age. Bowel resection was required in more than 85% of the cases during the surgical procedures.

scholarly journals Management of Symptomatic Meckel's Diverticulum in Infants and Children

2021 ◽  
Author(s):  
Rajendra K. Ghritlaharey
Keyword(s):  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Surgical Procedures ◽  
Postoperative Period ◽  
Incidental Finding ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Infants And Children ◽  
Adjacent Segment ◽  
Bowel Gangrene

Abstract Objectives The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome. Materials and Methods This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum. This study was conducted at the author's department of pediatric surgery, and it was performed for 21 years from January 1, 2000 to December 31, 2020. Results Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period of 21 years. The ratio for males to females was 3:1. This study consisted of infants, (n = 22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n = 43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n = 59, 70.23%), (2) perforation peritonitis (n = 17, 20.23%), (3) lower gastrointestinal bleeding (n = 4, 4.76%), and (4) incidental finding (n = 4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n = 17) of Meckel's diverticulum was responsible for the secondary intussusception. In children (n = 84), for Meckel's diverticulum, surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n = 36, 42.85%); (2) Meckel's diverticulectomy (n = 32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n = 12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n = 4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period. Conclusion Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.

Meckel's diverticulum in infants and children

1954 ◽  
Vol 87 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Marshall A. Freedman ◽  
Donald P. Chance ◽  
Lloyd E. Harris ◽  
John W. Kirklin
Keyword(s):  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Infants And Children ◽  
In Infants And Children

Technetium Pertechnetate Scintigraphy to Detect Ectopic Gastric Mucosa in Meckel's Diverticulum

1984 ◽  
Vol 25 (5) ◽  
pp. 417-422 ◽  
Author(s):  
M. Fries ◽  
W. Mortensson ◽  
B. Robertson
Keyword(s):  
Gastric Mucosa ◽  
Diagnostic Accuracy ◽  
Rectal Bleeding ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Infants And Children ◽  
Histologic Examination ◽  
Ectopic Gastric Mucosa ◽  
Consistent Finding ◽  
Predominant Symptom

Tc-pertechnetate scintigraphy was performed in 81 infants and children, clinically suspected to have Meckel's diverticulum with ectopic gastric mucosa. The predominant symptom was rectal bleeding and anemia. Twenty-two patients underwent laparotomy and 12 had Meckel's diverticulum with ectopic gastric mucosa. In operated patients the sensitivity of scintigraphy in detecting ectopic gastric mucosa was 0.75, the specificity 1.0 and the diagnostic accuracy 0.86; the diagnostic accuracy was estimated to 0.96 for the whole material. Histologic examination of the diverticula showed a smaller area of the ectopic mucosa in cases with negative scintigraphic findings. In addition, prominent fibrosis seemed to be a more consistent finding in cases with negative as opposed to those with positive scintigraphic findings. Presence of anemia may provide a guideline as to whether or not scintigraphy is indicated.

Neuroendocrine Tumors of Meckel’s Diverticulum: Lessons from a Single Institution Study of Eight Cases

2010 ◽  
Vol 15 (1) ◽  
pp. 101-109 ◽  
Author(s):  
Gilles Poncet ◽  
Valérie Hervieu ◽  
Thomas Walter ◽  
Florian Lépinasse ◽  
Laurence Chardon ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Single Institution

scholarly journals Symptomatic and Incidental Meckel’s Diverticulum in Children: Our Experience and Lesson

2020 ◽  
Author(s):  
Rakesh Kumar ◽  
Vivek Srivastava ◽  
Vaibhav Pandey
Keyword(s):  
Wedge Resection ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Complication Rates ◽  
Symptomatic Group ◽  
Younger Age ◽  
Segmental Bowel Resection ◽  
Incidental Group ◽  
The Mean

Introduction: The management of incidentally detected Meckel’s Diverticulum (MD) at laparotomy or laparoscopy has been debatable. In asymptomatic cases, the surgical management is associated with complication of around 1% but the complication rates are variable in other conditions like peritonitis. Aim: To assess the management and outcome of incidentally diagnosed MD. Materials and Methods: A retrospective study was conducted from January 2012 to December 2019 using the case records of the patient. The study included all the patients who were diagnosed with cases of MD in the Department. The patients were divided into two groups: Symptomatic Group and Incidental Group. The case records of all the patients were reviewed and data were collected for the demographic details, mode of presentation, the basis of diagnosis, treatment, outcome and follow-up. Results: Total 132 patients were included in the study, 74 (56.06%) subjects were in symptomatic group and 58 (43.9%) were in incidental group. The mean age of symptomatic patients was 3.1±1.1 years and the incidental group was 6.5±2.4 years. It was significantly less in the symptomatic group (p≤0.001). All the patients in the symptomatic group were managed by laparotomy with diverticulectomy in 8 (10.8%), Wedge resection in 10 (13.5%) cases, segmental bowel resection in 44 (59.4%) and ileostomy in 12 (16.2%) cases. In the incidental group 9 (15.5%) patients underwent laparoscopic diverticulectomy and in rest 49 (66.2%) cases, only the primary procedure was performed. Six (10.3%) patients of incidental group without any intervention presented with complication in follow-up. Conclusion: The laparoscopic diverticulectomy of MD should be performed in incidentally diagnosed cases of younger age group.

Sign in / Sign up

Export Citation Format

Share Document