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.

scholarly journals Perforated Meckel’s Diverticulum Lithiasis: An Unusual Cause of Peritonitis

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Umasankar Mathuram Thiyagarajan ◽  
Amirthavarshini Ponnuswamy ◽  
Atul Bagul ◽  
Prabakar Ponnuswamy
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Congenital Malformation ◽  
Healthy Individual ◽  
Stone Formation ◽  
Meckel’S Diverticulum ◽  
Exploratory Laparotomy ◽  
Meckel's Diverticulum

Meckel’s diverticulum is the commonest congenital malformation of gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, it can present as bleeding, perforation, intestinal obstruction, intussusception, and tumours. These complications, especially bleeding, tend to be more common in the paediatric group and intestinal obstruction in adults. Stone formation (lithiasis) in Meckel’s diverticulum is rare. We report a case of Meckel’s diverticulum lithiasis which presented as an acute abdomen in an otherwise healthy individual. The patient underwent an exploratory laparotomy which revealed a perforated Meckel’s diverticulum with lithiasis; a segmental resection with end-to-end anastomosis of small bowel was performed. Patient recovery was delayed due to pneumonia, discharged on day 20 with no further complications at 6 months following surgery.

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.

Возможности ультразвукового исследования в диагностике удвоений желудочно-кишечного тракта у детей

2019 ◽  
pp. 40-56
Keyword(s):  
Acute Pancreatitis ◽  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Emergency Surgery ◽  
Alimentary Tract ◽  
Meckel’S Diverticulum ◽  
Duplication Cyst ◽  
Meckel's Diverticulum

В статье представлен анализ диагностики удвоений желудочно-кишечного тракта по историям болезни хирургического отделения, отделения патологии новорожденных, 1-го инфекционного отделения для детей грудного возраста ГБУЗ ВО “Областная детская клиническая больница” (г. Владимир) за последние 13 лет (с 2005 по 2017 г.). Было изучено 6 случаев диагностики и лечения удвоений пищеварительного тракта. У всех пациентов имело место удвоение различных отделов кишечника. Всем детям в ходе обследования выполнялось ультразвуковое исследование. Проведенный анализ позволил выделить 5 вариантов ультразвукового изображения удвоения кишечника и связанных с ним осложнений: 1) ультразвуковая картина кисты брюшной полости (n = 2, 33,4%); 2) ультразвуковая картина кисты брюшной полости с признаками кишечной непроходимости (n = 1, 16,7%); 3) ультразвуковая картина кишечной непроходимости (n = 1, 16,7%); 4) ультразвуковая картина перитонита (n = 1, 16,7%); 5) ультразвуковая картина образования, сходного с дивертикулом Меккеля (n = 1, 16,7%). В статье приведен обзор литературы, посвященный этой редко встречающейся аномалии развития и трудностям ее дооперационной диагностики. Отмечено отсутствие специфической клинической картины как самой аномалии развития, так и ее осложнений, что затрудняет доопеарционную диагностику удвоений пищеварительного тракта. Этому же способствует многообразие форм и локализаций данной аномалии развития, что отражается в разнообразии клинической и ультразвуковой картины. Подробно обсуждены и обобщены различные варианты ультразвуковой картины на примере собственных наблюдений и обзора литературы. Ключевые слова: ультразвуковая диагностика, удвоения желудочно-кишечного тракта, кишечная непроходимость, кистозная форма удвоения, острый живот, острый аппендицит, острый панкреатит, дивертикул Меккеля, неотложная хирургия, дети, ultrasound, alimentary tract duplications, intestinal obstruction, duplication cyst, acute abdomen, acute appendicitis, acute pancreatitis, Meckel’s diverticulum, emergency surgery

THE UMBILICAL POLYP, A REMNANT OF THE OMPHALOMESENTERIC DUCT

PEDIATRICS ◽  
1957 ◽  
Vol 20 (1) ◽  
pp. 98-100
Author(s):  
Stanley E. Crawford
Keyword(s):  
Young Children ◽  
Intestinal Obstruction ◽  
Neonatal Period ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Recent Case ◽  
Early Age ◽  
Review Of The Literature ◽  
Omphalomesenteric Duct ◽  
Umbilical Polyp

THE PURPOSE of this paper is to report a recent case of an umbilical polyp and intestinal obstruction during the neonatal period. Umbilical polyps are rare. When present, they may be associated with Meckel's diverticulum because both are remnants of the omphalomesenteric duct. The presence of the visible polyp may give an external clue to otherwise obscure intraabdominal symptoms. A review of the literature earlier than 1916 is well summarized in a book by Thomas Cullen. This unusual volume lists six cases of umbilical polyp accompanied by other pathologic complications of Meckel's diverticulum. This author stressed that in these cases it should be pointed out to either the patient or his parents that possible intra-abdominal duct remnants may, at any time, give rise to symptoms such as intestinal obstruction. Penberthy and Benson reported a 9-year-old male with an umbilical polyp which had been present since birth and was without discharge. This youngster died following operation for intestinal obstruction due to volvulus about the diverticulum and its fibrous connection with the umbilical polyp. These authors pleaded for early elective operations in these cases prior to such complications. Gross gave other reasons for observation, and exploration at a reasonably early age, if a Meckel's diverticulum is suspected. Peritonitis from a ruptured Meckel's diverticulum is peculiarly dangerous; in young children the protecting omentum is inadequate and the migrating nature of the anomaly adds to the danger. Fluid from perforation of a diverticulum is usually of greater volume than that found in appendiceal rupture and abscess.

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