Subacute Meckel’s diverticulum perforation

Meckel’s diverticulum is the most common intestinal congenital defect, its prevalence is 0.2%–4.0% and it occurs more commonly in children younger than 2-year old with intestinal bleeding and abdominal pain. Perforation in the elderly is very rare with no more than 35 articles reported worldwide. Here we report the case of a 62-year-old man who was admitted to hospital with a history of acute abdominal pain with a 20-day onset. The patient was treated with laparotomy and 30 cm ileal resection was performed for an 8×5 cm perforated ileum tumour at 50 from ileocecal valve with a side-to-side mechanical anastomosis for reconstruction. Having morbidity Clavien-Dindo scale I in postsurgical and good outcome in 6-month follow-up. Meckel’s diverticulum is an infrequent pathology in paediatric and even rarer in adult population, however, it is always important to keep in mind how to act when is seen either as a finding or as a complication.

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A Rare Cause of Abdominal Pain in Adults: Meckel’s Diverticulitis

Case Reports in Gastroenterology ◽

10.1159/000494752 ◽

2018 ◽

Vol 12 (3) ◽

pp. 709-714 ◽

Cited By ~ 3

Author(s):

Usman Pirzada ◽

Hassan Tariq ◽

Sara Azam ◽

Kishore Kumar ◽

Anil Dev

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum ◽

Emergency Laparotomy ◽

Contrast Enhanced ◽

Meckel’S Diverticulitis ◽

The Right ◽

Enhanced Computed Tomography

A 42-year-old man presented to the emergency room with complaints of periumbilical abdominal pain. A contrast-enhanced computed tomography revealed mucosal thickening in the small bowel of the right abdomen. There was a fairly large small bowel diverticulum associated with this segment. Findings were suggestive of small bowel diverticulitis or possibly focal enteritis. A Meckel’s diverticulum scan was diagnostic of Meckel’s diverticulum. The patient was then immediately taken to the operating room for emergency laparotomy and was intra-operatively found to have a thickened Meckel’s diverticulitis with adjacent small bowel obstruction. Meckel’s diverticulectomy was performed in continuity with the adjacent inflamed small bowel. The patient had a stable postoperative course without any complications and was discharged within 10 days. At the 3-month follow-up, the patient was well and remained asymptomatic.

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Chronic Nocturnal Abdominal Pain as the Presentation of Inverted Meckel Diverticulum: A Case Report

Children ◽

10.3390/children9010069 ◽

2022 ◽

Vol 9 (1) ◽

pp. 69

Author(s):

Ting-Yu Wang ◽

Yu-Tsun Su ◽

Po-Jui Ko ◽

Yea-Ling Chen ◽

Hsiang-Hung Shih ◽

...

Keyword(s):

Abdominal Pain ◽

Meckel’S Diverticulum ◽

Clinical Manifestations ◽

Exploratory Laparotomy ◽

Meckel's Diverticulum ◽

Distended Abdomen ◽

History Of ◽

The Common ◽

Hospital Visits ◽

Inverted Meckel’S Diverticulum

The common clinical manifestations of Meckel’s diverticulum include painless lower gastrointestinal bleeding and intestinal obstruction due to intussusception. Intussusception induced by inverted Meckel’s diverticulum has rarely been reported; furthermore, there is no report thus far of chronic nocturnal abdominal pain as a presenting symptom in children with Meckel’s diverticulum. A 4-year-and-10-month-old girl with no significant history of previous illness presented with the sole complaint of chronic nocturnal abdominal pain for 3 months. The patient was reported to be asymptomatic during the day. A provisional diagnosis of chronic ileoileal intussusception was already under consideration in her previous hospital visits elsewhere. Physical examination revealed a soft, non-distended abdomen without tenderness. Imaging studies revealed ileoileal intussusception. Exploratory laparotomy showed ileoileal intussusception induced by an inverted Meckel’s diverticulum with ulceration. The patient underwent successful surgery and made a full recovery. We report this case to remind physicians that Meckel’s diverticulum should be considered in differential diagnosis of children presenting with the isolated symptom of chronic nocturnal abdominal pain.

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Intussusception due to an Inverted Meckel’s Diverticulum Diagnosed by Double-Balloon Enteroscopy

Case Reports in Gastroenterology ◽

10.1159/000481161 ◽

2017 ◽

Vol 11 (3) ◽

pp. 640-644 ◽

Cited By ~ 1

Author(s):

Yuki Kawasaki ◽

Satoshi Shinozaki ◽

Tomonori Yano ◽

Kenichi Oshiro ◽

Mitsuaki Morimoto ◽

...

Keyword(s):

Abdominal Pain ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

Meckel's Diverticulum ◽

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Double Balloon ◽

Contrast Medium Injection ◽

Emergent Surgery ◽

Inverted Meckel’S Diverticulum

An 18-year-old man presented after undergoing multiple investigations for abdominal pain. Retrograde double-balloon enteroscopy showed a protruding red lesion in the ileum with small ulcers, approximately 75 cm proximal to the ileocecal valve, resulting in an intussusception. An inverted Meckel’s diverticulum was strongly suspected. Pressure was applied to the protruding lesion using contrast medium injection after wedging the lumen with a balloon. The intussusception partially reduced, avoiding the need for emergent surgery. Endoscopic tattooing was performed to mark the lesion for subsequent resection. Elective laparoscopy-assisted surgery with minimum laparotomy revealed an inverted Meckel’s diverticulum, which was resected.

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Phytobezoar Within Meckel’s Diverticulum Presenting With Partial Intestinal Obstruction

Case Reports in Clinical Practice ◽

10.18502/crcp.v5i1.3609 ◽

2020 ◽

Author(s):

Reza Mosaddegh ◽

Mohammad Hossein Ghafouri ◽

Mahdi Rezai ◽

Mohammad Reza Maghsoudi ◽

Farzaneh Beigmohammadi

Keyword(s):

Gastrointestinal Tract ◽

Intestinal Obstruction ◽

Case Reports ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

Meckel's Diverticulum ◽

Midline Laparotomy ◽

Ectopic Tissue ◽

History Of ◽

Partial Intestinal Obstruction

Introduction: Meckel’s Diverticulum (MD) affects approximately 2% of the population. Phytobezoar is defined as a vegetable and fiber-based ball in the gastrointestinal tract. We report a rare case of phytobezoar within MD presenting with partial intestinal obstruction. Case Reports: We hereby present a 20-year-old man who referred to the Emergency Department of a hospital with a two-day history of nausea, vomiting, abdominal pain, and constipation. He underwent a midline laparotomy with surgical exploration, which revealed an MD 60 cm proximal to ileocecal valve containing phytobezoar. Histopathology reported the extracted specimen as an MD without ectopic tissue. Conclusion: Meckel’s diverticulum can be affected by bezoars as well as other parts of the gastrointestinal tract. We recommend that phytobezoar within MD be considered among differential diagnosis of bowel obstruction.

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Meckel’s Diverticulum Diagnosed by Balloon-Assisted Enteroscopy: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID)

Gastroenterology Research and Practice ◽

10.1155/2021/9574737 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Jen-Wei Chou ◽

Chen-Shuan Chung ◽

Tien-Yu Huang ◽

Chia-Hung Tu ◽

Chen-Wang Chang ◽

...

Keyword(s):

Small Bowel ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

Pancreatic Tissue ◽

Meckel's Diverticulum ◽

Primary Indication ◽

The Mean ◽

Small Intestinal ◽

Retrospective Multicenter Study

Background and Aims. Patients with Meckel’s diverticulum (MD) are difficult to preoperatively diagnose because of its endoscopic inaccessibility. Balloon-assisted enteroscopy (BAE) allows endoscopic access to the entire small intestine. The aim of the current study was to investigate patients with MD diagnosed by BAE in Taiwan. Methods. We conducted a retrospective, multicenter study of patients with MD who were diagnosed by BAE in Taiwan. The clinical characteristics, endoscopic features, histopathological findings, treatment methods, and outcomes were analyzed. Results. A total of 55 patients with MD were enrolled (46 males and 9 females). The mean age at diagnosis was 34.1 years. Overt gastrointestinal bleeding (87.3%) was the primary indication for BAE, followed by abdominal pain (9.1%), suspected small bowel tumor (1.8%), and Crohn’s disease follow-up (1.8%). The mean distance between the ileocecal valve and MD was 71.6 cm (regarding diagnostic yields: BAE—100%, capsule endoscopy—40%, Meckel’s scan—35.7%, computed tomography—14.6%, small bowel series—12.5%, and angiography—11.1%; regarding endoscopic features of MD: a large ostium—89.1%, a small ostium—7.3%, and a polypoid mass—3.6%). Surgical treatment was performed in 76.4% patients, and conservative treatment was performed in 23.6% patients. The mean length of MD in 42 patients who underwent surgical resection was 5.2 cm (in 43 patients of MD with available histopathology: heterotopic gastric tissue, 42.4%, heterotopic gastric and pancreatic tissues, 7%; heterotopic pancreatic tissue, 4.7%; heterotopic colonic tissue, 2.3%; and a neuroendocrine tumor, 2.3%). Conclusions. The current study showed BAE is a very useful modality for detecting MD compared with other conventional modalities.

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Stromal Tumor in a Perforated Meckel's Diverticulum: A Case Report

Swiss Surgery ◽

10.1024/1023-9332.8.6.273 ◽

2002 ◽

Vol 8 (6) ◽

pp. 273-276 ◽

Cited By ~ 2

Author(s):

Frühauf ◽

Garcia ◽

Rosso

Keyword(s):

Abdominal Pain ◽

Abdominal Mass ◽

Meckel’S Diverticulum ◽

Signs And Symptoms ◽

Meckel's Diverticulum ◽

Stromal Tumor ◽

Intestinal Bleeding ◽

High Preference ◽

Poorly Differentiated ◽

Acute Perforation

Stromal tumors are rare neoplasms of the small bowel that locate in Meckel's diverticulum with high preference. Perforation of those tumors is very uncommon.There are 96 cases reported in current literature, including only 6 perforations. The diagnosis of that kind of tumor is very difficult because of lack of pathognomonic signs and symptoms. The clinical presentation include abdominal pain, intestinal bleeding, abdominal mass, intestinal obstruction and less commonly, acute perforation. We report the case of a 61-years old patient with a poorly differentiated stromal tumor in a perforated Meckel's diverticulum. The difficulty of identifying a stromal tumor preoperatively and the therapeutic options are emphasised. It is suggested that an aggressive attitude should be taken in the preoperative management of any patient over 50 years of age who presents with melena and abdominal pain.

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Perforation of a Meckel’s diverticulum secondary to chronic NSAID use: case report and review of the literature

International Surgery Journal ◽

10.18203/2349-2902.isj20203797 ◽

2020 ◽

Vol 7 (9) ◽

pp. 3082

Author(s):

Francisco Terrazas Espitia ◽

David Molina Davila ◽

Luis Villalobos Ramirez ◽

Bruno Salazar Trujillo ◽

Lucio Santos Moyron ◽

...

Keyword(s):

Epigastric Pain ◽

Iliac Fossa ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

Acute Onset ◽

Meckel's Diverticulum ◽

Male Population ◽

History Of ◽

Heterotopic Tissue ◽

The Right

Meckel´s diverticulum is an abnormality in the development of the gastrointestinal system, its origin and clinical significance was first described by Johan Friedrich Meckel in 1809. It is a remnant of the omphalomesenteric duct which is usually observed following the rule of 2’s, located 2 feet proximal to the ileocecal valve, before 2 years of age in approximately 2% of the population, and is twice as common in male population. It is considered a true diverticulum because it presents all the histopathological layers of the bowel; 6% of the cases present with heterotopic tissue, mainly pancreatic, gastric, colonic or jejunal. We present the case of a 37-year-old patient who presented with acute onset epigastric pain which migrated to the right iliac fossa, he had a history of chronic non-steroidal anti-inflammatory drugs (NSAIDs) usage for articular pain. He underwent abdominal contrast tomography (CT) scan with double iodine contrast enhancement, which revealed the presence of a perforated Meckel´s diverticulum in the antimesenteric portion of the terminal ileum. The patient underwent laparoscopic diverticulectomy with no complications and was discharged 72 hours after the procedure. Histopathological confirmation of a perforated meckel’s diverticulum with heterotopic gastric mucosa confirmed the clinical suspicion of perforation secondary to chronic NSAIDs usage.

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Axial torsion of Meckel’s diverticulum causing acute peritonitis in the first trimester of pregnancy: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0754-y ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Hiromitsu Nagata ◽

Hiroyasu Nishizawa ◽

Susumu Mashima ◽

Yasuyuki Shimahara

Keyword(s):

Clinical Diagnosis ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

First Trimester ◽

Meckel's Diverticulum ◽

Ileocecal Resection ◽

Bowel Loop ◽

Axial Torsion ◽

First Trimester Of Pregnancy ◽

In Pregnancy

Abstract Background Meckel’s diverticulum is considered the most prevalent congenital anomaly of the gastrointestinal tract. Approximately 4% of patients are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation, while axial torsion of Meckel’s diverticulum is rare, particularly in pregnancy. Case presentation A 31-year-old woman in week 15 of pregnancy complained of epigastric pain, nausea and vomiting. Clinical diagnosis was severe hyperemesis gravidarum. Because the symptoms persisted during hospitalization, CT was performed and revealed dilated small bowel loops with multiple air-fluid levels. In the right mid-abdomen, there was a large part of air containing a cavity connected to the small intestine, which was considered a dilated bowel loop. Emergency laparotomy was performed and axial torsion of a large Meckel’s diverticulum measuring 11 cm was found at a few centimeters proximal to the ileocecal valve. Ileocecal resection including Meckel’s diverticulum was performed. The postoperative course was uneventful. At 40 weeks gestation, she had vaginal delivery of normal baby. Conclusion The physiological and anatomical changes in pregnancy can make a straightforward clinical diagnosis difficult. Prompt diagnosis and management were needed in order to avoid significant maternal and fetal risks. The use of imaging examinations, especially CT examination, with proper timing may be helpful to prevent delay in diagnosis and surgical intervention. Here, we report the case of a patient with axial torsion of Meckel’s diverticulum in pregnancy. To our knowledge, axial torsion of Meckel’s diverticulum in the first trimester of pregnancy has not been reported in the English medical literature.

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Rare cause of chronic abdominal pain: left paraduodenal hernia and its surgical management

BMJ Case Reports ◽

10.1136/bcr-2021-245024 ◽

2021 ◽

Vol 14 (12) ◽

pp. e245024

Author(s):

Ajay Chikara ◽

Sasidhar Reddy Karnati ◽

Kailash Chand Kurdia ◽

Yashwant Sakaray

Keyword(s):

Abdominal Pain ◽

Stable Condition ◽

Paraduodenal Hernia ◽

Inferior Mesenteric Vein ◽

Anterior Border ◽

Initial Reduction ◽

Contrast Enhanced ◽

History Of ◽

Enhanced Computed Tomography

A 30-year-old man presented with colicky abdominal pain for 2 months, associated with occasional episodes of bilious vomiting. He had a history of similar complaints at the age of 16 and 26 years. Contrast-enhanced computed tomography abdomen was consistent with a diagnosis of left paraduodenal hernia. On laparoscopy a 3 × 3 cm hernial defect was identified in the left paraduodenal fossa (fossa of Landzert). Contents were jejunal, and proximal ileal loops which were dilated and edematous. Anterior border of the sac was formed by the inferior mesenteric vein and left branch of the left colic artery. Initial reduction of contents was easy. However, complete reduction proved to be difficult due to adhesions with the sac opening, the hernial sac instead laid open by dividing the Inferior Mesentric Vein (IMV) (anterior border of defect) using a vascular stapler. The patient was discharged on postoperative day 3 in a stable condition. On follow-up the patient is doing well.

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Meckel’s diverticulum with intraperitoneal hemorrhage in a child detected with screening laparoscopy: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01347-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kazuki Wakizaka ◽

Lee Wee Khor ◽

Kazuya Annen ◽

Tsuyoshi Fukushima ◽

Mitsuko Furuya ◽

...

Keyword(s):

Abdominal Pain ◽

Gastric Mucosa ◽

Meckel’S Diverticulum ◽

Lower Abdominal Pain ◽

Abdominal Distension ◽

Small Bowel Resection ◽

Massive Bleeding ◽

Meckel's Diverticulum ◽

Ectopic Gastric Mucosa ◽

Intraperitoneal Hemorrhage

Abstract Background The most common presentation of symptomatic Meckel’s diverticulum (MD) are intestinal obstruction, gastrointestinal hemorrhage, and inflammation of the MD with or without perforation. Intraperitoneal hemorrhage because of MD is extremely rare. We report a case of MD with intraperitoneal hemorrhage in a child detected with screening laparoscopy. Case presentation An 11-year-old girl presented to another hospital with lower abdominal pain and vomiting that lasted for 2 days. Acute appendicitis was suspected, and she was referred to our department. Abdominal enhanced computed tomography showed an abscess in the lower abdomen with ascites in the pelvis. She was diagnosed with a localized intra-abdominal abscess and the decision was made to treat with antibiotics. However, her abdominal pain worsened, with abdominal distension, tenderness and guarding. She was diagnosed with panperitonitis and the decision was made for surgery 5 h after admission. During surgery, laparoscopic observation from the umbilical region revealed 200 ml of fresh blood throughout the peritoneal cavity, originating from the mesentery of the ileum. MD was observed with bleeding from the surrounding mesentery. Small bowel resection was performed, and the patient was discharged on the 5th postoperative day. Pathological findings revealed an MD containing ectopic gastric mucosa and small intestinal ulcer perforation at the base of the MD. Conclusions We report an extremely rare case of an MD with intraperitoneal hemorrhage in a child. In pediatric cases, it is possible that perforation with ectopic gastric mucosa may cause massive bleeding because of rupture of the surrounding mesenteric blood vessels.

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