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

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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Axially torsional Meckel's diverticulum accompanied by small bowel volvulus: a case report

Journal of International Medical Research ◽

10.1177/03000605211053554 ◽

2021 ◽

Vol 49 (10) ◽

pp. 030006052110535

Author(s):

Yang Chen ◽

Yongzhi Liu ◽

Lihui Jiang ◽

Feng Jiang ◽

Tieming Zhu

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Standard Treatment ◽

Meckel’S Diverticulum ◽

Delayed Diagnosis ◽

Intestinal Resection ◽

Meckel's Diverticulum ◽

Small Bowel Volvulus ◽

Blind Ending ◽

Small Intestinal

Small bowel volvulus secondary to Meckel’s diverticulum is rare, and a delayed diagnosis results in disastrous outcomes. Computed tomography is conducive to early differential diagnosis. In particular, a blind-ending pouch structure on CT always indicates Meckel’s diverticulum. Diverticulectomy with or without adjacent partial small intestinal resection is the standard treatment for symptomatic Meckel’s diverticulum. However, the therapy for asymptomatic Meckel’s diverticulum is controversial. Here, we report the case of a 20-year-old man who suffered intestinal obstruction secondary to small bowel volvulus caused by an axially torsional, gangrenous, and giant Meckel’s diverticulum. Diverticulectomy with partial intestinal resection was performed.

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Meckel's Diverticulum Series at UCMS, Bhairahawa, Nepal

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v1i3.8767 ◽

2013 ◽

Vol 1 (3) ◽

pp. 56-57

Author(s):

P Joshi

Keyword(s):

Small Bowel ◽

Meckel’S Diverticulum ◽

Case Series ◽

Pancreatic Tissue ◽

Intestinal Wall ◽

Meckel's Diverticulum ◽

Medical Sciences ◽

Medical College ◽

Ileocaecal Junction ◽

Specific Symptoms

Meckel's Diverticulum is the most common congenital malformation of the Gastrointestinal tract. It represent the patent intestinal end of the vitellointestinal duct. It occurs in 2 % of of population in autospy series and usually lie 60 cm from the Ileocaecal junction. It possesses all the three coats of intestinal wall. It has the same microscopic structure as the adjacent small bowel and it has a separate blood supply from the adjacent small bowel mesentery (the omphalomesenteric artery).1 In 20% of the cases, the mucosa contains heterotopic epithelium, namely gastric, colonic and sometimes pancreatic tissue. Although Meckel's diverticulum occurs with equal frequency in both sexes, symptoms usually resulting from the epithelium contained in the diverticulum predominantly occur in males.2Complications develop in only 4% of patients with this malformation, with most cases presenting in childhood3. Complications of Meckel's diverticulum include hemorrhage, bowel obstruction, inflammation, and perforation. All of these complications can be challenging to diagnose because patients may present with non-specific symptoms, which produce a clinical picture that can mimic other more common gastrointestinal disorders.4 Most of the cases are diagnosed intraoperatively. Here, we present a case series of 5 patients in a year 2012 at Universal College of Medical College & Teaching Hospital, Bhairahawa, Nepal.DOI: http://dx.doi.org/10.3126/jucms.v1i3.8767 Journal of Universal College of Medical Sciences Vol.1(3) 2013: 56-57

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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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Gastrointestinal stromal tumor in perforated Meckel’s diverticulum: a case report and literature review

Surgical Case Reports ◽

10.1186/s40792-020-01038-x ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Naoki Hashizume ◽

Saki Sakamoto ◽

Suguru Fukahori ◽

Shinji Ishii ◽

Nobuyuki Saikusa ◽

...

Keyword(s):

Small Bowel ◽

Gastrointestinal Stromal Tumor ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

Meckel's Diverticulum ◽

Stromal Tumor ◽

Free Air ◽

Meckel’S Diverticulitis ◽

Colon And Rectum ◽

Enhanced Computed Tomography

Abstract Introduction Gastrointestinal stromal tumor (GIST) is rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. GIST has been found largely in the stomach, small bowel, colon and rectum, and esophagus, but about 5% are found in other locations. We herein report a 56-year-old woman with a GIST in perforated Meckel's diverticulum. After encountering this patient, a review of the literature found reports of 18 similar patients. Case presentation A 56-year-old woman diagnosed with galactosialidosis (β-galactosidase-neuraminidase deficiency) presented with vomiting. On contrast-enhanced computed tomography, peritonitis due to perforation of the intestine was diagnosed based on the free air and dilated loop of the small bowel. Laparotomy revealed perforation of Meckel’s diverticulitis located 50 cm from the ileocecal valve. Partial resection of the ileum, including the diverticulum, and end-to-end anastomosis of the small intestine were performed. Regarding the pathological findings, the edge of the diverticulum wall consisted of a solid mass measuring 1.0 cm in size, and the tumor cells were spindle-shaped with 1 mitosis present per 50 high-power fields. The diagnosis was established as GIST of the Meckel's diverticulum. The postoperative period was uneventful. Follow-up at two years revealed no evidence of recurrence. Conclusion GIST in perforated Meckel's diverticulum is very rare. The potential for the coexistence of GIST or other tumor should be considered in the treatment of perforated Meckel's diverticulum.

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

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45626.14080 ◽

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.

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Subacute Meckel’s diverticulum perforation

BMJ Case Reports ◽

10.1136/bcr-2020-237840 ◽

2021 ◽

Vol 14 (3) ◽

pp. e237840

Author(s):

Alberto Robles Méndez Hernández ◽

Oscar Alejandro Mora-Torres ◽

Hugolino Andrade Lopez ◽

Jorge Alfonso Perez Castro Y Vazquez

Keyword(s):

Abdominal Pain ◽

Adult Population ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

The Elderly ◽

Meckel's Diverticulum ◽

Intestinal Bleeding ◽

History Of ◽

Mechanical Anastomosis

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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Intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing gastric cystica profunda component cells within the inverted Meckel’s diverticulum: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01061-y ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Natsuko Yamauchi ◽

Takashi Ito ◽

Hiroki Matsuoka ◽

Teruhiro Chohno ◽

Hiroshi Hasegawa ◽

...

Keyword(s):

Adipose Tissue ◽

Small Intestine ◽

Gastric Mucosa ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum ◽

Ectopic Gastric Mucosa ◽

Crypt Epithelium ◽

Small Intestinal ◽

Inverted Meckel’S Diverticulum

Abstract Background Lipomas are the most common cause of intussusception in adults. To our knowledge, however, no cases of lipoma and ectopic gastric mucosa with gastritis cystica profunda (GCP) have been reported. We report a case of intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing GCP-component cells within the inverted Meckel’s diverticulum. Case presentation A female in her 40s underwent computed tomography for postoperative follow-up of left breast cancer. A tumor, suspected to be a lipoma, was found in the ileum. Since there were no symptoms, the patient underwent regular follow-up. However, gradual enlargement was observed, and surgery was recommended due to the risk of intussusception. After reduction via the Hutchinson technique, laparoscopically assisted partial resection of the small intestine was performed due to suspicion that the tumor was causing intussusception starting from the ileum. Histopathologic examinations revealed proliferation of mature adipose tissue in the subserosal layer, which was diagnosed as lipoma. Furthermore, adipose tissue was found in the stem area and accordingly, we diagnosed lipoma associated with the inverted Meckel’s diverticulum. Moreover, gastric mucosa-like crypt epithelium and proper glandular tissue were identified in the mucosal membrane at the area of onset, and signs of gastric pit dilatation over the submucosa and crypt epithelium hyperplasia were observed. Diagnosis was ectopic gastric mucosa containing GCP component tissue. Conclusions Intussusception in the small intestine complicated with lipoma and ectopic gastric mucosa with GCP within the Meckel’s diverticulum has not been reported, demonstrating the rarity of our case.

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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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Inverted Meckel's diverticulum simulating a pedunculated small bowel polyp

Abdominal Imaging ◽

10.1007/bf00200403 ◽

1995 ◽

Vol 20 (3) ◽

pp. 236-237 ◽

Cited By ~ 5

Author(s):

M. Simms ◽

D. A. Malatjalian ◽

L. Fried ◽

H. Al-Jawad

Keyword(s):

Small Bowel ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum ◽

Inverted Meckel’S Diverticulum

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A Triad of Congenital Diaphragmatic Hernia, Meckel’s Diverticulum, and Heterotopic Pancreas

Case Reports in Pediatrics ◽

10.1155/2014/725945 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Parkash Mandhan ◽

Amer Al Saied ◽

Mansour J. Ali

Keyword(s):

Case Report ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Chromosomal Abnormalities ◽

Meckel’S Diverticulum ◽

Pancreatic Tissue ◽

Meckel's Diverticulum ◽

Developmental Anomaly ◽

Heterotopic Pancreatic Tissue ◽

First Case

Congenital diaphragmatic hernia is a common developmental anomaly encountered by paediatric surgeons. It is known to be associated with extradiaphragmatic malformations, which include cardiac, renal, genital, and chromosomal abnormalities. Herein, we report a newborn born with concurrent congenital diaphragmatic hernia, Meckel’s diverticulum, and heterotopic pancreatic tissue. This is the first case report of such a triad with description of possible mechanisms of the development.

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