Meckel’s Diverticulum in Children: A Monocentric Experience and Mini-Review of Literature

Vitelline duct anomalies (VDA, including Meckel’s diverticulum (MD)) result from failed embryologic obliteration. This study aimed for characteristics in symptomatic versus asymptomatic VDA, analyzing clinico-laboratory data from 73 children, aged 1 day to 17 years, treated at a tertiary Pediatric Surgery Institution from 2002–2017. A male preponderance was obtained (ratio 3.6:1). MD accounted for 85% of VDA. Incidence of symptomatic VDA decreased with older age. Leading symptoms were intestinal obstruction and hemorrhage. Mucosal heterotopia (present in 39% of symptomatic MD) was associated with anemia and lowered CRP-levels. On ROC-analysis, hemoglobin < 8.6 g/dL, CRP < 0.6 mg/dL and MD distance to ileocecal valve >40 cm were predictors of ectopic tissue in symptomatic MD. Our data confirmed known characteristics as male preponderance, declined incidence of symptomatic cases with age and predominance of gastric ectopia in symptomatic MD. Moreover, anemia and prolonged distance of MD to ileocecal valve were predictors of ectopic mucosa in symptomatic MD.

The unusual cytoarchitecture of “vitelline follicles” in freshwater blood flukes of the genus Sanguinicola (Digenea, Aporocotylidae)

This is the first study assessing the cytoarchitecture of the vitellarium of members of the freshwater, teleost-infecting lineage of blood-flukes (Aporocotylidae). The vitelline cytoarchitecture of two innominate species of Sanguinicola from freshwater fishes in Russia showed that vitelline cells at different stages of maturation are widely distributed throughout much of the body and are mixed with other cell types. The latter feature indicates that use of the term “follicular vitellarium” is inappropriate for species of this genus. An additional characteristic of the vitelline cells in these Sanguinicola spp. is their ability to form long, pseudopodia-like extensions of the peripheral cytoplasm that contact neighbouring vitelline cells and sarcoplasmic extensions, forming both heterologous and homologous intercellular junctions. Within the vitelline duct lumen, the cytoplasm of mature vitelline cells is filled with regular clusters (0.5–1.0 μm in diameter), comprising 10–30 vitelline globules, which have heterogeneous contents and electron-lucent lipid droplets (1.1–1.7 μm in diameter), but no apparent modifications of vitelline globules occur within the vitelline duct. The flattened, ciliated, epithelial lining of the common vitelline duct contains intra-epithelial nuclei, its luminal surface bears shallow lamellae and adjacent cells are adjoined by apical septate junctions. All of these observations, when compared to the marine Aporocotyle simplex, likely represent additional characteristics supporting the divergent evolutionary lineages of marine and freshwater aporocotylids.

Heterotopic Gastric Mucosa in the Ileum: A Rare Cause for Intussusception in Adults

Intussusception is the leading cause for intestinal obstruction in children. However, it accounts for only 5% of bowel obstructions in adults. Heterotopic gastric mucosa (HGM) can occur anywhere in the gastrointestinal tract; nevertheless, its occurrence in the small intestine is rare unless associated with remnants of vitelline duct (Meckel’s diverticulum). Herein, we describe a case of a 33-year-old male who presented with symptoms and signs of intestinal obstruction caused by ileo-colic intussusception, in which polypoid HGM acted as the organic lead point for intussusception. Several cases of intussusception caused by HGM have been reported in pediatric age group; however, this event is exceedingly rare in adults.

An atypical presentation of a mesenteric Meckel’s diverticulum in a 7-year-old warmblood mare: case report

Background Meckel’s diverticula are a rare cause of small intestinal strangulation, diagnosed at laparotomy or necropsy. This congenital anomaly of the gastrointestinal tract originates from a remnant of the vitelline duct. In reported equine cases, they present as a full-thickness diverticulum on the antimesenteric border of the distal jejunum or proximal ileum. Case presentation On laparotomy a Meckel’s diverticulum positioned at the mesenteric side was found to be the cause of small intestinal strangulation. This position is very uncommon and to the best knowledge of the authors there is no unambiguous description of another case. Conclusions Meckel’s diverticula should be on the list of differential diagnoses in cases of small intestinal strangulation. As in humans, equine Meckel’s diverticula can have the standard antimesenteric as well as a more exceptional mesenteric location. This case adds to the series of anecdotal reports of anomalies with regard to Meckel’s diverticula in the horse.

Changes in the Prevalence of Embryologic Remnants in Umbilical Cord With Gestational Age

The aim of this study was to examine the prevalence of embryologic remnants in umbilical cords of different gestational ages. Sections from 392 umbilical cords were examined using light microscopy. Of these, 52% contained at least 1 remnant, most commonly of the allantoic duct type. Although there was a significant decrease in vitelline duct remnants over increasing gestational age, from 11% at weeks 11–25 to 1.6% at weeks 36–42 ( P = .009; χ2 test), the allantoic duct remnants remained constant in prevalence irrespective of gestational age.

Littre Hernia: A Rare Case of an Incarcerated Meckel’s Diverticulum

A Meckel’s diverticulum is a remnant of the vitelline duct, which leads to the formation of a true diverticulum containing all layers of the small intestine. The diverticulum can contain ectopic gastric, duodenal or pancreatic tissue and is the most common congenital anomaly of the gastrointestinal tract with estimates of prevalence ranging from 0.3% to 3%. The condition is usually clinically silent. In children the most common complication is gastrointestinal bleeding caused by ulceration due to the acid secretion by ectopic gastric mucosa.