Its presentation as a giant Meckel’s diverticulum (>5 cm) is rare and is Publisher: El divertículo de Meckel corresponde a la persistencia. Intussusception secondary to Meckel’s diverticulum in a 3-month-old girl. Case reportInvaginación intestinal secundaria a diverticulo de Meckel en niña de 3. Int. J. Morphol., 25(3), CASE REPORT. Meckel’s Diverticulum. A Case Report. Divertículo de Meckel. Reporte de Caso. Sampath Madhyastha.
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Surgical pathology associated with Meckel’s diverticulum in a tertiary hospital. Rubio Chaves 1J. We report the clinical presentation, complementary test, interventions, and the postoperative follow up. Access to the abdominal cavity using routine laparoscopy provides essential information on the diagnosis and for the treatment. Meckel’s diverticulum MD is a vestigial remnant of the omphalomesenteric duct of the foetal digestive tract, which was not fully reabsorbed before birth.
However, these diverticula can become infected diverticulitis in divrrticulo small number of patients, causing intestinal blockage or bleeding of the mucosa. Meckel’s diverticulitis is frequently misdiagnosed as appendicitis. It usually presents in the first years of life, but can also occur in adults. The objective of this study was to show the prevalence of this disease in our area and perform a systematic review of the literature.
We present a series of 45 cases undergoing surgery in the general and paediatric surgery units of our hospital between January and January We reviewed all patient records and analysed each patient’s features, presentation of the disease, divegticulo resources used, treatment received, complications and follow-up to final healing.
A total of 45 patients aged between 0 and 68 years were operated on. Many of the patients had no history of the condition and where it did exist, it was very varied, and no causal relationship could meckep be established.
The clinical symptoms of the disease Fig. In 26 cases there was no previous suspicion of divertjculo disease, while in 19 cases Meckel’s diverticulum was suspected due to initial symptoms.
The diverticulum was the cause of the disease and required surgery in all these cases. All patients underwent basic laboratory tests abdominal and thorax X-rays, biochemical analysis, blood count and coagulation study as part of the preoperative evaluation. The diagnostic tests were varied. Only in 2 selected cases computed tomography Divertidulo was used. In less acute cases, where the disease was suspected and viverticulo was possible to complete the study for a specific diagnosis, endoscopy, colonoscopy, scintigraphy with Tc 99 and arteriography were subsequently used Fig.
Divertículo de Meckel perforado
Abdominal ultrasound performed in 16 patients: Scintigraphy with Tc The surgical technique performed was diverticulectomy and enterorrhaphy in 37 patients The lesion in all cases diverticupo confined to the ileal segment of the small intestine and Meckel’s diverticulum was confirmed after the relevant anatomopathological study.
All patients underwent surgery successfully, with remission of the symptoms being achieved in all cases. Postoperative complications were as follows: The follow-up time was months for children aged less than 18 years and longer months for adults. There was no recurrence of the msckel. Meckel’s diverticulum is the most common congenital anomaly divwrticulo the gastrointestinal tract. MD stems from the incomplete atrophy of the omphalomesenteric duct, which normally closes from the tenth week of embryological development and becomes a fibrous band that disappears 2.
As well as MD, other secondary abnormalities due to the incomplete regression of the doverticulo duct are umbilico-ileal fistula, umbilical sinus and the presence of a mekel fibrous cord.
The most common site for DM is the antimesenteric border of the terminal ileum, cm from the ileocecal valve in adults, and cm in children.
Large series for DM, both at autopsy and during surgical procedures, show no differences between the sexes 3. However, for symptomatic DM, the incidence is somewhat higher in men than in women 1. Anatomopathologically, DM is considered as a diverticulum, as it includes all layers of the intestinal wall.
There are studies of tumours lodging in the DM lumen, which may be benign, such as leiomyomas, angiomas, or neurofibromas, or malignant, such as leiomyosarcomas or carcinoid tumours 2.
Most DM cases are asymptomatic, and may be an incidental finding during imaging studies or surgery for other reason. Lower gastrointestinal bleeding is the most common clinical manifestation, especially in children under 2 years 8 ranging from positive mdckel occult blood to massive obvious bleeding.
The second most common manifestation is intestinal obstruction, mainly in adolescents and adults 2,9. This appears as a mechanical obstruction of the small intestine with distension, diffuse abdominal pain, vomiting and constipation, the pathophysiological mechanism being a volvulus or intussusception 2. Incarceration of a DM in a hernia sac is known as Littre’s hernia. The laparoscopic transabdominal TAPP and preperitoneal TEP approach is currently playing an important role, where the diverticulum is removed and the wall defect repaired comfortably and safely, with an overview of the entire cavity and abdominal wall Acute inflammation of DM is usually accompanied by fever, vomiting and abdominal pain, and is often indistinguishable from acute appendicitis.
Divertículo de Meckel: Reporte de Caso
When performing additional examinations, the age of the patient and clinical manifestations must meeckel considered. Thus, barium studies are diverticylo in patients with persistent abdominal pain of unknown origin, positive faecal occult divreticulo without endoscopic findings, or where Divertlculo is inconclusive.
Its usefulness lies in the isotope uptake by ectopic gastric mucosa as well as the thyroid and salivary gland tissue 2. The main drawback is that this is not available at all hospitals. An arteriography may be used in adult patients with episodes of intermittent bleeding or faecal occult blood.
Flow in the omphalomesenteric artery is dicerticulo for DM, it usually occurs in an aberrant branch of diverticilo superior mesenteric mefkel 2. The flow must be greater than 0. If diagnostic angiography and conventional endoscopy do not reveal the cause of lower gastrointestinal bleeding, capsule endoscopy 14 may be performed, although its value in the acute process is limited 8. In patients with intestinal obstruction, simple abdominal X-ray may show an enterolith in the lower right quadrant of the image Usually, CT does not accurately show the presence of DM as a cause of obstruction; therefore, presence of DM as the cause of the obstruction is usually confirmed during surgery.
However, for Meckel’s diverticulitis without obstruction, CT is the radiological study of choice. The presence of an image with inflammatory changes around a cul-de-sac, and enteroliths occasionally being appreciated, supports the diagnosis Abdominal ultrasound can be used as a screening df in patients with acute abdominal pain, as provides a tubular and compressible hyperechoic image 14which explains the local inflammatory process and indicates emergency surgery.
However, it is often misdiagnosed as acute appendicitis. It is generally agreed that all symptomatic DM cases should be surgically treated, with the laparoscopic approach being the technique of choice It is especially useful in cases where clinical symptoms and findings of additional tests provide results that are indistinguishable from those expected for acute appendicitis At present, there is still controversy about the management of DM as an incidental finding, which is in general prophylactic diverticulectomy.
Although it is not without risk, it is considered justified given the possibility of developing future complications and the presence of intradiverticular tumours, and the possibility of malignisation Meckel’s diverticulum is much more frequent in children than in adults. The laparoscopic approach is appropriate when DM is suspected, as the entire abdominal cavity can be explored with the minimum possible surgical trauma.
We understand that prophylactic appendectomy should be performed in all cases affected by DM. No specialised tests are needed when meckdl is clear clinical suspicion and surgery must be performed without delay in emergency cases. For less urgent cases, abdominal ultrasound and scintigraphy with Tc 99 although it has a high rate of false negatives are recommended, with the most sensitive and specific being vascular interventional Divertiiculo, which is usually reserved.
Given the symptoms of active lower gastrointestinal bleeding or acute abdominal pain, and general malaise and fever, we are forced to rule out the acute diverticular disease and indicate emergency surgery if reasonable suspicion exists.
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Semin Pediatr Surg ;5: Malik, Shams-ul-Bari, Khrshid A. The Saudi Journal of Gastroenterology ;16 1: Meckel’s diverticulum and other omphalomesenteric duct remnants. Wyllie R, Hyams JS, editors. Mackey WC, Dineen P. A fifty year experience with Meckel’s diverticulum. Surg Gynecol Obstet ; Association between Meckel’s diverticulum and Crohn’s disease: Does Helicobacter pylori colonize the gastric mucosa of Meckel’s diverticulum? Mayo Clin Proc ; Meckel’s diverticulum in adults: Eur J Surg ; Hemorragia digestiva baja severa originada en el intestino delgado.
Rev Esp Enferm Dig ; Complications and management of Dverticulo diverticulum: Meckel’s diverticulum as a cause of lower gastrointestinal bleeding in adults. Rev Esp Enferm Dig ; 9: Acute diverticulitis of the small bowel: The value of sonography, CT and air enema for detection of complicated Meckel diverticulum in children with nonspecific clinical presentation.
Laparoscopic management of Meckel’s diverticulum in adults. Laparoscopic surgery for perforation of Meckel’s diverticulum. Singapore Med J ; Laparoscopic resection for incidentally detected Meckel diverticulum. World J Gastroenterol ; General and Digestive Surgery. Introduction Meckel’s diverticulum MD is a vestigial remnant of the omphalomesenteric duct of the foetal digestive tract, which was not fully reabsorbed before birth. Material and methods We present a series of 45 cases undergoing surgery in the general and paediatric surgery fe of our hospital between January and January Results A total of 45 patients aged between 0 and 68 years were operated on.
A detailed description is as follows: Discussion Meckel’s diverticulum is the most common congenital diverticjlo of the gastrointestinal tract. Conclusions Meckel’s diverticulum is much more frequent in children than in adults.