Meckel Diverticulum Causing Intestinal Volvulus
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ABSTRACT:
SUBMITTER: Musteata L
PROVIDER: S-EPMC7533013 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Project description:Introductionand importance: Caecal volvulus represents 30% of colonic volvulus. It happens due to torsion or hyperflexion of a hypermobile caecum. Usually it is secondary to an axial rotation of the caecum and the ileum around the mesentery. On the other hand Intestinal malrotation occurs due to incomplete or faulty rotation and fixation of the gut during fetal life. The occurrence of these two anomalies together is scarse which makes this case report interesting.Case presentationA 75 year old man with medical history of terminal kidney failure, presented to the emergency room with an intestinal obstruction syndrome. On examination the patient had a distended abdomen with tenderness in the left upper quadrant. Biology found an important biological inflammatory syndrome with hyperleukocytosis and elevated CRP. Plain X-ray of the abdomen in erect posture showed an air fluid colonic level in the left hypochondrium. CT scan showed signs of caecal volvulus with intestinal malrotation. A brief reanimation and nasogastric aspiration couldn't solve the problem therefore emergency laparotomy was needed ileocaecal resection was performed associated with LADD's procedure in order to treat both anomalies and prevent further gut volvulus.Clinical discussionDespite it's rareness, caecul volvulus represents the second cause of large bowel volvulus just behind sigmoid volvulus. Intestinal malrotation in adults subjects is estimated to occur in 0.2-0.5%.The uniqueness of our case is that these two anomalies were associated in such a way that it made both the diagnosis and the therapy even more difficult. Abdominal CT has become mandatory for pre-operative diagnosis of intestinal volvulus. Surgery is the gold standard treatment for caecal volvulus. The usual options are manual detorsion, carcopexy, caecostomy and colectomy.ConclusionThis case reports a rare association of a caecum volvulus with intestinal malrotation that emphasis the place of modern technologies such as CT scan in order to achieve correct preoperative diagnosis. We also describe our approach to this uncommon surgical emergency in order to provide an efficient treatement.
| S-EPMC8121876 | biostudies-literature
Project description: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.
| S-EPMC8774205 | biostudies-literature
Project description:IntroductionMeckel diverticulum (MD) is the most common congenital abnormality of gastrointestinal tract. Tough believed to occur in 2% of population, most of them remain veiled because majority are clinically asymptomatic and remain obscure in radiological examination.Clinical findings and diagnosisA 26-year-old male with episodic black colored stool since last 10 years. Tough symptomatic, diagnosis of pathological lesion, and the bleeding site could not be established with any of the sophisticated diagnostic technique. After 10 years, it was finally diagnosed as MD with careful observation of bowel loops on computed tomography enterography (CTE) where remnant of vitelline vessel and hyper-enhancing nodule are seen along the wall of diverticular loop.Interventions and outcomesThe patient underwent robot assisted laparoscopic surgery with excision of diverticular loop. To the best of our knowledge, this robot-assistant Meckel diverculectomy is probably the first reported surgical procedure in PubMed. Follow-up for 3 month showed no complication or recurrence.ConclusionEvery case is unique and we must be aware and remain alert in tracing the possible morphological variation of the case. Here, we present one unique but rare feature of MD, which helped us in making diagnosis.
| S-EPMC5072975 | biostudies-literature
Project description:BackgroundMeckel syndrome (MKS) is the most severe form of an autosomal recessive ciliopathy and is clinically characterized by occipital encephalocele, severely polycystic kidneys, and postaxial polydactyly (toes). The association of TXNDC15-related MKS has been reported. We report the case of a homozygous mutation in the TXNDC15 gene, causing MKS14 in the Chinese population.MethodsThe fetal skin tissue and parental peripheral blood were retained for whole-exome sequencing and Sanger sequencing, which investigated the potential pathogenic variants associated with MKS.ResultsThe fetus was homozygous for a mutation in the TXNDC15 gene (NM_024715.3), specifically c.560delA (p.Asn187llefsTer4), and both parents were heterozygous for this mutation.ConclusionOur study identified a new mutation that adds to the mutational landscape of MKS, which provide a basis for genetic counseling and the selection of reproductive options.
| S-EPMC10958169 | biostudies-literature
Project description:Meckel diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract in children. The aim of this study was to review and analyze clinical data on the diagnosis and management of Meckel diverticulum in pediatric patients. The records of 102 pediatric patients (<14 years old) who underwent surgery for Meckel diverticulum at our institute between 2001 and 2015 were reviewed. Clinical, imaging, laboratory, surgical, and pathological data were recorded. The series comprised 65 males and 37 females with a median age of 5.6 years. Lower gastrointestinal bleeding was the most frequently identified clinical manifestation of Meckel diverticulum, and this manifestation was observed in 41 patients. Intussusception secondary to Meckel diverticulum was identified in 32 patients. Twelve patients presented clinical features of peritonitis; of these patients, 8 had perforated Meckel diverticulum and 4 had Meckel diverticulitis. In 10 patients, Meckel diverticulum was incidentally diagnosed during other surgeries, including appendectomy and neonatal enterostomy. Seven patients were diagnosed with intestinal obstruction. Technetium-99m pertechnetate imaging offered high diagnostic yield. Open surgery was performed on 59 patients, while a laparoscopic approach was employed in 35 patients. The remaining 8 patients did not undergo resection of the Meckel diverticulum. Histology revealed ectopic gastric mucosa in 42 patients (44.7%), ectopic pancreatic tissue in 35 patients (37.2%), mucosa of the small intestine in 15 patients (16.0%), and both gastric and pancreatic ectopic tissue in 2 patients (2.1%). All patients recovered uneventfully except 2 patients in whom an intestinal adhesion obstruction was identified after discharge. Meckel diverticulum had various clinical manifestations in children. Technetium-99m pertechnetate imaging may be useful for diagnosing Meckel diverticulum. Surgical excision of the Meckel diverticulum may be safe and effective in symptomatic patients, and relatively better outcomes can be achieved using this approach.
| S-EPMC5556236 | biostudies-other
Project description:Introduction and Importance: Meckel's diverticulum band is an uncommon cause of intestinal obstruction in adults. Case presentation We report the case of a 57-year-old diabetic and hypertensive male who presented with sudden onset of vomiting and abdominal pain. Initial laboratory and imaging investigations, including an abdominal X-ray and computed tomography scan, were suggestive of an intestinal obstruction; however, these were not helpful in assigning a presumptive cause. A laparoscopic exploration was offered after a repeated abdominal X-ray showed an air-fluid level. Intraoperative findings revealed an ischemic closed loop obstructed by a fibrous band of Meckel's diverticulum. Resection and anastomosis of the bowel was performed, and the patient was discharged on day 3 post-operative with no complications. Clinical discussion Surgical resection performed by open or laparoscopic approach is the recommended treatment for patients with symptomatic Meckel's diverticulum. Generally, a wedge resection of the Meckel's diverticulum is performed, and occasionally part of the ileum is resected by end-to-end anastomosis, as was the case in our patient. Conclusion We believe early surgical intervention is crucial for a favorable outcome. Thus, surgeons should consider complicated Meckel's diverticulum in patients presenting with signs and symptoms of small bowel obstruction. Highlights • Intestinal Obstruction Caused by Meckel's Diverticulum Band are extremely rare in adult.• Obstruction Caused by Meckel's Diverticulum Band may present a challenging clinical diagnosis.• Surgical resection remains the treatment of choice and plays a potentially curative role.
| S-EPMC9207010 | biostudies-literature
Project description:A 46-year-old Chinese woman with a history of cholecystectomy and appendicectomy presented to the emergency department with symptoms of intestinal obstruction. Physical examination revealed central abdominal tenderness but no clinical features of peritonism. Plain radiography of the abdomen revealed a grossly distended large bowel loop with the long axis extending from the right lower abdomen toward the epigastrium, and an intraluminal air-fluid level. These findings were suspicious for an acute caecal volvulus, which was confirmed on subsequent contrast-enhanced computed tomography (CT) of the abdomen and pelvis. CT demonstrated an abnormal positional relationship between the superior mesenteric vein and artery, indicative of an underlying intestinal malrotation. This case highlights the utility of preoperative imaging in establishing the diagnosis of an uncommon cause of bowel obstruction. It also shows the importance of recognising the characteristic imaging features early, so as to ensure appropriate and expedient management, thus reducing patient morbidity arising from complications.
| S-EPMC5331133 | biostudies-literature
Project description:A 23-year-old man presented with history of fever and pain in the right lower abdomen. He was diagnosed to have acute appendicitis with perforation and was taken up for emergency laparotomy after resuscitation. There was pus in the right iliac fossa and a tumor at the fundus of Meckel's diverticulum, which had perforated. Appendix was found to be normal. The histopathology examination showed it to be gastrointestinal stromal tumor of Meckel's diverticulum. The gastrointestinal stromal tumor causing Meckel's diverticulum perforation and peritonitis is very rare, and prior to this indexed case, only two such cases have been reported in the literature.
| S-EPMC3693379 | biostudies-other
Project description:Fetal intestinal volvulus is a rare condition that can lead to hemorrhage, bowel necrosis, and urgent surgical treatment after birth. Thus, prompt diagnosis and treatment are essential to avoiding fetal or neonatal demise. Prenatal ultrasound is a keystone tool in the diagnostic course. However, sonographic findings tend to be non-specific, with limited understanding of the pathophysiology behind their atypical presentation. With a literature review and a case series, we aim to optimize the antenatal diagnosis and management of this rare but life-threatening condition. Six cases from our institution were retrospectively analyzed over 12 years. A literature review was conducted until December 2022. A total of 300 articles matched the keyword "Fetal volvulus", and 52 studies were eligible for the review. Our 6 cases are added to the 107 cases reported in the literature of fetal intestinal volvulus with antenatal ultrasound assessment and without associated gastroschisis or omphalocele. Several prenatal symptoms and ultrasound markers, even if not specific, were more frequently reported. Different experiences of management were described regarding follow-up, the timing of delivery, the mode of delivery, and surgery outcomes. This paper highlights the importance of suspecting and assessing fetal volvulus at routine ultrasound scans, describing the most frequent antenatal presentations and management in order to improve fetal and neonatal outcomes.
| S-EPMC10381374 | biostudies-literature
Project description:This data is part of a pre-publication release. For information on the proper use of pre-publication data shared by the Wellcome Trust Sanger Institute (including details of any publication moratoria), please see http://www.sanger.ac.uk/datasharing/ Onchocerca volvulus is a filarial nematode parasite of humans, causing Onchocerciasis, or River Blindness, which affects over 37 million people, mainly in Africa. It is a severely debilitating disease, which is transmitted to humans by black fly. This project aims to undertake high-throughput sequencing of Onchocerca volvulus transcriptome for de novo assembly of transcripts. The main objective of this project is to recognize genes expressed in given life stages.
2013-01-28 | E-ERAD-67 | biostudies-arrayexpress