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Giant Meckel's diverticulum compressing root of mesentery - A rare cause of ileal gangrene - Case report and review of literature.

ABSTRACT: Meckel's diverticulum (MD) commonly presents as gastrointestinal bleeding in the pediatric population and intestinal obstruction in adults. There is no consensus for surgical excision of an incidentally diagnosed MD. We present a hitherto unreported vascular cause of intestinal gangrene due to MD.A 16year old boy was referred as an acute abdomen for tertiary hospital management. Clinical examination and CT suggested small bowel obstruction and emergency laparotomy was performed. A giant MD compressing the root of mesentery, causing critical occlusion of the ileal vessels and extensive ileal gangrene was found. The gangrenous bowel was resected and a jejuno-ascending colon anastamosis was done. Postoperative recovery was uneventful.This case report highlights an unrecognized complication of a giant Meckel's diverticulum. There are no clear guidelines on the management of an incidentally discovered MD though certain studies recommend resection of an incidental MD in males and individuals less than 50 years of age or when the MD is larger than 2cm or contains histologically abnormal tissue. Other meta-analyses do not recommend routine resection. MD has been identified as a high risk region for ileal malignancy and its resection usually has minimal morbidity. A valid consent for opportunistic resection of a Meckel's diverticulum in any laparotomy would be discerning.Appropriate opportunistic resection of an incidental Meckel's diverticulum may prevent extensive surgical morbidity later. This case highlights the need to revisit guidelines for management of incidentally identified MD.

SUBMITTER: Farooq M

PROVIDER: S-EPMC5522956 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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A rare case of intestinal obstruction caused by Meckel's diverticulum band

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

Emergency surgery for Meckel's diverticulum.

Project description:The current work attempts to highlight the various life threatening complications of Meckel's diverticulum and to present the surgical strategies used in the emergency conditions so far in the form of a review of the works presented in the literature. Our aim behind this presentation is to cover the possible indications, methods, their complications and the outcome of these surgical techniques. For this, we made an extensive literature search using Google and Pubmed with the words-"Meckel's diverticulum", "Complications", "Management" and "Emergency surgery". All the relevant articles containing the surgical aspects of symptomatic Meckel's diverticulum till May 2008 were collected and analyzed. Meckel's diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications.

| S-EPMC2533303 | biostudies-literature

MECKEL'S DIVERTICULUM - REVISITED.

Project description:Twenty five cases of Meckel's diverticulum were studied between 1985-1995. Eight of these were symptomatic and in the remaining 17 it was an incidental finding. The symptomatic patients presented with intestinal obstruction (5 cases), perforated peritonitis (2 cases) and intussusception (1 case). All cases of acute appendicitis were also subjected to a search for Meckel's diverticulum. Of the 25 Meckel's diverticuli encountered, 22 were resected and in 3 patients it was left in situ. Both the patients with perforated Meckel's diverticulum showed ectopic gastric mucosa. Complications occurred only after surgery for symptomatic Meckel's diverticulum. All patients undergoing incidental diverticulectomy had a smooth and uncomplicated recovery.

| S-EPMC5530974 | biostudies-other

Spontaneous perforation of Meckel's diverticulum in an adult female with literature review.

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| S-EPMC6211145 | biostudies-other

CT findings of Meckel's diverticulum perforation in a geriatric patient.

Project description:Meckel's diverticulum is a remnant of the omphalomesenteric duct, found only in approximately 2% of the population. Although Meckel's diverticulum is often diagnosed in nonsymptomatic patients as incidental radiologic findings, complications of Meckel's diverticulum can also be seen on radiologic evaluation. We present a rare care of perforated Meckel's diverticulum in a geriatric patient demonstrated on contrast computed tomography. This was later confirmed during laparoscopic surgery with pathologic evaluation.

| S-EPMC7083787 | biostudies-literature

Sonographic Detection of a Torsed Meckel's Diverticulum Misinterpreted as Acute Appendicitis.

Project description:A 38-year-old female presented to the emergency department (ED) with acute-onset right lower quadrant abdominal pain following two days of nausea and vomiting. Physical examination revealed right lower quadrant tenderness to palpation, rebound tenderness, and guarding. Point-of-care ultrasound (POCUS) of the right lower abdomen was performed and interpreted as probable appendicitis. However, upon laparoscopic examination of the abdomen, a benign-appearing appendix was visualized. Further investigation revealed the source of the patient's pain to be a torsed Meckel's diverticulum. Although rare, a torsed and inflamed Meckel's diverticulum can be visualized by POCUS in the ED without the need for further imaging or delay.

| S-EPMC6682254 | biostudies-literature

Giant diverticulum- A rare complication of a common surgical condition.

Project description:A gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diverticulum. A giant diverticulum, typified by diverticula greater than 4 cm, often requires colonic resection. Fewer than 200 cases have been reported, most measuring 7-15 cm. I present a rare complication of a common surgical condition with images.

| S-EPMC4856254 | biostudies-other

Complicated Meckel's diverticulum: Presentation modes in adults.

Project description:Complicated Meckel's diverticulum represents a common etiology of acute abdomen in children. However, this condition is less frequent in adults. We reviewed the records of adult patients who underwent the surgical removal of complicated Meckel's diverticulum between 2001 and 2017 at 2 tertiary French medical centers. We then analyzed the clinical characteristics, mode of presentation, and management for all patients.The Meckel's diverticulum was resected in 37 patients (24 males and 13 females). The mean patient age was 46.1?±?21.4 years. The most common clinical presentations of complicated Meckel's diverticulum were diverticulitis (35.1%, n?=?13), small-bowel obstruction (35.1%, n?=?13), and gastrointestinal bleeding (29.8%, n?=?11) (anemia, n?=?1; hematochezia, n?=?10). Age distribution was significantly different (P?=?.02) according to the 3 Meckel's diverticulum complications: patients with diverticulitis (P?=?.02) were statistically more frequently over 40 (P?=?.05), significantly older than patients with gastrointestinal bleeding who were more frequently <40 (P?=?.05). There was a preoperative diagnosis available for 15 of the 37 patients (40%). An exploratory laparoscopy was necessary to determine the cause of disease for the other 22 patients (60%). An intestinal resection was performed in 33 patients (89%) and diverticulectomy was performed in 4 patients (11%). There was heterotopic tissue found in only 6 patients (16%). Postoperative complications were as follows: 1 death by cardiac failure in a 92-year-old patient and 2 patients with postoperative wound infections. The follow-up time was 3 to 12 months.The correct diagnosis of complicated Meckel's diverticulum in adults is difficult due to the lack of specific clinical presentation. As a result, exploratory laparoscopy appears to play a central role in cases of acute abdomen with uncertain diagnosis.

| S-EPMC6160168 | biostudies-other

Rare giant maxillay mucocele: A rare case report and literature review.

Project description:IntroductionMucocele is a slow growing, benign but locally aggressive cystic structure lined by true epithelium. It often results due to obstructed sinus outflow or obstruction of gland-like mucous retention cyst. It can cause bony destruction and might result in orbital symptoms like diplopia, orbital displacement, visual disturbances. Other clinical features are facial numbness, dental problems, etc. Radiological evaluation is the preferred diagnostic modality. Surgical removal is the treatment of choice both endoscopic and open (could well luc) approach or combined approach are preferred. Here we report a very typical case of maxillary mucocele who presented with subtle symptoms of nasal obstruction. The study was done in compliance with SCARE guidelines.[1].Case presentationWe present a very unique case of 24 years man with complaints of nasal obstruction and swelling over the right cheek for 2 years. He had a history of facial trauma two years back. Diagnosis was made on the basis of radiological examination CT (Computed Tomography) scan. He underwent enucleation via Cold well Luc's approach with good postoperative results.ConclusionMaxillary mucoceles are slow growing benign lesions. However, they are locally aggressive and cause bony destruction resulting into orbital and dental symptoms. Thus early recognistion with regular folllowr up and planning for surgical intervention can help avoid complications.

| S-EPMC6556524 | biostudies-literature

A Meckel's diverticulum presenting as pyogenic liver abscesses.

Project description:Meckel's diverticula are the most common congenital malformation of the small intestine. The condition is rarely symptomatic and is usually an incidental finding during surgery. Bleeding in children and obstruction in adults are the most common symptomatic presentations. Our case involves a 50-year-old man with multiple pyogenic liver abscesses due to a Meckel's diverticulum. The abscesses were percutaneously drained and the diverticulum was eventually resected. Pyogenic liver abscess is a very rare presentation of a Meckel's diverticulum. The diverticulum in our case appeared to have a thickened wall on imaging but no signs of acute inflammation were present on the CT scan or noticed intraoperatively. It was presumed to be the possible source as all other possibilities were ruled out. Ultimately, the surgical pathology revealed acute inflammation and focal abscess. We propose that elective resection of a Meckel's diverticulum should be considered in the setting of pyogenic liver abscess with no other identifiable source.

| S-EPMC4551069 | biostudies-other

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