Bleeding Meckel&amp;rsquo;s diverticulum in a 4-month-old infant: Treatment with laparoscopic diverticulectomy. A case report and review of the literature

Poley, J. Rainer; Thielen, Thomas E; Pence, Jeffrey C.

doi:10.2147/ceg.s3792

Cited by 17 publications

(18 citation statements)

References 21 publications

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“…Diverticulum with an abnormal cord causes intestinal volvulus, internal hernia, intussusception, and other rare disorders, such as twisted intestine, presenting small bowel obstruction without history of prior abdominal surgery. It is usually difficult to make preoperative diagnosis of inflammation of Meckel's diverticulum [ 18 ]. From the present group of cases, lack of awareness and the development of nonspecific symptoms may make the diagnosis of Meckel's diverticulum difficult.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Manifestation Variety and Management Choice of Meckel’s Diverticulum with Complication: A Single Center Experience

Geng

et al. 2021

Gastroenterology Research and Practice

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Background. The study was to analyze the clinical manifestation variety and management choices of symptomatic Meckel’s diverticulum in children. Methods. From July 2008 to October 2018, 28 cases of Meckel’s diverticulum with a variety of complications were admitted to our hospital. The clinical data included age, gender, symptoms and signs, investigations, intraoperative and pathological findings, and outcome. Results. The ratio of males to females was 2.5 : 1. The diagnoses were made by 99mTc-pertechnetate scan (in 5 cases) and by exploratory laparotomy (in 2 cases). The initial diagnosis in the other cases includes intussusception (in 4 cases), acute appendicitis (in 5 cases), intestinal obstruction (unknown origin), peritonitis, and even shock in 12 cases. Laparoscopic surgery was performed in 8 cases; 18 cases underwent open surgery. Excision of partial bowel segment with diverticulum and primary anastomosis was done in 22 cases and wedge resection of diverticulum in 4 cases. Two other cases received nonoperative therapy and went to other hospitals to receive surgical management. Ectopic gastric mucosa in the diverticulum was found in 9 cases, including 6 cases with lower gastrointestinal bleeding. Conclusion. The clinical characteristics of Meckel’s diverticulum varied. Children with hematochezia, peritonitis, and intestinal obstruction without history of prior abdominal operation should be suspected with this disease until proven otherwise. Hematochezia is often associated with ectopic gastric mucosa in the diverticulum. Laparoscopic surgery should be one of the choices for the diagnosis and treatment of Meckel’s diverticulum with complications.

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Section: Discussionmentioning

confidence: 99%

The Clinical Manifestation Variety and Management Choice of Meckel’s Diverticulum with Complication: A Single Center Experience

Geng

et al. 2021

Gastroenterology Research and Practice

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“…Indeed, an omphalomesenteric duct will persist in approximately 2% of the population forming a true diverticulum located typically 45–60 cm proximal to the ileocecal valve. 2–4 Given its relative commonality, Johann Meckel in 1809 described this congenital diverticulum as the most prevalent anomaly of the alimentary tract. 5, 6 …”

Section: Introductionmentioning

confidence: 99%

Optimizing surgical resection of the bleeding Meckel diverticulum in children

Robinson

Correa

Brinkman

et al. 2017

Journal of Pediatric Surgery

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Purpose Meckel diverticula containing gastric heterotopia predispose to local hyperacidity, mucosal ulceration, and gastrointestinal bleeding in children. Eradication of acid-producing oxyntic cells is performed by either of two surgical methods: segmental enterectomy including the diverticulum or diverticulectomy only. Methods Retrospective review of all children having surgical resection of a Meckel diverticulum at a tertiary-referral children’s hospital from 2002–2016 was performed. Demographic data, surgical method, pathological specimens, and outcomes were evaluated. Results 102 children underwent surgical resection of a Meckel diverticulum during the study period. 27 (26.5%) children presented with bleeding, of which 16 (59%) had diverticulectomy only, and 11 (41%) had segmental ileal resection. All Meckel diverticula in children presenting with bleeding contained gastric heterotopia, and resection margins were free of gastric mucosa. Histologically, 19 specimens showed microscopic features of ulceration, on average 2.95 mm (SD 4.49) from the nearest gastric mucosa (range: 0–16 mm). Mean length of hospitalization after ileal resection was 4.0 days (SD 1.2) compared to 1.6 days (SD 0.9) for diverticulectomy only (p<0.001), with no re-bleeding occurrences. Conclusion In the operative management of children having a bleeding Meckel diverticulum, diverticulectomy-only completely eradicates gastric heterotopia without increased risk of continued bleeding or complications and significantly shortens hospitalization.

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“… 8 In a review of 158 infants less than one-year-old with lower gastrointestinal tract bleeding, only six presented with bleeding MD. 9 Brookes, et al reported nine months as the youngest among 43 children with MD. 10 Rutherford, et al showed that 43 out of 80 patients with symptomatic presentation had a bleeding MD but no age range was available.…”

Section: Discussionmentioning

confidence: 99%

“…Poley, et al study concluded that MD is rare among infants, and their patient was only the second 4-month-old infant. 9 Studies show almost 50% of bleeding from an MD, occurs before the child is two years of age. 11 From the above discussion, we can conclude that MD commonly presents in the pediatric age group and the presentations of MD vary from bleeding, abdominal pain, and intestinal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Massive Gastrointestinal Bleeding Masquerading Coagulopathy in Acute Viral Hepatitis: A Case Report

et al. 2020

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Hepatitis A virus infection is typically an acute self-limiting illness associated with general nonspecific symptoms such as fever, malaise, anorexia, nausea, vomiting, abdominal pain or discomfort,and diarrhea. This may have atypical manifestation like prolonged cholestasis. Despite havingvarying typical and atypical manifestations such a case may present with life-threatening bleedingfrom a co-existing surgical cause such as perforation of Meckel’s diverticulum.

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Bleeding Meckel’s diverticulum in a 4-month-old infant: Treatment with laparoscopic diverticulectomy. A case report and review of the literature

Cited by 17 publications

References 21 publications

The Clinical Manifestation Variety and Management Choice of Meckel’s Diverticulum with Complication: A Single Center Experience

The Clinical Manifestation Variety and Management Choice of Meckel’s Diverticulum with Complication: A Single Center Experience

Optimizing surgical resection of the bleeding Meckel diverticulum in children

Massive Gastrointestinal Bleeding Masquerading Coagulopathy in Acute Viral Hepatitis: A Case Report

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