Concurrent perforated Meckel's diverticulum and intestinal malrotation in an 8-year-old boy

Taylor, Henry M.; Venza, Marco; Badvie, S

doi:10.1136/bcr-2015-212377

Cited by 4 publications

(7 citation statements)

References 4 publications

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“…It is notable that our patient had the presence of a fibrous band compressing the bowel in contrast to all the 3 previous cases where Ladd's band was absent. 1 As in our case, all the 3 cases featured chronic intermittent abdominal pain since childhood, most probably due to intermittent self-limiting subacute intestinal obstruction. Meckel's diverticulum, in addition to intestinal malrotation, has also been associated with broncho-gastric fistula and pulmonary sequestration in two children, and both of them presented within 2 years of age with respiratory complaints.…”

Section: Discussionsupporting

confidence: 68%

“…Meckel's diverticulum is another congenital abnormality that represents the remnant of the omphalomesenteric duct at the antimesentric border of the distal ileum. 1 Usually concurrence of these abnormalities is rare and most importantly its presentation in an adult is worth mentioning. Here we described a case of concurrent intestinal malrotation with Meckel's diverticulum presenting as an emergency in an adult.…”

Section: Introductionmentioning

confidence: 99%

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Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

et al. 2021

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Intestinal malrotation is the partial or complete failure of rotation of midgut around the superior mesenteric artery, while Meckel’s diverticulum is the remnant of vitellointestinal duct and concurrence of these congenital abnormalities in an adult is considered a rarity. Till date only 3 cases of concurrent intestinal malrotation and Meckel's diverticulum have been reported. We report a 18 years male who presented with a 3 day history of abdominal pain, bilious vomiting, obstipation and chronic abdominal pain on and off since 3 years of age. During the last episode which occurred 1 year back, he was diagnosed with intestinal malrotation with subacute intestinal obstruction and was treated conservatively. Examination revealed the presence of signs of peritonitis. After resuscitation, CECT abdomen was taken which showed dilated small bowel loops in the subhepatic region associated with malrotation. Emergency laparotomy revealed a Ladd's band below which the gangrenous small bowel loops 150 cm from the duodenojejunal (flexure until 5 cm proximal to the ileocecal junction) were found herniating into the subhepatic region with a Meckel’s diverticulum and a right sided DJ flexure. We proceeded with the band release and resection of gangrenous bowel followed by proximal jejunostomy with distal ileostomy. HPE was consistent with Meckel’s diverticulitis without any ectopic gastric or pancreatic mucosa. Ostomy reversal was done after 8 weeks. Patient had an uneventful postoperative recovery during both the admissions and he is on regular follow-up now.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

et al. 2021

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“…Previous case reports of concurrent Meckel’s diverticulum and malrotation have described acute presentations secondary to malrotation with incidental intraoperative findings of Meckel’s diverticulum. 7,8 This case is unique in that the primary cause of the acute presentation was small bowel obstruction secondary to a Meckel’s band and necrotic Meckel’s diverticulum with incidental malrotation noted both on imaging and intraoperatively.…”

Section: Outcome Follow-up and Discussionmentioning

confidence: 85%

“…Prior reports of concurrent malrotation and Meckel’s diverticulum describe a more acute on chronic picture with the chronic symptoms likely secondary to episodes of subacute volvulus. 7 These prior reports have also attributed the delayed presentation of malrotation to the absence of fibrous bands between the caecum and peritoneum. 7,8 However, in this case, Ladd’s bands were found overlying the DJ flexure at the time of surgery and therefore it is surprising that this did not present in the neonatal period.…”

Section: Outcome Follow-up and Discussionmentioning

confidence: 97%

“… 7 These prior reports have also attributed the delayed presentation of malrotation to the absence of fibrous bands between the caecum and peritoneum. 7,8 However, in this case, Ladd’s bands were found overlying the DJ flexure at the time of surgery and therefore it is surprising that this did not present in the neonatal period.…”

Section: Outcome Follow-up and Discussionmentioning

confidence: 97%

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Intestinal malrotation and Meckel’s diverticulitis in a 19-month-old boy

et al. 2022

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Acute intestinal obstruction is a common paediatric surgical emergency and should be considered in any child presenting with vomiting, abdominal pain and abdominal distension. Many causes of bowel obstruction arise from congenital anomalies and recognition of the underlying cause of obstruction can be challenging in these settings. These cases can be further complicated if two or more congenital anomalies are present. Malrotation of the gut is defined as a congenital developmental anomaly of the rotation of the intestine and encompasses a spectrum of abnormalities. Meckel’s diverticulum is another congenital anomaly which occurs secondary to the failure of the vitellointestinal duct to close and can present in 2% of the population. We describe an interesting case of a 19 month old-boy who presented acutely with symptoms of bowel obstruction and was found to have both intestinal malrotation and Meckel’s diverticulum.

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Midgut Volvulus Secondary to Intestinal Malrotation and Meckel’s Diverticulitis: A Case Report

Bhattarai,

Luitel,

Poudel

et al. 2024

Preprint

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Background: Volvulus, a condition where the intestines twist upon themselves, is a serious surgical emergency that commonly affects children. Midgut volvulus is frequently caused by congenital malrotation, a developmental anomaly where the intestines fail to rotate and fixate properly during fetal development. Although Meckel's diverticulum, the most prevalent gastrointestinal congenital anomaly, occurs in approximately 2% of the population, its coexistence with intestinal malrotation is rare. Case Presentation: A 7-year-old boy presented with recurrent abdominal pain and bilious vomiting over the past month, worsening in recent weeks. Physical examination revealed mild abdominal distension and tenderness, with stable vitals. Laboratory findings indicated mild leukocytosis and elevated C-reactive protein, suggesting inflammation. Imaging studies, including X-ray, ultrasound, and contrast-enhanced CT, revealed features of small bowel obstruction, midgut volvulus, and intestinal malrotation. An emergency exploratory laparotomy confirmed a volvulus caused by a fibrous band of the vitelline duct, with Meckel's diverticulum and an inflamed appendix. The patient underwent wedge excision of the Meckel’s diverticulum and appendectomy, with an uneventful recovery. He was discharged on postoperative day 4 and remained symptom-free at a 6-month follow-up. Discussion and Conclusion: Midgut volvulus, primarily caused by intestinal malrotation, is a life-threatening condition in children that can lead to bowel obstruction and ischemia. While malrotation accounts for 70-80% of volvulus cases, rarer causes, such as Meckel's diverticulum, contribute to fewer than 5%. In this case, the volvulus was further complicated by a fibrous band associated with Meckel’s diverticulitis and concurrent appendicitis. Surgical intervention, including Ladd’s procedure, wedge excision of the Meckel’s diverticulum, and appendectomy, was crucial in preventing further complications. Early diagnosis and prompt surgical correction are essential to avoid volvulus-related morbidity. This case highlights the importance of recognizing coexisting conditions like Meckel’s diverticulitis and appendicitis, which can exacerbate volvulus. The patient recovered uneventfully and remained symptom-free at follow-up, emphasizing the necessity of timely surgical intervention for successful outcomes.

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Concurrent perforated Meckel's diverticulum and intestinal malrotation in an 8-year-old boy

Cited by 4 publications

References 4 publications

Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

Intestinal malrotation and Meckel’s diverticulitis in a 19-month-old boy

Midgut Volvulus Secondary to Intestinal Malrotation and Meckel’s Diverticulitis: A Case Report

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