Diverse Presentation of Meckel’s Diverticulum in Pediatric Patients

Abstract

IntroductionMeckel’s Diverticulum is the most common congenital disease and seen in 2% of population. It is difficult to diagnose preoperative, mostly seen during operation with its various presentation.Material and Methods This is a retrospective study in which all the cases diagnosed as Meckel’s diverticulum with its complication diagnosed while doing operation were included. Demographic data, clinical presentation, preoperative diagnosis, intraoperative findings, surgical procedure performed, histopathological report and postoperative follow up of patients were recorded and statistically analyzed. The aim of this study was to assess various presentation of Meckel’s diverticulum in 8 years of duration in college of medical sciences, Bharatpur Nepal. ResultsOut of 32 cases, there were 20 male and 12 female with M:F ratio1.66:1. The mean age was 8.34 ± 3.98 years. All together sixteen (50%) patients had features intestinal obstruction. Perforation was seen in 28.1% patients, intussusception in 21.8%, diverticulitis in 15.6%, small bowel volvulus around fibrous band in 18.8%, internal herniation in 9.4% and massive bleeding in 6.3% patients. The average distance from ileocecal junction was 40-60 cm. All cases underwent emergency laparotomy, presence of Meckel’s diverticulum was incidental intraoperative finding. Three cases had superficial wound infection. Small intestine mucosa followed by gastric, pancreatic and colonic mucosa were most common histological finding. The average duration of hospital stay was 5 to 8 days.ConclusionMeckel's Diverticulum is a true diverticular anomaly that may remain clinically silent for lifetime, or it may have life-threatening complications. Due to nonspecific features in case of acute abdomen, Meckel’s diverticulum and its complications should be kept as an important differential diagnosis.Keywords: intestinal obstruction; meckel’s diverticulum; volvulus.

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

“… 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. 6 , 12 , 13 It is really difficult to diagnose MD in asymptomatic children. 6 , 12 Focusing on this particular case where the HAV infection with prolonged cholestasis as atypical manifestation was the presumptive diagnosis.…”

“…Hepatitis A virus (HAV) infection is common, typically an acute self-limiting illness may have several atypical manifestations including hepatic and extrahepatic. 13 We encountered a case of HAV infection which complicates with its atypical manifestation and become critical enough and shifted to the pediatric intensive care unit (PICU), where he developed uncontrolled massive lower gastrointestinal bleeding. Later the cause for bleeding was found to be due to Meckel’s diverticulum perforation diagnosed via exploratory laparotomy.…”