Laparoscopy-assisted Resection of Complicated Meckel's Diverticulum in Adults

Abstract

The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.

A videolaparoscopia no diagnóstico e tratamento da obstrução intestinal

“…Com o aumento da experiência na utilização do método, a abordagem da obstrução intestinal por VL foi sendo cada vez mais empregada, e as intervenções tanto diagnósticas como terapêuticas puderam ser realizadas nestes pacientes com mais liberalidade [8][9][10] . Após relatos publicados de tratamento por VL de obstruções intestinais secundárias a bezoares, divertículos de Meckel, aderências e vários tipos de hérnias, os cirurgiões passaram a considerar a obstrução intestinal como contra-indicação apenas relativa ao método 11,12 .…”

CT features of small bowel obstruction sur to mesodiverticular band

“…As this occurs, the yolk sac also begins to atrophy (11). In 0.3% to 2.5% of the population, this vitelline duct persists to become a Meckel's Diverticulum (1,11). The yolk sac is supplied by 2 vitelline arteries, one of which degenerates as the yolk sac atrophies, while the remaining artery develops into the superior mesenteric artery (11).…”

“…Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, affecting 2% of the general population (1)(2)(3). Most of the Meckel's diverticula are discovered incidentally during the surgical procedures performed for other reasons.…”

Meckel’s Diverticulum in Adults: A Preoperative Diagnostic Dilemma

“…Divertculectomy was done after mini-laparotomy and exteriorization which is an acceptable approach. Altinli et al reported extracorporeal transumbilical resection of the Meckel's diverticulum with handsewn anastomosis [13]. Saggar et al described with the laparoscope, both extracorporeal (LATUM i.e.…”