Laparoscopy-Assisted Surgical Management of Obscure Gastrointestinal Bleeding Secondary to Meckel's Diverticulum in a Pediatric Patient

Abstract

Despite advances in endoscopy and imaging, acute gastrointestinal (GI) bleeding of obscure origin in children presents a challenge to pediatric gastroenterologist. Bleeding Meckel's diverticulum (MD) commonly presents with acute episode of lower GI bleeding. A conventional diagnostic algorithm includes endoscopy, technetium 99m pertechnetate scintigraphy, angiography, and exploratory laparotomy. The advent of minimal access surgery prompts the use of laparoscopy for children with obscure GI bleeding. Laparoscopy assists in the diagnosis and can offer definitive treatment of patients with MD. Herein, we report a case of pediatric GI bleeding of obscure origin associated with MD that was successfully diagnosed and managed via laparoscopy. This article updates the current management for pediatric patients with obscure GI bleeding and the role of laparoscopy in the management of MD.

Technetium-99m scan in the laparoscopic management of a misdiagnosed Meckel's diverticulum: a case report

“…The safety and efficacy of diagnostic but also therapeutic laparoscopy are widely accepted [2]. A great variety of laparoscopic techniques have been used in the surgical treatment of MD [12]. Attwood et al [13] performed laparoscopy-assisted extracorporeal Meckel's diverticulectomy for inflamed MD using an endoscopic mechanical stapler.…”

Management by the intensivist of gastrointestinal bleeding in adults and children

“…More rarely, vascular malformations of the colon or small intestine are observed [32]. If the GI endoscopic findings are normal, thus discounting rupture of varices, scintigraphy or even surgical exploration should be performed to search for a Meckel’s diverticulum [33]. …”

Minimally invasive operating suite in the 21st century: Endo‐Lap operating room

“…However, the increased acceptance of laparoscopic surgery by the community and the speedy advancement of camera technology and laparoscopic devices have both led to an increased applicability 12 and wider penetration of these minimally invasive procedures. Increasingly, more and more complex surgical procedures can now be accomplished laparoscopically, 13–26 and the application has even extended into various surgical emergencies 27–34 . This necessitates increasing the number of complex equipment and mobile carts, cables, tubing and wiring to be installed into the MIS suite, which is practically stretched to its limit.…”

“…Increasingly, more and more complex surgical procedures can now be accomplished laparoscopically, [13][14][15][16][17][18][19][20][21][22][23][24][25][26] and the application has even extended into various surgical emergencies. [27][28][29][30][31][32][33][34] This necessitates increasing the number of complex equipment and mobile carts, cables, tubing and wiring to be installed into the MIS suite, which is practically stretched to its limit. The situation desperately calls for the development of a new type of OR to facilitate the safe performance of these technically and technologically demanding complex procedures.…”