Meckel Diverticulum

Park, John J.; Wolff, Bruce G.; Tollefson, Matthew K.; Walsh, Erin E.; Larson, Dirk R.

doi:10.1097/01.sla.0000154270.14308.5f

Cited by 504 publications

(316 citation statements)

References 12 publications

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“…In a retrospective review from the Mayo clinic among symptomatic adults patients with a MD, 5.5% presented with a small bowel volvulus. 3 The most common mechanism of volvulus formation is twisting of the small bowel around the Figure 1 Computed tomography demonstrating the whirlpool sign of the small bowel mesentery (indicated by white arrow).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of terminal ileal volvulus caused by Meckel’s diverticulum

Xanthis

Hakeem

Safranek

2015

annals

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Complications from a Meckel's diverticulum include diverticulitis, bleeding, intussusception, bowel obstruction, a volvulus, a vesicodiverticular fistula, perforation or very rarely as a tumour. We report a case where a Meckel's diverticulum presented with a terminal ileal volvulus in a 32-year-old man without the presence of a typical vitelline band or axial torsion of the diverticulum causing the volvulus. It was successfully managed laparoscopically. KEYWORDSMeckel's diverticulum -Ileal volvulus -Small bowel obstruction -Minimally invasiveLaparoscopic Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract.1 Although it presents more commonly in a paediatric age group, a diverticulum can become symptomatic in adults, presenting as diverticulitis, bleeding, intussusception, bowel obstruction, a volvulus, a vesicodiverticular fistula, perforation or very rarely as a tumour. We report a case where a MD presented with a terminal ileal volvulus without the existence of the typical vitelline band or axial torsion of the diverticulum causing the volvulus that was successfully managed laparoscopically. Case HistoryA 32-year-old man presented with colicky right-sided abdominal pain associated with vomiting and absolute constipation for the preceding 24 hours. He reported many previous episodes of similar abdominal pain, associated with vomiting and constipation, that were followed by diarrheoa, which resolved spontaneously. The patient had required admission two years previously with similar symptoms, at which point a computed tomography of the abdomen and pelvis (CTAP) demonstrated small bowel obstruction with a transition point at the distal ileum, suggestive of ileal volvulus. As the patient's symptoms resolved spontaneously, he was discharged within 24 hours. Owing to persistent epigastric pain, outpatient ultrasonography of the upper abdomen and upper gastrointestinal endoscopy were requested, both of which were unremarkable. The patient was reviewed in the outpatient clinic at three months and as he was symptom free, he was discharged with advice to return if symptoms recurred.On examination, there were no hernias. The patient was tender to deep palpation in the epigastrium and right side of the abdomen. The inflammatory markers were elevated (white cell count 11.5 Â 10 9 /l, C-reactive protein 16mg/l). Urgent CTAP was requested, which demonstrated similar findings to the previous imaging with high grade small bowel obstruction secondary to volvulus of terminal ileum with the whirlpool sign of the small bowel mesentery (Fig 1).A diagnostic laparoscopy was performed. The infraumbilical Hasson technique was used to generate the pneumoperitoneum. Two further ports were inserted under vision: a 12mm port for the left iliac fossa and a 5mm port in the right upper quadrant. The intraoperative findings were twisted small bowel mesentery adherent to the anterior abdominal wall at the right iliac fossa (Fig 2) and minimal adhesions in the left iliac fossa. On further di...

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Section: Discussionmentioning

confidence: 99%

Laparoscopic management of terminal ileal volvulus caused by Meckel’s diverticulum

Xanthis

Hakeem

Safranek

2015

annals

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“…A study by PantongragBrown et al [29] in 1996 evaluated 84 patients with Meckel' s diverticulum and described 8 (10% prevalence) cases of enteroliths at the time of surgery, a much higher rate than what had been previously reported. Alternatively, a review of 1476 adult patients found to have Meckel's diverticulum during surgery in the Mayo clinic found that enteroliths were seen in 6% of symptomatic and 0.7% of asymptomatic patients at the time of surgery [30] . Gallstone ileus remains the most common form of secondary enterolithiasis.…”

Section: Epidemiologymentioning

confidence: 99%

Enterolithiasis

Gurvits¹,

Lan²

2014

WJG

194

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Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis in the presence of the intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, and stenosing or stricturing Crohn's disease and intestinal tuberculosis. Enterolithiasis is classified into primary and secondary types. Its prevalence ranges from 0.3% to 10% in selected populations. Proximal primary enteroliths are composed of choleic acid salts and distal enteroliths are calcified. Clinical presentation includes abdominal pains, distention, nausea, and vomiting of occasionally sudden but often fluctuating subacute nature which occurs as a result of the enterolith tumbling through the bowel lumen. Thorough history and physical exam coupled with radiologic imaging helps establish a diagnosis in a patient at risk. Complications include bowel obstruction, direct pressure injury to the intestinal mucosa, intestinal gangrene, intussusceptions, afferent loop syndrome, diverticulitis, iron deficiency anemia, gastrointestinal hemorrhage, and perforation. Mortality of primary enterolithiasis may reach 3% and secondary enterolithiasis 8%. Risk factors include poorly conditioned patients with significant obstruction and delay in diagnosis. Treatment relies on timely recognition of the disease and endoscopic or surgical intervention. With advents in new technology, improved outcome is expected for patients with enterolithiasis.

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“…[13] In conclusion, intestinal obstruction is the most common complication of Meckel's diverticulum. [1,5] A preoperative diagnosis was not possible in view of the non-specific nature of the clinical and radiological findings. Intestinal obstruction due to Meckel's diverticulum might cause ileal strangulation because of acute obstruction.…”

Section: Cases Reportsmentioning

confidence: 99%

“…[3,4] Only 16% of Meckel's diverticula give rise to symptoms. [5] The most common presentation in adults is intestinal obstruction. The most common means of obstruction is intussusception with the Meckel's diverticulum being the lead point.…”

Section: Ileus Due To Meckel's Diverticulum: Case Reportsmentioning

confidence: 99%

“…It may produce obstruction by diverticular inversion causing luminal obstruction or leading to an intussusception, volvulus from persistent attachment to the umbilicus, adhesions, congenital meso-diverticular bands, diverticulitis, foreign body impaction, inclusion of the diverticulum into a hernia, neoplasm, Meckel's diverticulum lithiasis, or formation of a loop. [5,6] A band extending between the diverticulum and the base of the mesentery can also form a loop in which a part of the ileum may get stuck, causing obstruction. [7] Other mechanisms involve rare causes of obstruction like tumors (lipomas, carcinoid tumors and others), impacted meconium in neonates causing inflammatory adhesions of Meckel's diverticulum to surrounding structures leading to volvulus, cecal volvulus around the band extending from Meckel's diverticulum to the umbilicus, gallstone ileus, and obstruction secondary to phytobezoar formation in the Meckel's diverticulum.…”

Section: Cases Reportsmentioning

confidence: 99%

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Ileus Due To Meckel's Diverticulum: Cases Reports

Sözen¹,

Topuz²,

Tükenmez³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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Meckel divertikülü ince bağırsağın en sık rastlanan doğumsal anomalisi olup genel nüfusta %1-3 oranında gö-rülür. Erişkinlerde en sık görülen komplikasyonu bağır-sak tıkanıklığıdır. Ameliyat öncesi tanının sıklıkla müm-kün olmaması ve ameliyatta gecikilmesi ciddi sorunlara neden olabilir. Bu yazıda, Meckel divertikülü nedeniyle bağırsak tıkanıklığı olan hastaların tanısı ve tedavi yöne-timi sunuldu.Anahtar Sözcükler: İleus; bağırsak tıkanıklığı; Meckel divertikülü.Meckel's diverticulum is the most common congenital anomaly of the small intestine, with an estimated incidence of approximately 1-3% in the general population. Intestinal obstruction is the most common complication in adult patients. Since accurate diagnosis before the operation is difficult, decision for surgery is delayed, and serious problems may be encountered. Here in, we present the diagnosis and management of our patients with intestinal obstruction due to Meckel's diverticulum.

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Meckel Diverticulum

Cited by 504 publications

References 12 publications

Laparoscopic management of terminal ileal volvulus caused by Meckel’s diverticulum

Laparoscopic management of terminal ileal volvulus caused by Meckel’s diverticulum

Enterolithiasis

Ileus Due To Meckel's Diverticulum: Cases Reports

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