Meckel’s diverticular complications in children: is laparoscopy the order of the day?

Abstract

Meckel's diverticulum (MD), a seemingly innocuous anomaly of the gastrointestinal tract, presents distinctive challenges to a clinician, as it is prone to varied complications that are frequently elusive to diagnosis with conventional diagnostic modalities. This case series illustrates the diverse presentations and advantages of laparoscopic-assisted management of Meckel's diverticular complications in children. Between October 2002 and April 2006, 36 patients (27 males and 9 females) aged 1.5 to 16 years (median 10 years) underwent laparoscopic-assisted trans-umbilical Meckel's diverticulectomy (LATUM). Sixteen (44.4%) patients presented with lower gastrointestinal bleeding (14 with painless bleed and 2 with perforated peptic ulcer in the ileum adjacent to the MD), six (16.7%) patients presented with intestinal obstruction (four due to a mesodiverticular band and one each due to intussusception and floppy giant cystic dilatation of MD causing intestinal compression) and four (11.1%) patients presented with features masquerading as appendicitis (one with Meckel's diverticulitis and perforation, one with perforated peptic ulcer adjacent to MD and two with a torted and gangrenous MD). In ten (27.8%) patients, incidental MD with a narrow base was noted at laparoscopic exploration for suspected appendicitis. All patients underwent successful LATUM along with appendicectomy in 15 (41.7%) patients. The operative duration ranged from 72 to 266 min (mean 125.9+/-48.4). There were no intra-operative complications and none required conversion to open surgery. The hospital stay was 3 to 9 days (mean 5.3+/-1.2). There were three (8.3%) cases of postoperative adhesive intestinal obstruction; two underwent successful laparoscopic adhesiolysis and one necessitated conversion to suprapubic laparotomy to release the pelvic adhesions. There were no other complications during the follow-up (median 16 months). LATUM is a safe, effective and an esthetic procedure offering timely diagnosis and cure for diverse Meckel's diverticular complications. The technique also allows palpation of the MD and avoids usage of expensive staplers.

Perforated Meckel’s Diverticulum- A Rare Case Presentation

“…The most common presentation in the pediatric age group is painless rectal bleeding. In a retrospective study of 71 pediatric patients with diagnosed MD, 55.5% of the patients initially presented with rectal bleeding 5 ; however, this number varies among studies 6,7,8 . In a study of 776 patients, Kusumoto et al found that an accurate preoperative diagnosis was made only in 11% of patients presenting with symptoms other than bleeding, compared to 88% in bleeding patients 9 .…”

“…Many of other presenting symptoms, such as abdominal pain and nausea, are non specific and may mimic appendicitis. In one study, 11% of children with complicated MDs were initially diagnosed with appendicitis 6 . Ueberrueck et al found that 5 MDs were found incidentally in a series of 311 appendicectomies performed at one institution over 3 year 10 .…”

Laparoscopic-Assisted Surgery for Small Bowel Obstruction Caused by a Mesodiverticular Band: Report of a Case

“…However, laparoscopic procedures were performed in 8 of these case reports ( Table 1 ). There are disadvantages to performing intracorporeal resection of Meckelʼs diverticulum, including leakage of the bowel contents during stapling and incomplete resection of the ectopic gastric mucosa 4,9) . It has been reported that laparoscopic-assisted transumblical extracorporeal resection of the diverticulum is a safe and appropriate procedure for treating Meckelʼs diverticulum 1,4,[9][10][11] .…”

“…Meckelʼs diverticulum is a remnant of the bowel component and a mesodiverticular band is a remnant of the vascular component of the omphalomesenteric duct 2) . The incidence of Meckelʼs diverticulum is reported to be 1-3% 3) , and 4-34% of affected patients develops complications 4) .…”

The use of laparoscopy in the management of Littre’s hernia in children

“…With the advances in the development of laparoscopic technique in children, the use of laparoscopy in the management of inguinal hernia [5][6][7][8] and complicated Meckel's diverticulum had been reported, respectively [9,10]. We herein report the use of laparoscopy in the management of Littre's hernia in two children.…”