ABSTRACT
Introduction: Meckel’s diverticulum is a relatively common congenital diverticulum of ileum resulting from incomplete atrophy of the vitellointestinal duct in the embryo. Even though the majority of Meckel’s diverticulum is asymptomatic, their potential to present with severe complications such as bleeding and perforation, intestinal obstruction has, nevertheless, caused much debate regarding whether a silent Meckel’s should be pre-emptively resected when incidentally discovered during acute abdominal surgeries. Aim: Our study aims to analyze the incidental finding of Meckel’s diverticulum during acute abdominal surgeries and its surgical management. Materials and Methods: This prospective observational study was conducted for the incidental findings of Meckel’s diverticulum during acute abdominal surgeries. All the patients clinical, radiological, laboratory, and pathological findings were collected and the results were statistically analyzed and discussed. Results: Out of 13 patients, 9 were males and 4 were females, based on age 10 years, patients had age below 40 years and 3 of them had above 40 years, based on clinical manifestations, 1 had perforative peritonitis, 1 had intestinal obstruction, 1 had acute diverticulitis, 1 had recurrent abdominal pain, and 9 were asymptomatic and incidentally found, among them 5 were found during appendectomy, 1 during gastrectomy, 1 during hernia surgery, 1 during traumatic Whipple’s procedure, and 1 during gastrojejunostomy. Conclusion: Symptomatic Meckel’s diverticulum was associated with dreaded complications such as perforative peritonitis, intestinal obstruction, and diverticulitis with severe pain which made us conclude about even an asymptomatic Meckel’s diverticulum found incidentally during acute abdominal surgeries need to be resected.
ABSTRACT
Introduction: Acute appendicitis is the most common surgical emergency faced in today’s world. The inguinal hernia is the most common type of hernia seen in surgical practice. It can be of a direct and an indirect type. While the indirect type has a congenital cause, direct hernias are attributable to the weakness of abdominal wall musculature. Aim: This study aims to study the prevalence of right (direct) inguinal hernia in patients who underwent open surgery for appendicitis. Materials and Methods: In this retrospective study, 100 patients who underwent surgery for the right direct inguinal hernia were included in the study. Patients’ demographic details, history of open appendectomy, and the clinical presentation were collected. The examination consisted of inspection, palpation, percussion, and auscultation and included various tests such as cough impulse and three-finger test. These findings were later confirmed with an ultrasound abdomen examination. Results: Among these 100 patients, 13 of them had the previous history of open appendectomy, all the study patients were male and they had the right direct inguinal hernia after 5 years of surgery. Among these 13 patients, 10 had perforated appendicitis, 2 had abscess, and 1 had purulent appendicitis. Among these 13, 11 of them had cosmetic Rutherford Morrison or Lanz incision and 2 of them had classical McBurney’s incision. Conclusion: The choice of the incision during open appendectomy is important and the surgeon should avoid injury to the ilioinguinal nerve motor branches which supplies the internal oblique and transverse abdominis muscles, care must be taken during surgery, especially below the horizontal line extending from the anterosuperior iliac spine to the rectus muscle.