Diagnosis and Treatment of Bleeding Meckel's Diverticulum

The major complications of Meckel's diverticulum(MD) are bleeding, intestinal obstruction, infection, umbilical fistula and perforation. Although the relative incidences vary between authors, bleeding is the most common complication in children. The aim of our study is to show the symptomatic guideline for the diagnosis of the bleeding MD. Eight cases with bleeding MD which were operated upon at the department of Pediatric Surgery, Yeungnam University Hospital from April 1985 to April 2001 were reviewed. Half of the patients were under 2 years of age and all patients were male. All patients were preoperatively diagnosed by previous history of intestinal bleeding (melena, hematochezia) and 99mTc pertechnetate MD scan. Segmental resection and end-to-end anastomosis was performed in 6 patients and diverticulectomy in 2 patients. Heterotropic gastric mucosa was found in 6 patients. Postoperative complication was not observed in any cases. In conclusion, in any male children with obscure intestinal bleeding, especially less than 2 years of age, bleeding MD must be suspected. It seems to us that 99mTc pertechnetate MD scan is a useful tool to diagnose bleeding MD.

The Safety of Intraoperative Colonic Irrigation for Single Stage Procedure in Emergency Based Left Colonic Pathology

Staged procedures are preferred to single stage procedures in emergency based left colonic obstruction or perforation because of the safety. PURPOSE: To evaluate whether the single stage procedure in emergency based left colonic pathology is not safe. METHODS: We compared medical records of single stage procedure (SP, n=22 male; 10, mean age: 60+/-17, range: 26-82 Yrs) with Hartmanns procedure (HP, n=23 male; 13, mean age: 58+/-16, range: 18-90 Yrs) and diverting loop colostomy (DC, n=19, male; 12, mean age: 59+/-19, range: 19-80 Yrs) in these 4 years. All the patients were admitted via emergency room. Intraoperative colonic irrigation method with newly developed irrigation device (MITech co., Ltd, Seoul, Korea) was used for SP. APACHE III scoring system was applied to evaluate the physiologic status of the patients. Preoperative data were compared with the 1st and 3rd postoperative day (POD). RESULTS: There were no statistically significant differences in patient demographics and preoperative APACHE III scores. The improvement of APACHE III score was significant in SP and DC on the 3rd POD from 29.6+/-20.9 to 22.9+/-10.2 and 25.7+/-13.3 to 21.4+/-14.8 (P<0.05). There was also a significant improvement in DC (25.7+/-13.3 to 21.9+/-12.9, P<0.05) on the 1st POD, however, there was only a tendency of improvement in SP (29.6+/-20.9 to 26.1+/-12.3) without statistical significance. The scores in HP showed no improvement on the 1st and 3rd POD. There were 3 operative mortalities in HP and one in DC. CONCLUSIONS: Our results suggest that the safety of the single stage procedure with newly developed colonic irrigation device is comparable to palliative decompressive loop colostomy and better than Hartmanns procedure in emergency based left colonic pathology.

Noncancerous Right Portal Vein Occlusion: 2 cases / 한국간담췌외과학회지

Portal vein thrombosis is a rare condition occuring in association with a wide varitey of precipitation factors. Among these, advanced hepatoma constitute the major etiology of portal vein thrombosis. Noncancerous intrahepatic portal vein occlusion was reported in some cases of repeated cholangitis. Generally, Intrahepatic stones occures in Lt. lobe of liver and repeated inflammatory precesses occlude peripheral branch of Lt. portal vein. So, noncancerous Rt. portal vein occlusion is extremly rare condition. Two Patients visited our hospital with Rt. upper quadrant abdominal pain and fever. Preoperative abdominal ultrasonography, computerlized tomography, endoscopic retrograde cholagiopancreaticography revealed multiple Rt. intrahepatic stones and Rt. portal vein 1st branch occlusion. Rt. lobectomy of liver were performed. Pathologic reports were portal vein occlusion due to inflammatory thrombi, not tumor thrombi. Thus authors experienced 2 cases of Rt. portal vein 1st branch occlusion due to noncancerous benign condition, such as multiple intrahepatic stones, we report these cases with brief review of literature.