Divertículo de Meckel complicado. Experiencia de 15 años en un hospital interzonal / Complicated Meckel's diverticulum. Fifteen years of experiencein an interzonal hospital in the Province of Buenos Aires

Introducción: el divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Puede presentarse con hemorragia, obstrucción intestinal o diverticulitis, complicaciones que disminuyen con la edad, por lo que en el adulto el diagnóstico suele ser incidental. El tratamiento de las complicaciones es quirúrgico, mediante diverticulectomía o resección segmentaria del intestino delgado, dependiendo de sus características morfológicas. Objetivo: analizar nuestra experiencia en el manejo del divertículo de Meckel complicado en un período de 15 años. Diseño: estudio descriptivo, observacional, transversal, retrospectivo. Material y métodos: se revisaron las historias clínicas de los pacientes operados por divertículo de Meckel complicado en el Servicio de Cirugía General del Hospital San Roque durante el periodo 2007-2022. Se registraron datos demográficos, presentación clínica, diagnóstico preoperatorio, tratamiento quirúrgico, complicaciones postoperatorias y hallazgos histopatológicos. Resultados: se incluyeron 25 pacientes, 21 (84%) hombres, 3 menores de 18 años. La presentación clínica fue un síndrome de fosa iliaca derecha en el 80% de los casos, obstrucción intestinal en el 16% y hemorragia en el 4%. En solo 2 casos se realizó el diagnóstico preoperatorio, confirmado mediante tomografía computada. Se realizó diverticulectomía en el 68% de los pacientes y resección segmentaria el 32%. El abordaje fue laparotómico en el 64%, principalmente en el periodo inicial y laparoscópico en el 36%. Hubo una complicación IIIb de Clavien-Dindo en un paciente pediátrico tratado con drenaje percutáneo. En un solo paciente (4%), que se presentó con hemorragia digestiva masiva, se encontró epitelio de tipo gástrico y páncreas ectópico en el divertículo. Conclusiones: En nuestra experiencia el divertículo de Meckel complicado se presentó predominantemente en hombres. La complicación más frecuente en el adulto fue la diverticulitis. El diagnóstico preoperatorio fue infrecuente y realizado por tomografía computada. La diverticulectomía es suficiente en la mayoría de los casos. Actualmente, la laparoscopia es una herramienta segura, rentable y eficiente que permite el diagnóstico y tratamiento oportunos de esta entidad. (AU)

Introduction: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can present with bleeding, intesti-nal obstruction or diverticulitis, complications that decrease with age, so in adults the diagnosis is usually incidental. Treatment of complications is surgical, through diverticulectomy or segmental resection of the small intestine, depending on its morphological characteristics. Objective: to analyze our experience in the management of complicated Meckel's diverticulum over a period of 15 years. Design: descriptive, observational, cross-sectional, retrospective study. Materials and methods: the medical records of patients operated on for complicated Meckel's diverticulum in the General Surgery Service of the San Roque Hospital during the period 2007-2022 were reviewed. Demo-graphic data, clinical presentation, preoperative diagnosis, surgical treatment, postoperative complications, and histopathological findings were recorded. Results: twenty-five patients were included, 21 (84%) men, 3 under 18 years of age. The clinical presentation was a right iliac fossa syndrome in 80% of cases, intestinal obstruction in 16% and hemorrhage in 4%. In only 2 cases was the preoperative diagnosis made, confirmed by computed tomography. Diverticulectomy was performed in 68% of patients and segmental resection in 32%. The approach was by laparotomy in 64%, mainly in the initial period, and by laparoscopy in 36%. There was a Clavien-Dindo IIIb complication in a pediatric patient treated with percutaneous drain-age. In only one patient (4%), who presented with massive gastrointestinal bleeding, gastric-type epithelium and ectopic pancreas were found in the diverticulum. Conclusions: In our experience, complicated Meckel's diverticulum occurred predominantly in men. The most frequent complication in adults was diverticulitis. Preoperative diagnosis was infrequent and was made by computed tomography. Diverticulectomy is sufficient in most cases. Currently, laparoscopy is a safe, profitable and efficient tool that allows for the timely diagnosis and treatment of this entity. (AU)

Divertículo de Meckel con tumor neuroendocrino: presentación inusual / Meckel's diverticulum with neuroendocrine tumor: unusual presentation

El divertículo de Meckel es una malformación congénita que suele presentarse como un hallazgo incidental asintomático. Puede complicarse por procesos inflamatorios o tumores, cursando con sintomatología abdominal sumamente inespecífica, lo que complica su diagnóstico oportuno. Aunque la incidencia de neoplasias malignas en estos divertículos es baja, los tumores neuroendocrinos son los más representativos. Presentamos el caso de una paciente de 72 años que consultó por dolor abdominal y deposiciones melénicas, con múltiples nódulos intrahepáticos sugestivos de tumores neuroendocrinos y hallazgo intraoperatorio incidental de diverticulitis aguda de Meckel con metástasis peridiverticular de un tumor neuroendocrino. (AU)

Meckel's diverticulum is a congenital malformation that usually presents as an incidental finding. It can be complicated by inflammatory processes or tumors, with non-specific abdominal symptoms which delay its timely diagnosis. Although the incidence of malignant neoplasms in these diver-ticula is low, neuroendocrine tumors are the most representative. We present the case of a 72-year-old female patient who consulted for abdominal pain and melenic bowel movements, with multiple intrahepatic nodules suggestive of neuroendocrine tumors and an incidental intraoperative finding of acute Meckel's diverticulitis with peridiverticular metastasis of a neuroendocrine tumor. (AU)

Diverticulitis de Meckel, una causa poco frecuente de abdomen agudo / Meckel's diverticulitis, an uncommon cause of acute abdomen

Resumen El divertículo de Meckel (DM) corresponde a la involución aberrante del canal onfalo-mesentérico o conducto vitelino, el cual se ubica a nivel del borde antimesentérico del íleon terminal. Es la anomalía estructural más común del tracto gastrointestinal, casi siempre es asintomático y su diagnóstico por lo general es incidental, sin embargo, la complica ción con diverticulitis es una condición poco usual. Describimos el caso de un hombre de 65 años, que ingresó referido de otra institución con diagnóstico de abdomen agudo, al examen físico presentó signos de irritación peritoneal con evidencia de leucocitosis y neutrofilia en hemograma de ingreso. Se realizó tomografía computarizada de abdomen con contraste endovenoso, la cual se interpretó como diverticulitis de Meckel complicada, siendo corroborado durante el acto quirúrgico y confirmado mediante anatomía patológica. La diverticulitis de Meckel es una entidad rara, sin embargo, es importante reconocerla dentro de los diagnósticos diferenciales de abdomen agudo, lo cual permitirá una pronta intervención y un favorable desenlace.

Abstract Meckel's diverticulum corresponds to the aberrant invo lution of the omphalo-mesenteric canal or vitelline duct, which is located at the level of the antimesenteric border of the terminal ileum. It is the most common structural anomaly of the gastrointestinal tract, it is almost always asymptomatic and its diagnosis is usually incidental, how ever the complication with diverticulitis is an unusual con dition. We describe the case of a 65-year-oldman, who was admitted from another institution with a diagnosis of acute abdomen. On physical examination, he presented signs of peritoneal irritation with evidence of leukocytosis and neutrophilia in the admission blood count. Computerized tomography of the abdomen with intra venous contrast was performed, which was interpreted as complicated Meckel's diverticulitis, being corroborated during the surgical act and confirmed by pathological anatomy. Meckel's diverticulitis is a rare entity, however it is important to recognize it within the differential diagnoses of acute abdomen, which will allow prompt intervention and a favorable outcome.

Divertículo de Meckel en el hiato de Winslow como causa extraordinaria de oclusión intestinal / Meckel's diverticulum in the foramen of Winslow as a rare cause of small bowel obstruction

RESUMEN El divertículo de Meckel es la malformación congénita más frecuente del tracto gastrointestinal. Puede permanecer completamente oculto sin dar síntomas o puede ser causa de abdomen agudo quirúrgico en donde se debe descartar patología inflamatoria, infecciosa y/o mecánica. Se presenta un caso excepcional de una obstrucción intestinal producido por una hernia interna generada por un divertículo de Meckel en el hiato de Winslow.

ABSTRACT Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It may remain asymptomatic or may cause acute abdomen requiring surgery due to inflammation, infection or mechanical obstruction. We report case of small bowel obstruction produced by an internal hernia generated by a Meckel's diverticulum in the foramen of Winslow.

Intestinal intussusception of Meckel's diverticulum, a case report and literature review of the last five years

ABSTRACT Meckel's diverticulum is the most common gastrointestinal tract anomaly. It arises from the incomplete closure of the omphalomesenteric conduit, which is a true diverticulum at the antimesenteric border of the ileum. Although the majority of patients are asymptomatic, they can present with inflammation, hemorrhage, intussusception, intestinal obstruction, and perforation, among others; this constitutes an important differential diagnosis for acute abdomen. A 19-year-old female sought medical attention because of intermittent diffuse abdominal pain for two months, nausea, and diarrhea. In the requested imaging tests, tomography, and enterotomography, a diagnosis of Meckel's diverticulum with some degree of intussusception was suggested. The patient underwent elective surgical treatment without complications and was discharged on the second postoperative day with clinical improvement. In this section, we review publications on similar cases published in the last five years.

Tc-99m scan for pediatric bleeding Meckel diverticulum: a systematic review and meta-analysis

Abstract Objective: Meckel diverticulum (MD) is a common malformation of the digestive tract, often accompanied by serious complications. It is important to find safe and effective diagnostic methods for screening MD. The aim of this study was to evaluate the effectiveness of a technetium-99m (Tc-99m) scan for pediatric bleeding MD. Methods: The authors conducted a systematic review of studies published in PubMed, Embase, and Web of Science before 1 January 2023. Studies based on PICOS were included in this systematic review. The flow chart was made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software. Results: Sixteen studies with 1115 children were included in this systematic review. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.80 [Confidence Interval (95% CI, 0.73-0.86) and 0.95 (95% CI, 0.86-0.98)], respectively. The area under the curve (AUC) was 0.88 (95% CI, 0.85-0.90). Publication bias (Begg's test p = 0.053) was observed. Conclusion: Tc-99m scan has high specificity, but moderate sensitivity, which is always influenced by some factors. Hence, the Tc-99m scan has some limitations in the diagnosis of pediatric bleeding MD.

Hallazgo Incidental de Tumor Estromal Gastrointestinal en Divertículo de Meckel. Caso Clínico

Introducción: El divertículo de Meckel es un defecto sacular ubicado en el íleon distal, con una tasa de complicaciones de 4%. La resección quirúrgica está indicada en estas complicaciones, siendo controversial en casos asintomáticos o incidentales. Dentro de las complicaciones existen tumores como los estromales gastrointestinales (GIST). Caso Clínico: Hombre de 57 años, postrado por múltiples factores, presenta úlcera por presión sacra grado IV sobreinfectada y con evolución tórpida. Se decide realizar colostomía terminal, evidenciando un divertículo de Meckel en el intraoperatorio con aspecto sospechoso, por lo cual se decide resecar, resultando en un GIST de bajo riesgo. Se mantiene en seguimiento por 6 meses, sin recidiva tumoral. Discusión: Mientras que la cirugía pareciera ser imperativa en complicaciones, aún existe debate respecto a las indicaciones de resección de divertículo de Meckel hallado incidentalmente en el intraoperatorio por cirugía de otra causa. Si bien puede aumentar la morbimortalidad, la resección estaría indicada según ciertas características como edad, sexo, tamaño y aspecto, dado el riesgo de desarrollo de complicaciones y neoplasias.

Introduction: Meckel's diverticulum is a saccular defect located in the distal ileum, with a complication rate of 4%. Surgical resection is indicated when these complications occur, yet resection in asymptomatic or incidental cases remains controversial. Among these complications, the appearance of tumors such as gastrointestinal stromal (GIST), may occur. Case Report: A 57-year-old male, bedridden due to multi- ple factors, presents with a complicated grade IV sacral pressure ulcer with a torpid evolution. An end colostomy is performed, evidencing a suspicious-looking Meckel's diverticulum intraoperatively, which was resected and resulted to be a low-risk GIST. At a 6-month follow-up, the patient showed no evidence of tumor recurrence. Discussion: While surgery seems to be imperative in complications, there is still a debate regarding the indications for resection of Meckel's diverticulum found incidentally intraoperatively due to surgery for another cause. Although it could increase morbidity and mortality, resection could be indicated according to certain characteristics such as age, sex, size and appearance, given the risk of developing complications and neoplasm.

Experiencia en cirugía de urgencia de Divertículo de Meckel en adultos

Objetivo: Describir la experiencia en cirugía de urgencia de divertículo de Meckel en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Materiales y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas de urgencia realizadas entre marzo de 2010 y marzo de 2021. Mediante búsqueda de registros de pabellón y ficha electrónica. Resultados: Dentro del período analizado se obtuvo 14 pacientes con diagnóstico posoperatorio y/o hallazgo de divertículo de Meckel. En un 78% se resecó el divertículo de Meckel, 100% de los divertículos resecados corresponden a casos complicados. Desde el año 2018, un 75% del abordaje fue mínimamente invasivo, con un 14% de conversión a cirugía abierta. El tipo de resección del divertículo fue un 77% en su base a través de sección con stappler o sutura manual, La ubicación media del divertículo de Meckel fue 77 cm. Un 14% de los pacientes requirieron reoperación por filtración anastomótica. No hubo mortalidad. Discusión: A diferencia de algunas series, en nuestro estudio existe una mayor proporción de abordaje mínimamente invasivo y mayor cantidad de resección en base del divertículo con resultados aceptables. Conclusión: El presente estudio, presenta una población de 14 pacientes con hallazgo de divertículo de Meckel complicado, a partir de los hallazgos de la cirugía en contexto de urgencias; se cumple el objetivo del estudio de caracterizar en un período de 11 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Aim: To describe the experience in emergency surgery for Meckel's diverticulum in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study, in emergency surgical interventions performed between March 2010 to March 2021 are analyzed. By searching the ward records and electronic file. Results: Within the analyzed period, 14 patients were obtained with a postoperative diagnosis and / or finding of Meckel's diverticulum. Meckel's diverticulum was resected in 78%, 100% of resected diverticula correspond to complicated cases. Since 2018, 75% of the approach was minimally invasive, with 14% conversion to open surgery. The type of resection of the diverticulum was 77% at its base through section with stappler or manual suture. The mean location of Meckel's diverticulum was 77 cm. 14% of the patients required reoperation due to anastomotic leakage. There was no reported mortality. Discussion: Unlike some series, in our study there is a higher proportion of minimally invasive approach and a greater amount of resection based on the diverticulum with acceptable results. Conclusion: These study presents a population of 14 patients with a finding of complicated Meckel's diverticulum, based on the findings of surgery in an emergency setting. the objective of the study is fulfilled to characterize in a period of 11 years the surgical results of this series, something not previously reported in the chilean literature.

Divertículo de Meckel como causa de oclusión intestinal mecánica en adulto. Presentación de un caso

RESUMEN El divertículo de Meckel se diagnostica por una complicación. Existen tres complicaciones más comunes: la hemorragia, la inflamación y la oclusión. Esta última se presenta con mayor frecuencia en niños. Tiene mayor incidencia en el sexo masculino, sin embargo, en los últimos años en el municipio Baracoa (Guantánamo, Cuba) se han presentado varios casos, cinco en el año 2019 y uno en el 2020; cuatro de ellos fueron mujeres. Se presenta el caso clínico de una paciente de 62 años de edad, con antecedentes de cirugía abdominal por úlcera duodenal perforada, la cual requirió atención médica en el servicio de guardia de Cirugía, del hospital municipal de Baracoa, por dolor abdominal tipo cólico, vómitos y dificultad en la expulsión de heces y gases. Se hospitalizó con diagnóstico presuntivo de oclusión intestinal mecánica por bridas postquirúrgicas y se realizó laparotomía exploradora, con hallazgo diagnóstico de divertículo de Meckel inflamado. Se concluyó con resección intestinal del segmento de íleon. La paciente evolucionó satisfactoriamente y fue dada de alta al octavo día después de la intervención, sin complicaciones.

ABSTRACT Meckel's diverticulum is diagnosed by a complication. There are three most common complications: hemorrhage, inflammation, and occlusion. The last one occurs more frequently in children. It has a higher incidence in males, however, in recent years in the Baracoa municipality (Guantánamo, Cuba) there have been several cases, five in 2019 and one in 2020; four of them were women. The clinical case of a 62-years-old patient is presented, with a history of abdominal surgery due to perforated duodenal ulcer, which required medical attention in the Surgery on-call service, of the Baracoa municipal hospital, due to colic-type abdominal pain, vomiting and difficulty in expelling stool and gas. She was hospitalized with a presumptive diagnosis of mechanical intestinal occlusion due to post-surgical bands and an exploratory laparotomy was performed, with a diagnostic finding of an inflamed Meckel's diverticulum. It was concluded with intestinal resection of the ileum segment. The patient evolved satisfactorily and was discharged on the eighth day after the intervention, without complications.

Hernia interna por divertículo de Meckel: una causa rara de obstrucción intestinal / Internal Hernia due to Meckel's Diverticulum: A Rare Cause of Intestinal Obstruction

Resumen El divertículo de Meckel (DM) es el remanente del conducto onfalomesentérico y se considera la malformación congénita más común del tracto gastrointestinal. La mayoría de los pacientes son asintomáticos; sin embargo, aquellos en los que se desarrollan síntomas, estos pueden manifestarse como: dolor abdominal, hemorragia de tracto gastrointestinal, perforación u obstrucción intestinal. El objetivo de este reporte es presentar un caso de hernia interna secundaria a un divertículo de Meckel, siendo esta una causa poco frecuente de obstrucción intestinal.

Abstract Meckel's diverticulum is the remnant of the omphalomesenteric duct and is considered the most common congenital malformation of the gastrointestinal tract. Most patients are asymptomatic, however patients who develop symptoms can manifest: abdominal pain, gastrointestinal tract bleeding, intestinal perforation or obstruction. The objective of this report is to present a case of internal hernia secondary to a Meckel's diverticulum, a rare cause of bowel obstruction.

Divertículo de Meckel como causa de obstrucción intestinal / Meckel's diverticulum as a cause of intestinal obstruction

RESUMEN Presentamos el caso de una paciente de 50 años que consultó por dolor abdominal y síntomas de obstrucción intestinal. Se realizaron los estudios prequirúrgicos correspondientes y se decidió efectuar laparotomía exploradora, en la que se encontró divertículo de Meckel complicado por obstrucción de banda fibrosa. A continuación, realizamos revisión bibliográfica, formas de estudio y tratamientos posibles.

ABSTRACT We report the case of a 50-year-old female patient with abdominal pain and symptoms of intestinal obstruction. Preoperative tests were performed, and the patient underwent exploratory laparotomy. A Meckel's diverticulum complicated with obstruction due to a fibrous band was found intraoperatively. We conducted a bibliographic review, with focus on diagnostic methods and treatments.

Management of Symptomatic Meckel's Diverticulum in Infants and Children

Objectives:The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome. Materials and Methods?This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum at the author's institute and included data from January 1, 2000 to December 31, 2020. Results?Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period. The ratio for males to females was 3:1. This study consisted of infants, (n?=?22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n?=?43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n?=?59, 70.23%), (2) perforation peritonitis (n?=?17, 20.23%), (3) lower gastrointestinal bleeding (n?=?4, 4.76%), and (4) incidental finding (n?=?4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n?=?17) of Meckel's diverticulum was responsible for the secondary intussusception. The surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n?=?36, 42.85%); (2) Meckel's diverticulectomy (n?=?32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n?=?12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n?=?4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period. Conclusion?Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.

Clinical features, diagnosis and treatment of intussusception secondary to inverted Meckel′s diverticulum in children / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics, diagnosis, treatment and prognosis of inverted Meckel′s diverticulum in children, and to summarize the clinical experience.Methods:Ten children who received surgical treatment in Beijing Children′s Hospital, Capital Medical University from October 2018 to October 2021 were retrospectively analyzed.The children were diagnosed with Mecker′s diverticulum.Their data were complete and their fo-llow-up information was available.The clinical features, diagnosis, treatment and prognosis were summarized.There were 6 males and 4 females, whose age of onset ranged from 5 months to 12 years and 5 months.The clinical manifestations were abdominal pain in 8 cases, crying in 2 cases and bloody stool in 3 cases.B-ultrasound showed suspected diseases secondary to inverted Meckel′s diverticulum, including small intestinal intussusception in 6 cases and back junction type intussusception in 4 cases.One case of small intestinal intussusception was misdiagnosed after laparoscopic exploration in other hospitals and suffered from recurrent intussusception.All patients underwent segmental bowel resection.Results:Of the 10 children, 8 cases received laparoscopic exploration and 2 cases underwent open surgery for secondary intestinal necrosis.Postoperative pathology revealed Meckel′s diverticulum.Ectopic tissue was accessible in 8 cases, including ectopic gastric tissue in 7 cases, and ectopic pancreas in 1 case.During the postoperative follow-up period (1 month-3 years), the patients were generally in good condition with no complications such as intestinal obstruction.Conclusions:Intussusception secondary to inverted Meckel′s diverticulum is rare and difficult to diagnose before operation.The diagnosis should be confirmed by surgical exploration and postoperative pathology.However, careful surgical exploration is required since inverted Meckel′s diverticulum is prone to be misdiagnosed during exploration.

Intestinal malrotation, mesocolic hernia, and Meckel diverticulum - differential diagnosis of abdominal pain in adults: case report and literature review

Intestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923. Intestinal malrotation is a rare condition among adults - prevalent in a mere 0.0001% to 0.19% of the population -, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptomsmay appear later in life,making diagnosis in adults difficult on account of non-specific symptoms. In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina. (AU)

Divertículo de Meckel perforado por un cuerpo extraño / Meckel's Diverticulum Perforated by a Foreign Body

Introducción: El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Por lo general, cursa asintomático, y su diagnóstico es transoperatorio. Cuando presenta síntomas se deben a sus complicaciones, de las cuales la perforación constituye solo el 0,5 por ciento. Objetivo: Describir las características clínico-quirúrgicas de la presentación de un paciente con divertículo de Meckel perforado por cuerpo extraño. Caso clínico: Paciente adulto de 46 años de sexo masculino, piel blanca, que acude con dolor generalizado en el abdomen que se trasladó a Fosa Ilíaca Derecha, con febrícula. Se interviene quirúrgicamente y se halla divertículo de Meckel perforado por cuerpo extraño. Conclusiones: El pronóstico de esta enfermedad depende de la evolución, diagnóstico precoz y tratamiento aplicado en las distintas complicaciones, así como de la decisión de realizar tratamiento quirúrgico en los hallazgos casuales(AU)

Introduction: Meckel's diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It is generally asymptomatic, with an intraoperative diagnosis. When it presents symptoms, they are due to its complications, of which perforation accounts for only 0.5 percent. Objective: To describe the clinical-surgical characteristics of a patient who presented with a Meckel's diverticulum perforated by a foreign body. Clinical case: 46-year-old adult patient of the male sex and white skin, who presents with generalized pain in the abdomen that moved to the right iliac fossa and low-grade fever. The patient underwent surgery and a Meckel's diverticulum was found, perforated by a foreign body. Conclusions: The prognosis of this disease depends on the evolution, early diagnosis and applied treatment according to the different complications, as well as on the decision to perform surgical treatment in accidental findings(AU)

Oclusión intestinal mecánica por divertículo de Meckel en un adulto / Mechanical intestinal occlusion by Meckel's diverticulum in an adult

Introducción: La incidencia del divertículo de Meckel en la población general, es aproximadamente del 1 al 2 por ciento y las manifestaciones clínicas son vistas en solo el 20 por ciento de estas personas. El diagnóstico en el 80 por ciento restante es incidental y se hace por hallazgos quirúrgicos. La forma oclusiva de presentación es infrecuente y requiere un elevado índice de sospecha. Objetivos: Describir la presentación clínica y características quirúrgicas de la oclusión intestinal mecánica por divertículo de Meckel en el adulto. Caso clínico: Paciente masculino de 54 años de edad, que acudió por un cuadro doloroso abdominal y elementos clínicos de un síndrome oclusivo. Durante la intervención quirúrgica se constató un divertículo de Meckel de base ancha, como punto de fijación y vólvulo del intestino delgado. Se realizó resección y anastomosis término - terminal en un plano. La evolución postoperatoria fue satisfactoria. Conclusiones: La oclusión intestinal mecánica, secundaria al divertículo de Meckel, constituye una causa infrecuente de síndrome oclusivo que se debe tener presente en la práctica quirúrgica(AU)

Introduction: The incidence of Meckel's diverticulum in the general population is approximately 1 to 2 percent and clinical manifestations are seen in only 20 percent of these people. The diagnosis in the remaining 80 % is incidental and is made by surgical findings, reported in approximately 2 percent of autopsies. Objective: To describe the clinical presentation and surgical characteristics of mechanical intestinal occlusion by Meckel's diverticulum in the adults. Clinical case: 54-year-old male patient who was attended with a painful abdominal condition and clinical elements of an occlusive syndrome. During surgery, a broad-based Meckel's diverticulum was found as a point of attachment, and small intestine volvulus. A terminal resection and anastomosis was performed in one plane. Postoperative evolution was satisfactory. Conclusions: Mechanical intestinal occlusion secondary to Meckel's diverticulum is a rare cause of occlusive syndrome that must be taken into account in surgical practice(AU)

Divertículo de Meckel en asociación a onfalocele y tetralogía de Fallot: reporte de caso y revisión de la literatura / Meckel's diverticulum in association with omphalocele and tetralogy of Fallot: Case report and literature review

El onfalocele o exónfalos se definen como un defecto congénito de la pared abdominal, que consiste en la herniación de las vísceras abdominales a través del anillo umbilical. Esta entidad rara vez se asocia a la comunicación del divertículo de Meckel con el saco del onfalocele. Teniendo en cuenta la escasa prevalencia de dicha entidad, compartimos el reporte de caso de un paciente recién nacido, con diagnóstico de onfalocele menor, en quien se sospechaba ruptura del saco, sin embargo, de manera intraoperatoria se encontró que la aparente ruptura del saco, correspondía a la comunicación con un divertículo de Meckel. El caso además se asoció con hallazgos ecocardiográficos de tetralogía de Fallot

Omphalocele or exomphalos are defined as a congenital defect of the abdominal wall, which consists of the herniation of the abdominal viscera through the umbilical ring. This entity is rarely associated with the communication of Meckel's diverticulum with the omphalocele sac. Considering the low prevalence of this entity, we report the case of a newborn with a diagnosis of minor omphalocele, in whom rupture of the sac was suspected; however, intraoperatively it was found that the apparent rupture of the sac corresponded to a communication with a Meckel's diverticulum. The case was also associated with echocardiographic findings of tetralogy of Fallot

Inverted Meckel’s diverticulum: a rare cause of intussusception in children

Invagination of proximal segment of intestine to distal one results in intussusceptions and is a common cause of intestinal obstruction in children. In most of the cases of intussusceptions, the cause is idiopathic in nature; the other causes may be infection, polyp or anatomical abnormalities. Occasionally, Meckel’s diverticulum may cause intussusception and inverted Meckel’s diverticulum leading to intussusceptions is very rare in children. It is difficult to diagnose inversion of Meckel’s diverticulum preoperatively. Here in we report a case of 6 yrs old male child, who was operated for intussusception and found to have inverted Meckel’s diverticulum as lead point.

Divertículo de Meckel como causa de sangrado gastrointestinal masivo en adulto. Hallazgos en imágenes y correlación anatomopatológica / Meckel's diverticulum causing massive gastrointestinal bleeding in an adult. Imaging findings and anatomopathological correlation

RESUMEN El divertículo de Meckel es la malformación congénita más frecuente del tracto gastrointestinal, generada por un defecto en el cierre del conducto onfalomesentérico. Si bien en la mayoría de los casos son asintomáticos, la presentación clínica más habitual es la de un sangrado digestivo asociado a la presencia de mucosa gástrica ectópica, principalmente durante la niñez, siendo esta presentación clínica infrecuente en adultos.

ABSTRACT Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. Its caused by a improper closure of the omphalomesenteric duct. Many cases are asymptomatic, and the most common clinical presentation is a gastrointestinal bleeding by the presence of ectopic gastric mucosa especially during childhood. This clinical presentation is uncommon in adults.

Meckel’s Diverticulum: Still Formidable during Acute Abdominal Surgeries – An Observational Study

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.