Two Congenital Gastrointestinal Malformations: A Case of Omphalocele and Meckel's Diverticulum in a Neonate.

Omphalocele is a malformation of the abdominal wall varying in size and located at the base of the umbilical cord. Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract with an increased prevalence in newborns with congenital malformations of the umbilicus and gastrointestinal tract. The association between Meckel's diverticulum and omphalocele has been described in rare cases. We present the case of a newborn diagnosed with both entities.

Pivotal Surgical Intervention for Pediatric Ileoileal Intussusception With Meckel's Diverticulum: A Case Report.

The most prevalent congenital gastrointestinal tract abnormality is Meckel's diverticulum. It is discovered in most instances incidentally. It can be observed as painless bleeding in the gastrointestinal tract. However, it can occasionally result in acute intestinal obstruction, which frequently masks the actual clinical presentation. This is a case of a four-and-a-half-year-old male child who presented with features of obstruction, which, on further evaluation, revealed ileoileal intussusception. An emergency surgical intervention was planned with an exploratory laparotomy and a reduction of intussusception. This case emphasizes the urgency of diagnosing and managing intussusception to prevent serious consequences such as bowel ischemia, bowel necrosis, bowel perforation, peritonitis, and sepsis. It stands as a stark reminder for medical professionals to stay vigilant for these critical gastrointestinal emergencies, and immediate treatment with a multidisciplinary approach is recommended to significantly enhance patient outcomes.

Spontaneous Perforation of Meckel's Diverticulum in a Young Adult Male: A Case Report and Review of the Literature.

Meckel's diverticulum, a congenital defect that affects about 2% of the population, is a remnant of the embryologic vitelline duct. Perforated Meckel's diverticulum, a rare consequence of an already rare disease process, frequently presents and is diagnosed as a perforated appendix. We report a case of a 28-year-old male who presented with a two-day history of right-sided lower abdominal pain associated with nausea. The abdominal examination revealed a soft, nondistended abdomen with tenderness in the right iliac fossa. A CT scan of the abdomen showed a normal appendix and inflammation of Meckel's diverticulum without any signs of perforation. Bowel exploration through a small midline incision indicated the presence of a highly inflamed Meckel's diverticulum with localized perforation 75 cm from the ileocecal valve. A resection of 15 cm of the small bowel and an end-to-end primary anastomosis were performed. The patient had an uncomplicated recovery and was discharged after a five-day admission to a surgical ward. This case report illustrates the significance of keeping Meckel's diverticulum as a differential diagnosis in all the patients who present with an acute abdomen.

Presentation of Perforated Meckel's Diverticulum and Phlegmon: A Case Report.

One of the most frequently encountered congenital anomalies of the gastrointestinal tract is the Meckel's diverticulum. Perforation of the diverticulum, a rare complication, can significantly hinder accurate diagnosis of the condition. Other common complications associated with Meckel's diverticulum include intestinal obstruction, intussusception, volvulus, inflammation, and hemorrhage. The presentation is similar to the presentation of appendicitis at times. Formation of a phlegmon around a perforated Meckel's diverticulum can mask clinical signs and symptoms. We present a case of a 59-year-old man who presented with pain in the right upper and lower quadrants. After imaging, the patient underwent exploratory laparotomy, which revealed a perforated Meckel's diverticulum. This case highlights the importance of considering Meckel's diverticulum as a possible diagnosis in patients presenting with acute abdominal pain. A thorough approach to history and physical exam combined with imaging can help in the early diagnosis of a perforated Meckel's diverticulum.

Symptomatic Meckel's Diverticulum Presenting As Recurrent Gastrointestinal Bleeding in an Adult.

A 51-year-old male presented to the hospital with recurrent gastrointestinal bleeding. Prior work up with an esophagogastroduodenoscopy (EGD), colonoscopy, and video capsule endoscopy failed to reveal a bleeding source. Given a history of a terminal ileum diverticulum noted on previous colonoscopy and persistence of hematochezia, a Meckel's scan was performed, which revealed abnormal uptake suspicious for a Meckel's diverticulum containing ectopic gastric mucosa. After surgical resection, pathology confirmed a Meckel's diverticulum with gastric heterotopia. This case highlights the importance of considering Meckel's diverticulum for instances of recurrent gastrointestinal bleeding, especially in patients who are still symptomatic despite an extensive workup. Moreover, it is important to note that a Meckel's diverticulum can be missed on video capsule endoscopy.

Primary Sclerosing Encapsulating Peritonitis (PSEP) With Meckel's Diverticulum: A Rare Case Report.

Sclerosing encapsulating peritonitis (SEP) is a rare disease. Preoperative diagnosis of SEP can be made with imaging, such as computed tomography (CT). SEP is characterized by a partial or complete encasement of the small intestine by a layer of a thick grayish-white fibro collagenous membrane similar to an abdominal cocoon. The most common symptoms of SEP are abdominal pain, nausea, and vomiting. This rare disease often leads to acute or sub-acute intestinal obstruction. We discuss, in this report, how we managed a case of primary sclerosing encapsulating peritonitis with Meckel's diverticulum at our institution.

Recurrent Intussusception in the Setting of Meckel's Diverticulum in an Infant.

Intussusception is a condition consisting of a proximal portion of the bowel contracting into a more distal bowel portion. The recurring act of intussusception is typically caused by a pathological lead point persisting within the bowel. The most common lead point for intussusception is a Meckel's diverticulum, which arises due to the incomplete obliteration of the omphalomesenteric canal causing a true diverticulum in the small bowel. This report outlines a case of a 10-month-old male infant who experienced three intussusception episodes, eventually requiring surgical intervention. A clinician's awareness of this phenomenon aids in implementing adequate treatment.

Meckel's Diverticulum Causing a Small Bowel Obstruction in an 80-Year-Old Male: Report of a Rare Case and Review of the Literature.

Meckel's diverticulum (MD) is the most common congenital malformation occurring in the gastrointestinal tract and results from the persistence of the vitelline duct during embryology. MD is typically asymptomatic in adults with most of its symptoms manifesting in early childhood. Small bowel obstruction (SBO) due to MD in the elderly population is an entity that has not been widely described in the literature. We present a very rare case of SBO in an 80-year-old patient with no previous abdominal surgeries (virgin abdomen). The cause of obstruction was determined to be an adhesive band formed on top of an MD. The obstruction was relieved and the small bowel segment that contained the diverticulum was resected, and anastomosis was made.

Incidental Meckel's Diverticulum With Neuroendocrine Tumor.

Meckel's diverticulum (MD), the most common congenital disease of the small bowel, commonly presents with symptoms of painless rectal bleeding and intestinal obstruction. The treatment of symptomatic MD involves resection of the lesion regardless of patient age; however, the excision of asymptomatic and incidentally identified MDs in adults remain controversial. On one hand, the complications arising from MDs decrease with age, leading to a lower benefit than risk ratio with prophylactic resection. On the other hand, malignancies, such as neuroendocrine tumors, may arise over time from untreated MDs. This can lead to poor prognostic complications, such as liver or lymph node metastases. In this case report, we describe an incidental Meckel's diverticulum discovered during an exploratory laparotomy for acute sigmoid diverticulitis in an adult male. Later biopsy findings discovered the lesion to contain a grade 1 neuroendocrine tumor. Based on our literature review findings, resection of the incidental Meckel's diverticulum was a reasonable approach given the low complication risks of the procedure and the possibility of malignant transformation and progression.

Hidden Dangers: A Gastrointestinal Stromal Tumor Concealed Inside of a Meckel's Diverticulum.

Meckel's diverticulum (MD) is one of the most common congenital abnormalities of the gastrointestinal tract, affecting approximately two percent of the population. Rarely, Meckel's diverticula have been found to harbor various tumors, which go unnoticed until later in their course. The clinical presentation varies among each individual, and tumors have often metastasized or caused diverticular rupture at the time of diagnosis. This is a case of a 55-year-old male with a past medical history of alcohol abuse and asthma who presented to the emergency department with abdominal pain. He denied any fever, chills, chest pain, nausea, changes in urinary patterns, recent travel, or sick contacts. He is a non-smoker but has been a heavy drinker for many years. On physical exam, he was found to have diffuse abdominal tenderness with pain greatest in the epigastric region and no bowel sounds. He was afebrile but tachycardic at 112 bpm, hypertensive at 168/98 mmHg, and tachypneic at 38 bpm. Labs showed a markedly elevated white blood cell count, hemoglobin and platelet count, as well as metabolic acidosis and elevated lactate levels. Abdominal CT showed a mechanical small bowel obstruction with unclear etiology. Of note was a 7.2 cm thick-walled collection in the right lower quadrant having no clear communication with any bowel loops. Despite aggressive hydration and supportive care, his abdominal exam continued to worsen, prompting an exploratory laparotomy. During the laparotomy, a perforated MD with frank succus was found. On pathology, the affected segment of the bowel revealed a CD117 and CD34 positive spindle cell gastrointestinal stromal tumor (GIST) with mild cytological atypia, no necrosis, and no regional lymph node involvement. Cultures of peritoneal fluid were positive for Klebsiella oxytoca, and the patient was started on meropenem and doxycycline. The patient showed significant improvement with the appropriate administration of antibiotics and was eventually discharged to follow-up with hematology/oncology as an outpatient for further management and monitoring of his GIST tumor. This case is unique as there are only a few reported cases of patients developing GIST inside of MDs. Despite the high five-year survival rate of typically localized GIST tumors, the complications (such as perforation in the case of our patient) caused by tumor growth inside a MD are detrimental if not diagnosed promptly. Not only does perforation increase the risk of metastasis but also the risk of peritonitis and other complications. This case calls for more research on standardization of care for patients who have MD to prevent malignant transformations as well as potential prophylactic excision of incidental MD findings in adult patients.

A Case of Jejunal Atresia Associated With Heterotrophic Pancreas and Meckel's Diverticulum.

Apart from meconium ileus, amniotic fluid plug syndrome, malrotation of the gut, Hirschprung's disorder, trauma, and other rare causes, bowel atresia is one of the most common causes of bowel obstruction in newborns. Jejunal atresia can affect multiple lengths of the bowel. The higher the level of atresia, the greater the severity. The outcome of bowel atresia related to surgical repair is favorable. In general, both mortality and morbidity are affected by affiliated medical conditions such as preterm birth, cystic fibrosis, and other congenital anomalies; the sophistication of the lesion; and surgical complications. We present the case of a one-day-old baby who had two episodes of bilious vomiting with abdominal distension within 10 minutes of birth. The baby was advised to undergo ultrasonography of the abdomen and pelvis for further evaluation, and the findings were reported.

Remanente uracal peritonizado y banda peritoneal congénita obstructiva. Reporte de caso / Peritonealized urachal remnant and obstructive congenital peritoneal band. A case report

Introducción: La obstrucción intestinal por bandas peritoneales con-génitas es poco común en la práctica quirúrgica. Su ubicación más fre-cuente compromete el intestino delgado y existen reportes que involucranel apéndice y el divertículo de Meckel, pero que un remanente uracal pe-ritonizado haga parte de una banda congénita es verdaderamente singular.Caso clínico: Niño de cinco años de edad con cuadro de obstruc-ción intestinal en el que confluyen una banda peritoneal, que va delmesenterio al apéndice y que se une a un remanente uracal peritonizado,asociado al hallazgo incidental de un divertículo de Meckel. El diag-nóstico se definió por medio de una laparoscopia y como tratamientose realizó la resección de la banda peritoneal, del remanente uracal ydel divertículo de Meckel.Discusión: La clasificación de bandas congénitas de Kerkenicomprende 4 grupos independientes, en este caso confluyen una bandaderivada de un remanente embriológico junto con el tipo idiopático.

Introduction. Intestinal obstruction as a result of congenital peri-toneal bands is rare in surgical practice. It typically compromises thesmall bowel, and it also has been reported to involve the appendix ora Meckel’s diverticulum. However, peritonealized urachal remnant aspart of a congenital band is highly infrequent.Case report: 5-year-old boy presenting with intestinal obstructionrelated to a peritoneal band from the mesentery to the appendix and aperitonealized urachal remnant, associated with an incidental findingof a Meckel’s diverticulum. Diagnosis was achieved laparoscopically.The peritoneal band, the urachal remnant, and the Meckel’s diverticulumwere resected.Discussion: Kerkeni’s congenital band classification consists of 4independent groups. This case combines both a band stemming froman embryological remnant and an idiopathic band.

[Intussusception due to Meckel´s diverticulum in adults: a case report]. / Invagination intestinale sur diverticule de Meckel chez l´adulte: à propos d´un cas.

Meckel´s diverticulum is the most common congenital anomaly affecting the gastrointestinal tract resulting from failure of involution of the omphalomesenteric duct. This anomaly is most often asymptomatic and may be revealed by a complication, such as intussusception. This study reports the diagnostic pathway and the management of an 18-year-old female patient admitted to the Emergency Department with ileoileal invagination due to Meckel´s diverticulum complicated by occlusion. This study is interesting because it provides an overview of this rare disease whose diagnosis, based on abdominal scanner, must be made early in order to prevent small bowel perforation or necrosis. Bowel resection without desinvagination is the gold standard treatment.

[Meckel's diverticulitis by ascaris in children: about a case]. / Diverticulite de Meckel d´origine ascaridienne chez l´enfant: à propos d´un cas.

We here report the case of a 4-year-old male child presenting with congenital umbilical bud that, recently, had begun to bleed. Physical examination showed pinkish umbilical bud with blood stains but without any fistula, measuring about 1,5 cm in diameter. Abdominal ultrasound was performed, which suggested urachal sinus. Surgery revealed umbilical bud communicating, in the abdominal portion, with hyperemic, inflammatory Meckel´s diverticulum placed 90 cm away from the ileocaecal angle in which many ascaris were detected. Anatomo-pathological examination of the surgical specimen showed diverticulitis. Thus, the diagnosis of Meckel´s diverticulitis by Ascaris was retained. Resection and anastomosis with bud excision were performed. The postoperative course was simple even after a 6-month follow-up period.

Meckel's Enterolith Causing Small Bowel Obstruction: A Useful Solution to a Unique Problem.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its course is usually benign but may also result in complications requiring surgical intervention. A diverticulum may also permit the removal of intraluminal objects without bowel resection and anastomosis. A woman in her 50s was found to have a mechanical small bowel obstruction secondary to an intraluminal mass within the terminal ileum. On exploration, an MD was encountered proximal to the mass. A diverticulectomy was performed after maneuvering the enterolith into the diverticulum. Meckel's diverticulum with an associated enterolith is a rare cause of small bowel obstruction. Historic imaging may show long-standing stones in the bowel lumen and provide a diagnostic clue. Diverticulectomy may be performed to reduce the risks of small bowel resection and anastomosis. This technique can be used for other intraluminal objects requiring removal in the presence of an MD.

Complicated Meckel's Diverticulum in Children: Clinical Presentation, Diagnostic Work-Out, Surgical Approach and Postoperative Complications.

Introduction Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of cases are asymptomatic and in cases with complications, the diagnosis may be a challenge and the surgical approach is not obvious. The primary aim of the present study was to evaluate the diagnostic process and surgical approach in relation to clinical presentation. The secondary aim was to evaluate the severity of postoperative complications.  Methods A two-center, retrospective analysis of all children below the age of 15 years, operated for complications to MD during the period from January 2003 to December 2016. Results A total of 58 patients were included. In the 40 patients presenting with an acute abdomen an average of 2.3 preoperative diagnostic investigations was performed. In only five cases an MD was recognized preoperatively. In the 18 patients presenting with rectal bleeding or melaena an average of 3.2 preoperative investigations were performed and in only one case the MD was recognized preoperatively. Laparoscopy was the surgical approach in 36 patients (62%) with a conversion in 8. Postoperative complications were seen in two patients (Clavien-Dindo II and IIIb). Conclusion Despite extensive diagnostic work-out an MD was recognized in only a few patients preoperatively. Laparoscopy was the surgical approach in two-thirds of the patients.

Perforation of Meckel`s diverticulum in a very low birth weight neonate with severe pneumoperitoneum and review of literature.

Wang YJ, Wang T, Xia SI, Zhang YC, Chen WB, Li B. Perforation of Meckel`s diverticulum in a very low birth weight neonate with severe pneumoperitoneum and review of literature. Turk J Pediatr 2019; 61: 460-465. Perforation is a rare complication of Meckel`s diverticulum (MD), but it could be severe, even life-threatening for pediatric patients. There is a paucity of data on etiology of perforation, as well as clinical manifestations, management and prognosis in very low birth weight (VLBW) neonates with perforated MD. We report a rare case of spontaneously perforated MD in a VLBW neonate presenting with severe pneumoperitoneum. To our knowledge, this is one of the earliest reported VLBW cases with this rare complication. Furthermore, we review relevant publications and summarize major characteristics of all VLBW cases previously reported in order to provide some practical experience and interesting issues for pediatricians. Perforated MD should be kept in mind when VLBW neonates present with pneumoperitoneum.

Meckel's diverticulum causing intestinal obstruction in the newborn.

The causes of neonatal bowel obstruction are variable and dominated by malformations and the Meckel diverticulum must remain exceptional. We report a case of neonatal bowel obstruction in a six day old male neonate admitted on account of inability to pass stool, abdominal distension and bilious vomiting. The radiologic additional examinations are non-specific. Exploratory laparotomy found obstruction at the site of a Meckel's diverticulum.

Divertículo de Meckel complicado como presentación de abdomen agudo: reporte de un caso y revisión de la literatura / Complicated meckel´s diverticulum presenting as acute abdomen. Case report and a review of the literature

El divertículo de Meckel (DM) es la regresión incompleta del conducto onfalomesentérico y representa la malformación congénita gastrointestinal más común, en alrededor de 2% de la población. Hasta un 4 a 6% se puede complicar, incluyendo sangrado gastrointestinal, obstrucción o inflamación diverticular. Al realizar una apendicectomía en blanco, debe explorarse como diagnóstico diferencial en el intraoperatorio. Se presenta el caso de un paciente operado por abdomen agudo de probable origen apendicular, sin embargo en el intraoperatorio se evidenció el apéndice cecal sano, pero cursando con una diverticulitis de Meckel. Se presenta además, una breve revisión de la literatura.

Meckel´s diverticulum is the most common congenital gastrointestinal malformation, present in 2% of the population, and is formed through incomplete regression of the omphalomesenteric duct. 4 to 6% show symptoms such as gastrointestinal bleeding, intestinal obstruction or diverticular inflammation. It should be considered in the differential diagnosis during surgery for suspected appendicitis. We present the case of a patient undergoing acute abdomen surgery for suspected appendicitis whose cecal appendix was healthy but who was found to have Meckel´s diverticulitis. We also present a brief review of the literature.

Spontaneous hemoperitoneum caused by meckel's diverticulum in an elder patient.

Symptomatic Meckel's Diverticulum is a rare entity in old patients. The most common complications are gastrointestinal bleeding, intestinal obstruction, acute inflammation, and perforation. Usually those complications occur on the first two decades of life and mostly before the fifth decade. We report an extremely unusual debut of Meckel's Diverticulum, presented as massive spontaneous hemoperitoneum in an 82-year-old man without gastrointestinal bleeding. A literature review of atraumatic hemoperitoneum as presentation of Meckel's diverticulum was made.