Meckel's diverticulum: a surgical dilemma?

In spite of the fact that Meckel's diverticulum is the most common congenital abnormality of the small bowel, there is considerable controversy concerning its surgical management. Resection of a symptomatic Meckel's diverticulum is not a common operation in the experience of most general surgeons. As illustrated by the cases presented in this series, the indications for operation are usually clear. Should abdominal exploration routinely include a search for a Meckel's diverticulum and should it be resected in the absence of symptoms? Although there is no compelling evidence to support the opinion that an asymptomatic Meckel's diverticulum constitutes a major threat to the future well-being of a patient, it is apparent that incidental removal is associated with minimal risk of complications. What are the medicolegal implications? A series of 13 patients is presented to review the salient features of this interesting anomaly, together with pertinent comments from the literature.

Primary pleural mesothelioma.

In this series of nine patients with primary pleural mesothelioma, three patients, all women, had "localized benign" tumors located in the left chest, although one had a recurrence on the right. Five patients all male, had the "diffuse malignant" type, and one woman had "multiple discrete" pleural tumors. Classification on the basis of gross appearance is useful clinically and prognostically, as reflected by the relatively benign behavior of localized pleural mesothelioma in contrast to the relentless lethal nature of the diffuse type. Although seven patients had pleural effusion, cytologic studies were of little help in establishing the diagnosis and all underwent thoracotomy. None of these patients had hypoglycemia or evidence of asbestosis, although three patients had a history of previous asbestos exposure.