Unusual disclosure of giant Meckel's diverticulum

At discovery of diabetes mellitus, complementary explorations revealed a superinfection of a giant Meckel's diverticulum. We present this clinical situation in one case and suggest possible nosologies. The epidemiology and clinical approach to Meckel's diverticulum are discussed.     

Laparoscopic diagnosis and excision of Meckel's diverticulum

Meckel's diverticulum is one of the primary concerns in the differential diagnosis of the pediatric patient with massive, acute gastrointestinal bleeding, intussusception, or abdominal pain of uncertain cause. The hospital course of two children with Meckel's diverticulum, successfully treated by laparoscopic excision, is presented, along with details of the operative procedure. Both patients recovered from the procedure without incident and were discharged at 24 and 48 hours after surgery. The authors believe a laparoscopic approach is safe and effective in the diagnosis and treatment of Meckel's diverticulum.     

Perforated duodenal diverticulum caused by enterolith

OBJECTIVES: To describe a community outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and to investigate risk factors for MRSA transmission and infection in a wrestling team. DESIGN: Case series and retrospective cohort study. SETTING: A high school wrestling team and the surrounding community in southern Vermont, 1993 to 1994. PATIENTS OR OTHER PARTICIPANTS: The case series included persons whose MRSA-positive infections were identified at a hospital laboratory from January 1, 1993, through February 28, 1994, and a health maintenance organization laboratory from July 1, 1993, through February 28, 1994. A wrestling team case-patient was a 1993-1994 team member with an MRSA-positive culture during the period from January 1, 1993, through February 28, 1994. INTERVENTIONS: Visual inspection of wrestlers before matches was instituted. Affected wrestlers were excluded from wrestling and advised to seek appropriate medical care. Heightened attention was given to personal and environmental hygiene. MAIN OUTCOME MEASURES: Colonization or infection with MRSA. RESULTS: Seven of 32 team members were MRSA positive (6 infected, 1 colonized). All lesion-positive wrestlers were tested by pulsed field gel electrophoresis and found to be infected with the same MRSA strain, as were 6 nonwrestlers. No risk factors for MRSA infection were identified. CONCLUSIONS: The MRSA was transmitted among members of a wrestling team. Infection with MRSA should be suspected in outbreaks of boils that are nonresponsive to standard antibiotic therapy among healthy participants of contact sports and their close contacts.     

Acute Meckel's diverticulum in a senior patient

Meckel's diverticulum is the most common congenital abnormality of the intestinal tract, occurring in 2% of autoptic studies. The case of an 85-year-old man referred to the Emergency Surgery Unit for intestinal obstruction and lower gastrointestinal tract bleeding is reported. Surgical exploration revealed a complicated Meckel's diverticulum full of coproliths, immersed in pus and blood. Examination of the resected diverticulum showed necrotic diverticulitis in the absence of ectopic gastric or pancreatic tissues.     

Meckel's diverticulum: angiographic findings in 16 patients

OBJECTIVE: The purpose of this study was to assess the sensitivity of angiography in revealing the vitellointestinal artery or other arteriographic abnormalities in patients in whom surgery subsequently proved Meckel's diverticulum. MATERIALS AND METHODS: From the 36 patients who had undergone a Meckel's diverticulectomy between 1980 and 1997 at Hammersmith Hospital or a referring hospital, we selected 18 who had undergone preoperative angiography at our institution. Case notes and angiograms of these 18 patients were reviewed for the presence of a persistent vitellointestinal artery or other angiographic evidence of a Meckel's diverticulum. RESULTS: Angiograms of 16 of 18 patients were available for review. A striking male preponderance existed (male:female = 13:3). Mean age was 28 years (range, 12-65 years). In 11 (69%) of the 16 patients, a persistent vitellointestinal artery was seen that had been noted at the time of the study and reported before surgery for nine patients. Other angiographic abnormalities at the site of the Meckel's diverticulum were present in four patients and included a vascular blush, early venous return, and arterial irregularity. CONCLUSION: Angiography will show a persistent vitellointestinal artery in most individuals with a Meckel's diverticulum who present with chronic gastrointestinal bleeding. However, the recognition of a persistent vitellointestinal artery may be difficult because of overlying vessels, and superselective catheterization of distal ileal arteries may be necessary.     

Meckel's diverticulum in adults. A 3-decade experience

OBJECTIVE: To review the prevalence, clinic manifestations and characteristics of the adult Meckel's diverticulum in the Hospital Espa?ol de México. BACKGROUND: The Meckel's diverticulum is the most frequent congenital malformation of the gastrointestinal tract. However, only in seldom occasions produces manifestations in adults. METHODS: Retrospective review of 31 years. RESULTS: Meckel's diverticulum was found in only 13 cases. The most common clinical manifestation was pain in the right lower abdominal quadrant; there was not a single case of bleeding. A correct pre surgical diagnosis was done in only one patients. Post surgical course was satisfactory in all patients. CONCLUSION: In adults, the Meckel's diverticulum complications are uncommon, being the most frequent clinical manifestation the pain in the right lower abdominal quadrant and intestinal obstruction.     

Meckel's diverticulum in childhood. The authors' own experience

Meckel's diverticulum occurs in approximately 2 percent of the population and may present at any age. Although Meckel's diverticulum may produce an intestinal obstruction or perforation, simulating an appendicitis, hemorrhage is its most important clinical presentation. From 1989 to 1994, Meckel's diverticulum was discovered in ten children at laparotomy. Three cases were asymptomatic, representing an incidental finding at laparotomy. Of the seven symptomatic patients, four presented with bowel obstruction (intussusception), three had rectal bleeding one of whom had diverticulitis. Contrast studies--in gastrointestinal hemorrhage--were not helpful in establishing the diagnosis; colonoscopy and gastroscopy ruled out other causes of bleeding. Five of seven symptomatic patients had an intestinal resection while two a diverticulectomy after assessment that the ulcer did not require resection. No postoperative morbidity and mortality is reported in either groups. A Meckel's diverticulum found incidentally at laparotomy should be always resected as the risk of complication is high and that of resection low.     

Perforated diverticulum of the cecum: a difficult preoperative diagnosis

A patient was admitted for a suspected appendicitis; occasionally, a roentgenogram of abdomen, an echography and a tomography: confirmed the suspect. At laparotomy a perforated diverticulum of cecum is suddenly reported: a segmentary resection of ascending colon is performed. Authors remark, according to literature, that preoperative diagnosis of perforated cecal diverticulum is difficult even today, in spite of diagnostic procedures.     

Intestinal obstruction due to Meckel's diverticulum. Description of three cases

Among 588 small bowel mechanical obstructions operated since January 1982 until December 1996 at the Flajani Surgery Department and Emergency Department of the San Camillo Hospital in Rome, 3 male patients were operated for intestinal obstruction due to Meckel's diverticulum. In one case, obstruction was caused by a small bowel volvulus rolling on a Meckel's diverticulum, whose gangrenous extremity was "blocked" on caecum. In the other two cases, intestinal loops were incarcerated into an internal hernial ring constituted by the same diverticulum whose inflamed extremity was fixed to corresponding mesentery. We examined embryologic and clinical aspects of the pathology here considered, particularly its complications, obstruction being the most common in adult age. Diagnosis is often misunderstood, since a complicated Meckel's diverticulum simulates many other abdominal pathologies. A straight radiography and an ultrasonography of the abdomen may be useful to reach the correct diagnosis. We performed diverticulectomy, using a linear stapler and we underline the opportunity of this method. In young age laparoscopy resection is considered the gold treatment of this pathology by some authors. We didn't observe any mortality, although one of our patients was in a severe septic condition. It is necessary to examine the last ileal 100 centimetres when a suspected acute appendicitis is not initially found by operation. The opportunity of a promptly performed operation is underlined to prevent that such a benign pathology may induce also exitus.     

Meckel's diverticulum. Internal hernia and adhesions without gastrointestinal bleeding--ultrasound and scintigraphic findings

The results from an ultrasound study performed on an 11-year-old boy, who had several weeks of intermittent abdominal pain, showed a nonperistaltic loop of bowel near the umbilicus, which suggested either an internal hernia or a diverticulum. Tc-99m pertechnetate imaging showed a focal collection near the umbilicus, which was consistent with a Meckel's diverticulum. No evidence was found of gastrointestinal bleeding. Exploratory laparotomy showed a Meckel's diverticulum near the terminal ileum and attached to the anterior abdominal wall close to the umbilicus. Small bowel had herniated through the loop formed by the terminal ileum and the diverticulum.     

Pathology of Meckel's diverticulum. Apropos of a case. Notes on surgical anatomy and surgical technic

Remembering an observed case of intestinal invagination from Meckel's diverticle the A. describe the most important anatomical and anatomo-surgical characteristics of the diverticle of Meckel, laying particular stress on the variation in form; position and size with reference to the part they have in surgical operations. The operation tecnique of transportation of the diverticle in its various pathologic cases is also a point treated in this work; the principle methods of ablation are brought up to date with synthetic iconography.