We present a case of Meckel diverticulitis in a boy of 7 years old, diagnosed by ultrasound and documented by surgery. We review the literature about the. Diagnóstico endoscópico de una invaginación por divertículo de Meckel. Article in Gastroenterology 34(9) · November with 3 Reads. El divertículo de Meckel se ha de considerar en el diagnóstico diferencial del dolor abdominal y la hemorragia digestiva baja, especialmente en la infancia.
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Giant Meckel’s diverticulum torsioned. We present the case of a year-old male with medical history of umbilical hernial surgery, who was admitted to the emergency department with a one-day history of intense epigastric pain. Preliminary exploration showed abdominal distension painfull in upper quadrants, which was severe and associated to tenderness in epigastric region.
An abdominal computed tomography CT was requested, which showed a not-enhanced intestinal loop with thickened walls in supramesocolic region. The adjacent mesentery vessels were twisted Fig. With the suspicion of intestinal ischemia secondary to internal hernia, the patient was transferred to the operating room. Surgical exploration revealed an axially torsioned gangrenous Meckel’s diverticulum MD.
This saccualar structure had cm length Fig. The MD was resected including the 5 cm surrounding intestinal loop, also ischemic, and an end-to end manual anastomosis was performed.
The exploration of the abdominal cavity revealed no other relevant findings.
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The pathologic report described transmural ischemia meckkel hemorrhage of the intestinal mucosa, which was unable to determine the presence of ectopic tissue. It results from incomplete involution of the most proximal portion of the omphalomesenteric duct during the week of fetal development 3.
MD is found on the anti-mesenteric border of the ileum, located within 90 cm of the ileocecal valve. The size is variable, but is defined as a giant when it exceeds 5 cm in length 5.
Intestinal Obstruction by Giant Meckel’s Diverticulum.
Due to diverticulum’s symptoms arise usually in complication’s development, carriers usually remained asymptomatic throughout their lives. Diverticulitis, diverticular perforation or enteroliths in diverticular lumen 7. Axial torsion of a MD is a rare complication.
Preoperative diagnosis is difficult because the clinical presentation may be indistinguishable from other causes of abdominal pain, like appendicitis or pancreatitis. In our patient, length of the diverticulum produced the pain’s jeckel location in the epigastrium.
Divertículo de Meckel perforado
The optimal surgical approach is on ds. Some authors preferred the resection of intestinal loop containing the MD, although other performed a simple diverticulectomy. This last has less complication rates in relation to wound infection, mechanical ileus or stenosis 8. In this case, we carry out a small bowel resection including the diverticulum, because the intestinal bowel near the MD was also ischemic. MD torsion can produce severe vascular obstruction and secondary diverticular gangrene 9and despite being a rare entity, this should be considered in the differential diagnosis of patients with clinical symptoms of acute abdomen.
Although this complication has been reported, to the best of dw knowledge this extreme size of MD has not been described previously, and that caused the atypical presentation. Early diagnosis and surgical treatment lead to the successful outcome.
Rev Esp Enferm Dig ; J Am Coll Surg ; Seth A, Seth J.
Axial torsion as a rare and unusual complication of a Meckel’s diverticulum: A case report and review of the literature. Journal of Medical Case Reports ;5: Diverticulo de Meckel torsionado con isquemia de asa intestinal.
Tan Y, Zheng Z. Recurrent torsion of a giant Meckel’s diverticulum. Dig Dis Sci ; Gangrene of Meckel’s diverticulum secondary to axial torsion: Am J Gastroenterol ; Axial torsion and gangrene of a giant Meckel’s diverticulum.
Diferticulo Gastrointest Liver Dis ; Dear Editor, We present the case of a year-old male with medical history of umbilical hernial surgery, who was admitted to the emergency department with a one-day history of intense epigastric pain.