Intraluminal duodenal diverticulum: a rare cause of abdominal pain in childhood

The intraluminal duodenal diverticulum (IDD) is an uncommon pathological condition that causes a mild clinical picture, arising in most cases in the pediatric age group. Often found incidentally, it is discovered in most patients on contrast X-ray examination, but in uncertain cases duodenoscopy or i.v. cholangiography can be performed. Surgical excision of the diverticulum by duodenotomy makes possible the remission of symptoms and allows complete recovery. A 10-year-old girl with IDD is reported who had recurrent epigastric, meal-related pain that led to appendectomy 1 year prior to admission. The diagnosis was made on X-ray examination and the patient underwent a laparotomy with complete excision of the diverticulum. The girl, at present, is the youngest patient with a true IDD ever reported in the literature.     

Intraluminal duodenal diverticulum in a child: incidental onset possibly associated with the ingestion of a foreign body

Funnel-type intraluminal duodenal diverticulum (windsock web) is a rare congenital malformation. A 4-year-old boy with vomiting and abdominal pain for several weeks was referred to the hospital. A plain abdominal X-ray on admission disclosed a double bubble sign. Abdominal echography and CT disclosed a foreign body lodged in the alimentary tract. After the foreign body was removed with a fibrescope, endoscopy showed a stenotic descending portion where the foreign body was located. An upper gastro-intestinal contrast study demonstrated a post-bulbar duodenal stenosis with a barium-filled pear-shaped sac in the descending portion of the duodenum. Surgical exploration was done under the diagnosis of windsock web of the duodenum. A simple excision of the web at its base was carried out. A hole 7 mm in diameter was found at the edge of the web. The microscopic appearance of the resected specimen was characterized by the duodenal mucosa with an extensive chronic inflammation lining both sides of the diverticulum and the lack of muscular layer of mucosa. Conclusion If an ingested material is not excreted in the stool, possible clogging in the intestinal tract should always be considered and a further intensive examination is warranted. Received: 2 September 1997 / Accepted in revised form: 1 July 1998     

Incomplete membrane stenoses of the duodenum (author's transl)

A report in 2 children with incomplete membrane stenoses of the duodenum and further abnormalities in the gastrointestinal tract, the urogenital region and on the skeleton. In the first case ileus symptoms existed in early infancy following operated anal atresia. A duodenal diverticulum near the papilla was found with reflux of contrast medium in the biliary and pancreatic tracts. In the second case the clinical symptoms were limited; however, the x-ray findings of an intraduodenal pseudodiverticulum were impressive. Both patients were operated successfully by removal of the incomplete duodenal membrane. Both cases clearly showed the great variability in clinical symptoms with etiologically similar disease patterns and typical x-ray signs.     

Intraluminal diverticulum of the duodenum

A case of intraluminal duodenal diverticulum associated with partial situs inversus in a 15 year-old girl is reported. Etiopathogenicity is discussed. The pathological characteristics explain that surgery associated with upper digestive endoscopy had to be performed and why endoscopic excision was not possible in this case.     

小儿非手术所致肠梗阻的病因学分析及诊断

目的 探讨小儿非手术所致肠梗阻的病因及诊断。方法 回顾性分析2001年8月～2004年12月收治的非手术所致肠梗阻患儿25例，所有病例均摄腹部立位正位片，行腹部超声检查，6例行上消化道造影，7例钡灌肠造影，均接受手术治疗。结果 23例获得治愈，1例死亡，1例放弃治疗。11例新生儿病例经手术证实4例为小肠闭锁，3例肠旋转不良，3例十二指肠膜状狭窄，1例胎粪性腹膜炎。8月-14岁的患儿经手术证实4例为肠重复畸形，5例美克尔憩室，2例美克尔憩室合并肠套叠，1例原发性肠套叠，2例腹茧症。结论新生儿期非手术所致肠梗阻以十二指肠隔膜狭窄或闭锁、肠闭锁或狭窄、肠旋转不良多见。婴幼儿和儿童非手术所致肠梗阻主要为美克尔憩室和肠重复畸形，原发性肠套叠早期得不到诊治也可引起肠梗阻。X线检查是诊断肠梗阻的主要手段，超声检查也具有一定的价值。     

Towards the elimination of iodine deficiency disorders in India

Iodine deficiency disorders (IDD) are an important public health problem in India with an estimated 270 million people at risk of IDD. India has adopted the strategy of salt iodisation for control of IDD and has the goal of “Universal iodisation of salt by 1995 and elimination of IDD by 2000”. There is a high degree of political commitment which need to continue if the goal is to be achieved. Currently the ban on ale of uniodised salt is only applicable to salt on human consumption. There is a need for extending the ban to include salt for animal consumption as IDD affects livestock as well. India has the installed capacity to produce its requirement of 5 million tonnes iodised salt. Communication strategies have to be strengthened especially to educate people who have concerns about of iodine toxicity. The success to a large extent depends on the quality control and monitoring of iodine content of salt at all stages from production to consumption. NGO’s and the community have to be encouraged to participate in this process. To sustain the elimination of IDD, a partnership of various stakeholders IDD elimination is essential.     

Consequences of iodine deficiency and preventive measures

Iodine Deficiency Disorders (IDD) can be prevented by an adequate intake of iodine in the population. Monitoring and evaluation are the most important phases of an IDD control program. The consequences of iodine deficiency are goiter and subclinical/clinical hypothyroidism in pregnancy. The deficiency is an important risk factor for brain damage and motor-mental development in the fetus, the neonate and in the child. In order to assess IDD, control programs should be developed, followed up and evaluated. The recommended methods of assessing status are; assessment of the goiter rate, measurement of urinary iodine concentration, determination of thyroid hormone levels and of thyroglobulin. Although adequate technology exists, elimination programs for IDD have not been successful until recent years. The most important issue at present is the long-term sustainability of salt iodization programmes. Alternative strategies are also needed for iodization in areas where iodized salt will not be available in the foreseeable future.     

Endoscopic diverticulotomy for symptomatic pediatric esophageal diverticula

There have so far been few reports on esophageal diverticulum in children. We experienced two symptomatic pediatric cases with esophageal diverticulum. Our cases manifested high fever and dysphagia with chest pain during swallowing. The patients underwent endoscopic diverticulotomy. The septum between the diverticulum and the esophagus was cut using the argon plasma coagulation (APC 3000) system. We recommend an endoscopic diverticulotomy as an effective treatment modality for such symptomatic cases.     

An unusual complication of umbilical catheterisation

We report the first case of perforated Meckel’s diverticulum in a 1-day-old pre-term infant as a consequence of umbilical vein catheterisation. The clinical course consisted of abdominal distension and pneumoperitoneum that occurred after 12 h of life. Perforated Meckel’s diverticulum was found at laparotomy. Neither inflammatory phenomena nor ectopic mucosa were found at microscopical examination. Perforation of the diverticulum was a complication of umbilical catheter insertion through a narrow lumen in the umbilical cord mistaken for an umbilical vein and connected to Meckel’s diverticulum through a very short fibrous band. A search of the literature did not reveal any similar cases.     

Scrotal pop off in a congenital anterior urethral diverticulum

Introduction and objectiveCongenital anterior urethral diverticulum is a rare entity. This teaching video shows the scrotal pop-off mechanism for an anterior urethral diverticulum and the unique voiding pattern of a boy who empties his bladder by compression of his scrotum. The findings during urethroscopy and open reconstruction are also demonstrated.Patient and methodsA four-year-old boy presented to the clinic with a poor urinary stream and scrotal swelling during voiding. Physical examination during voiding revealed a dumbbell-shaped anterior urethral diverticulum with scrotal pop off and preserved renal function.ResultsOpen excision of the scrotal part of diverticulum was performed. Urethroplasty was conducted using a de-epithelialised diverticular wall flap from the penobulbar urethra. On follow up the boy voided with a good flow and resolution of symptoms.ConclusionScrotal pop off with completion of voiding by manual compression of the diverticulum may preserve bladder and renal function. The preferred treatment of anterior urethral diverticulum is open excision of the diverticulum and reconstruction. The wall of the diverticulum may be used to reinforce the repair ventrally, where the corpus spongiosum is deficient.     

Adenomyoma Arising in a Meckel Diverticulum: Case Report and Review of the Literature

We report a case of adenomyoma of the small intestine arising in a Meckel diverticulum. The patient was a 22-month-old boy who presented with signs and symptoms of intussusception. At surgery, a Meckel diverticulum was found and removed. On histologic examination, a tumor consisting of dilated cystic glands and smooth muscle bundles was identified. A diagnosis of adenomyoma arising in a Meckel diverticulum was made. A review of the literature showed that only six other pediatric cases of adenomyoma of the small intestine have been reported. The presence of an adenomyoma in a young patient within a Meckel diverticulum favors the view that adenomyomas are a variant of pancreatic heterotopia. Received April 29, 1999; accepted August 17, 1999.     

Crohn’s disease in a Meckel’s diverticulum: report of a case

Meckel’s diverticulum has previously been reported to be present in patients with Crohn’s disease. However, the finding is typically an incidental one, and involvement of the diverticulum in the disease process is uncommon. We report a case of an adolescent with known Crohn’s disease who presented with symptoms thought to be due to terminal ileitis. At the time of laparoscopy the inflammation was found to be due to involvement of the Meckel’s diverticulum with Crohn’s disease.     

Current status of iodine deficiency disorders (IDD) and strategy for its control in India

Iodine Deficiency Disorders (IDD) reflects the broad manifestations of iodine deficiency including the implications on reproductive functions and lowering of IQ levels in school aged children. Today, IDD is a public health problem in 130 countries and affects 13% of world’s population. In India, no state is free from iodine deficiency and 200 million people are ‘at risk’ of IDD. Daily consumption of salt fortified with iodine is a proven effective strategy and is the measure stressed by the Government of India. The paper describes the major five phases of the IDD Control Programme in India. The paper describes the major five phases of the IDD Control Programme in India since 1962 and synthesizes the spectrum of activities that significantly attributed to the Universal salt lodisation (USI) efforts launched in 1992. The sustainability of the USI programme is critical since IDD prevalence will rise if programme of salt iodisation weakens. A two pronged strategy needs to be institutionalized for ensuring continued demand for iodised salt, linked to ongoing health, nutrition and education programmes as well as for ensuring supply of quality iodised salt     

The effect of pertussis vaccine on the insulin-dependent diabetes induced by streptozotocin in mice

Protective effect of pertussis vaccine (PV) against the development of insulin-dependent diabetes (IDD) induced by streptozotocin (STZ) in young CD-1 male mice were studied. When PV at a dose of 1.2 X 10(10) microorganism was administered on -10, 0, or +4 d relative to a single injection of STZ (60 mg/kg body wt) on d 0, it completely aborted the development of IDD after 140 d. When PV was given on +30 d after STZ injection and followed by PV booster injections, 66% of mice reverted to normoglycemic state. Intact islet cells in the pancreas were confirmed by histologic findings and normal plasma insulin values. The effect of PV was compared with that of boiled PV in another model of IDD induced by multiple injections of STZ (40 mg/kg for five doses). In this model, 60% of mice either remained or reverted to normoglycemic state with PV and booster injections whereas boiled PV protected 40% of mice from developing IDD. The protective effect appeared to reside in the biologic property of both pertussigen and endotoxin of Bordetella pertussis.     

Intrauterine fistulation of perforated Meckel's diverticulum to the surface of the sac of an intact exomphalos minor

The presence of Meckel's diverticulum in the exomphalos sac is a well known entity but the intrauterine perforation of the diverticulum is very rare. We report a case of intrauterine fistulation of Meckel's diverticulum to the surface of the intact sac of an exomphalos minor.     

Urethral diverticulum in a female child

A urethral diverticulum in a female arises from the wall of the urethra and consists mainly of fibrous tissue lined with epithelium. It is uncommon, and usually presents between decades 3 and 5. Most patients present with non-specific, refractory, lower urinary tract symptoms, unrelated to the diverticulum size or number. The diverticulum may also present as a mass at the introitus. We report a case of urethral diverticulum in a female child that presented as an introital mass.     

Biochemical assessment of iodine deficiency disorders in Baroda and Dang districts of Gujarat State

OBJECTIVE: (i) To assess the severity of Iodine Deficiency Disorders (DD) in Baroda and Dang Districts of Gujarat, using biochemical prevalence indicators of IDD; and (ii) To establish a biochemical baseline, in a sub-sample of the large population of Gujarat, that could be used to monitor the effectiveness of iodine replacement program. METHODS: 1,363 children (<1-15 years) were studied and data was collected on dietary habits, anthropometric and biochemical parameters such as height, weight and urinary iodine (UI) and blood TSH respectively. BSA and BMI were calculated. Drinking water and salt were analyzed for iodine content. RESULTS: Median true urinary iodine was 65 microg/I (interquartile-range 38-108). Mean TSH was 2.08 mU/1 (SD +/- 2.06) and 6% of the studied population had whole blood TSH values > 5 mU/1. Females from both districts were affected more by iodine deficiency as evidenced by lower true urinary iodine and higher mean TSH levels. The interfering substances were significantly higher in Baroda boys and Dang girls as compared to their counterparts (< 0.001). Boys were more malnourished than girls as evidenced by lower BMI. Dang district was more severely affected by IDD as compared to Baroda. Drinking water in Dang district was lacking in iodine content. Iodine in salt varied at around 7 to 2000 PPM. CONCLUSIONS: IDD is a public health problem in Gujarat. Baroda district is a new pocket of IDD. Dang district is the worse affected. The expression of IDD in these two districts of Gujarat revealed interplay of multiple factors.     

Isolated congenital left ventricular diverticulum

Congenital diverticulum of the left ventricle, a rare malformation, is usually associated with midline thoracoabdominal defect. We describe a case with congenital left ventricular diverticulum presenting as an isolated lesion. The lesion was suspected on two-dimensional echocardiography and was confirmed by cardiac catheterization and magnetic resonance imaging.     

Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage

A Meckel diverticulum is an embryonic remnant of the omphalomesenteric duct that occurs in approximately 2% of the population. Most are asymptomatic; however, they are vulnerable to inflammation with subsequent consequences including diverticulitis and perforation. We report an 11-year-old boy who underwent laparoscopic appendectomy for perforated appendicitis at an outside institution. During his convalescence he underwent percutaneous drainage of a presumed postoperative abscess. A follow-up drain study demonstrated an enteric fistula. The drain was slowly removed from the abdomen over a period of 1 week. Three weeks following drain removal the patient reported recurrent nausea and abdominal pain. A CT scan demonstrated a 3.7-cm rim-enhancing air-fluid level with dependent contrast consistent with persistent enteric fistula and abscess. Exploratory laparoscopy was performed, at which time a Meckel diverticulum was identified and resected. This case highlights the diagnostic challenge and limitations of conventional radiology in complicated Meckel diverticulum.     

单孔法腹腔镜辅助下小儿美克尔憩室切除术探讨

目的探讨脐部单孔腹腔镜辅助下切除小儿美克尔憩室的可行性及临床意义,评价有临床症状的小儿美克尔憩室患儿的超声影像特点与诊断价值。方法回顾性分析2007年1月至2011年1月在本院经超声诊断的17例美克尔憩室患儿临床资料,其中经脐部单孔腹腔镜辅助下切除15例,开腹手术2例。结果17例术前均超声诊断为美克尔憩室;2例直接开腹手术,15例经行单孑L法腹腔镜辅助下将憩室自脐部提出,并手术切除。其中楔形切除4例,肠切除肠吻合13例。术后恢复快,创伤小,美容效果好。16例病理检查结果与超声诊断一致,诊断符合率为94．1％（16／17）;1例病理检查结果为肠重复畸形。结论超声可作为小儿美克尔憩室出现并发症后的首选诊断方法。对于术前诊断明确的美克尔憩室,经脐部单孔腹腔镜辅助切除小儿美克尔憩室简单可行,方法实用,效果好。