Bleeding Meckel's diverticulum diagnosed with 99mTc-pertechnetate

The diagnosis of bleeding Meckel's diverticulum in an 11 year old boy, an 8 year old girl and a 2 1/2 year old boy, was established preoperatively using 99mTc-pertechnetate. These abdominal scannings were of value in the management of patients with rectal bleeding after ruling out other disorders by hematologic tests, usual radiologic studies and endoscopic examinations. To reduce ambiguities, the scanning was performed with the child in a fasting state and a nasogastric tube was led into the stomach to minimize volume and flow of radioactive gastric juice into the intestinal tract. Based on our experiences and review of reported cases, applicability of the scanning in the management of patients with Meckel's diverticulum is discussed.     

Meckel's diverticulum

Fifty cases of Meckel's diverticulum are presented and analyzed. The literature is consulted for comparison of this series with the series of other authors. The embryologic background is briefly given. The authors' experience in dealing with these patients is summarized and suggestions are made for improvement in diagnosis and treatment.     

Meckel's diverticulum.

One hundred and ninety surgically documented cases of Meckel's diverticulum encountered at the Mayo Clinic during a 51-year period, 1920 through 1971, are reviewed. In 39 patients, the diverticulum was left undisturbed. In 51 patients, the diverticulum was the primary surgical disease, and, in 100 patients, the diverticulum was removed incidentally. The clinical features are presented as well as the surgical considerations. Meckel's diverticulum is a relatively frequent development anomaly with eccentric manifestations, and its surgical management has intrigued physicians for over 350 years. Dr. Charles W. Mayo stated, "Meckel's diverticulum is frequently suspected, often looked for, and seldom found."     

Giant Meckel's diverticulum.

A case of incomplete intestinal obstruction caused by a giant Meckel's diverticulum in a 13-year-old girl is reported. Short resection of the ileum with the diverticulum and end-to-end anastomosis was carried out. The possibilities of diagnosis and treatment as well as the controversial classification of this rare congenital anomaly are discussed.     

Tumors of Meckel's diverticulum

The presentation of a rare case of leiomyoma of Meckel's diverticulum in a boy of 5 yr forms the starting point for a discussion of such cancers. In adult age, the complication is not so rare as the sporadic publications would suggest, incidence of tumoral forms being around 1 : 50 M.D. with a high malignancy frequency. In paediatric age, on the other hand, the tumoral degeneration of a M.D. is an exceptional occurrence: a review of more than 1,200 reported cases and personal experience (48 cases of M.D. in 15 yrs) confirm the rarity of the observation. The need to seek M.D. on each occasion and remove it to prevent the risk of tumoral degeneration in adult age is stressed. M.D. surgical removal tecniques are commented on and emphasis laid on the desirability of ample intestinal resection in cases of cancer of the diverticulum.     

Adenocarcinoma of Meckel's diverticulum

A case of adenocarcinoma of Meckel's diverticulum is reported. Small bowel neoplasias are the least frequent in the gastrointestinal tract and localization to the diverticulum is extremely rare. Among histological types, adenocarcinoma accounts for the minority of cases. Early diagnosis is difficult because of lack of specificity of signs and symptoms, except in advanced stages. Small bowel resection with lymphadenectomy is the recommended therapeutic approach. Although, in reported case it could not be performed, because of the diffuse intraabdominal metastasis at diagnosis. This and similar cases would open the discussion about a possible indication for prophylactic resection of Meckel's diverticulum. No definitive conclusion can be drawn at present since no follow-up study is available on the natural history of diverticula which have been observed during abdominal surgery and have not been resected.