Inverted Meckel's diverticulum causing intussusception in an adult

Adult intussusception is rare, making-up only about 1% of the causes of bowel obstruction intussusception, secondary to an inverted Meckel's diverticulum, is also a rare occurrence. Chronic abdominal pain, lower gastrointestinal bleeding, and recurrent obstructive symptoms may lead to an unnecessary delay in diagnosis. This case report describes a rare cause of adult intestinal intussusception due to inverted Meckel's diverticulum. Intussusception was diagnosed on emergency ultrasound of the patient, who was successfully managed with surgery.     

Adult intussusception due to inverted Meckel's diverticulum: laparoscopic approach

Nowadays, laparoscopy appears to be an attractive alternative to conventional surgery in the management of small bowel obstruction. Adult intussusception is an unusual cause of intestinal obstruction, and a wide range of pathologic conditions can result with intussusception. In this report, we present a very rare case of intussusception secondary to inverted Meckel's diverticulum in an adult who underwent laparoscopic surgery. The diagnostic modalities and surgical management of intussusception are discussed.     

Traumatic hemoperitoneum due to a Meckel's mesodiverticular band: case report

The blood supply to a Meckel's diverticulum exists either within the small bowel mesentery, or within a separate mesodiverticular band. The latter is associated with bowel obstruction. It is a rare source of hemorrhage. The case report describes hemoperitoneum resulting from blunt trauma-induced disruption of a mesodiverticular band.     

Laparoscopy for treating a small bowel obstruction due to a Meckel's diverticulum.

A Meckel's diverticulum is one cause of small bowel obstruction in the virgin abdomen. A 17-year-old female presented with a 24-hour history of lower abdominal pain and emesis. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A diagnostic laparoscopy was performed revealing a bowel obstruction secondary to a Meckel's diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day 3, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic tool for a patient with a small bowel obstruction with an unclear etiology.     

A case of intussuscepted and incarcerated Meckel's diverticulum in to the cecum

BACKGROUND: Intussusception with the Meckel's diverticulum is rare cause of small bowel obstruction in the adults. The Meckel diverticulum is the most common cause of intestinal obstruction in children. METHODS (CASE REPORT): We present a case of 18-year-old boy with developing signs of small bowel obstruction The onset of disease was the day before the first examination. There was no hystory of prior surgery. According to the clinical symptoms, physical examinations as well as radiographic and ultrasound examination, surgical treatment was indicated. Surgical approach was inferior medial laparotomy. Intussusceptions of the Meckel's diverticulum and into the coecum with incarceration were found. Desincarceration and simple diverticulectomy was done. CONCLUSION: The Meckels's diverticulum should be consider as a possible cause of the small bowel obs-truction in previously healthy patient.     

Intestinal obstruction by an enterolith from a perforated giant Meckel's diverticulum: diagnosis with CT reconstructed images

Complications caused by Meckel's enteroliths are very rare. Diagnosis is not usually made before surgery because symptoms are often of little value and imaging may be difficult to interpret. Computed tomography (CT) scanning, which is increasingly performed in emergency situations, could help make the diagnosis. We describe a 37-year-old man with intestinal obstruction caused by an enterolith resulting from a giant Meckel's diverticulum. The diagnosis was suggested preoperatively through the use of abdominal CT scanning with reconstructed pictures. A resection of the small bowel and diverticulum was performed with immediate anastomosis. The postoperative course was uneventful. Diagnosis of enterolith from Meckel's diverticulum can be suggested by CT frontal reconstructed sections in patients with small bowel obstruction and abdominal calcified opacities. This procedure could reduce the delay between onset of symptoms and adequate treatment before perforation and peritonitis occur.     

Meckel's diverticulum in the adult

Meckel's diverticula were removed from 49 adult patients during a 15 year period. In 24 (49 per cent) of the patients the diverticulum was the cause of symptoms while in the remaining 25 it was an incidental finding at laparotomy. Of the symptomatic patients, 10 had acute inflammation of their diverticula, 8 presented with small bowel obstruction (in 4 cases due to fibrous bands) and 4 attended because of gross rectal bleeding; of the 2 remaining patients one was found to have intussusception of Meckel's diverticulum into the terminal ileum whilst the other had a nodule of calcified material lying within a partly gangrenous vitellointestinal duct. There was no operative mortality in the series. Heterotopic tissue was noted histologically in six Meckel's diverticula, all of which produced symptoms. The importance of considering a diagnosis of Meckel's diverticulum in the young adult presenting with acute small bowel obstruction or rectal bleeding is emphasized.     

Meckel's diverticulum causing cecal volvulus

Meckel's diverticulum is present in 2 per cent of the population with bowel obstruction as its most common complication. This case report describes an extremely rare complication of a Meckel's diverticulum, a cecal volvulus. The diagnosis of cecal volvulus was made preoperatively on abdominal X-rays; the diagnosis of a Meckel's diverticulum was made intraoperatively. The cecum was found to be twisted around a vitelline band on a broad-based Meckel's diverticulum extending to the umbilicus. The diverticulum was resected. The patient did well postoperatively and was discharged without any difficulty.     

Intussusception of the Meckel’s diverticulum within its own lumen: Unknown complication

IntroductionIntussusception with the Meckel’s diverticulum (MD) is a rare cause of chonic abdominal pain in the adults. We wish to present this first case of intussusception of MD within its own lumen without small bowel obstruction.Presentation of caseWe report the case of a 27-year-old man who was admitted to the emergency room due to a diffuse abdominal pain. Abdominal CT scan showed invagination of MD. The exploratory laparoscopy revealed the presence of intussusception of MD within its own lumen. Segmental resection of the small intestine was performed. The patient was discharged on the third post-operative day.DiscussionThe prevalence of MD is 1 to 4%. Diagnosis is often difficult and delayed because clinical symptoms are not specific and the diagnosis is performed mainly by imaging studies. Factors pre-disposing these patients to intussusception of MD within its own lumen include a narrow diverticulum, large diverticululm, and associated inflammation of the diverticulum. Intestinal obstruction is a more common complication in adults, whereas in children, bleeding is the more common complication. In our case, the patient had a diffuse abdominal pain without small bowel obstruction because the intussusception of MD was within its own lumen. Laparoscopy may be useful for confirming the presence of intussusception, and demonstrating the underlying organic lesion serving as the lead point.ConclusionIt is important to differentiate this rare pathological feature of MD from other entities as the treatment is surgical rather than medical. Abdominal surgeons should bear in mind this rare entity.     

Loop formation of Meckel's diverticulum causing small bowel obstruction in adults: report of two cases

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, and in the majority of cases it remains asymptomatic. The total lifetime rate of complications is 4%. It is an uncommon cause of intestinal obstruction in adults. Loop formation of Meckel's diverticulum leading to small bowel obstruction is an extremely rare event. We report two such cases in which the bowel became obstructed and strangulated in a loop formed by adhesion of the distal end of the Meckel's diverticulum to the proximal ileum and mesentery.     

Laparoscopic reduction of incarcerated Meckel's diverticulum following abdominal hysterectomy.

BACKGROUND: Laparoscopic techniques are increasingly being utilized to diagnose and successfully manage intestinal obstruction. CASE REPORT: We describe a patient who presented with intestinal obstruction following a recent abdominal hysterectomy. The obstruction was caused by entrapment of a segment of small bowel containing a Meckel's diverticulum within a pouch formed by the peritoneal layer following mass closure of the abdominal wound. DISCUSSION: We discuss the literature on the abdominal wound closure technique. The role of laparoscopy in dealing with intestinal obstruction is reviewed briefly. We have also summarized the management of an incidental Meckel's diverticulum found at laparoscopy.     

Acute abdomen secondary to a Meckel's lipoma

Small bowel intussusception, presenting acutely in adults is an extremely rare event. We present an exceptional case, previously unreported in the English language, of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario.     

Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum

We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common.     

Laparoscopic treatment of small bowel obstruction with intussusception,volvulus and appendicitis caused by an inflammatory Meckel's diverticulum

Indications and contraindications for diagnostic laparoscopy in cases of intestinal obstructions are discussed in connection with a 16-year-old patient's case report with small bowel obstruction including intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum. The use of diagnostic laparoscopy in cases of intestinal obstructions is controversial. In the described case we performed completely laparoscopically the derevolving and desusception of the volvulus and intussusception, the appendectomy and resection of the diverticulum. The procedure itself and the postoperative course were uneventful.     

Acute hemorrhage from Meckel's diverticulum--Laparotomy or laparoscopy?

Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract with a potential risk to develop complications such as obstruction, diverticulitis or intussusception. Lower gastrointestinal bleeding due to ulceration of heterotopic gastric tissue of the diverticulum is a known phenomenon in children and young adults. We present two cases of a 15-year-old girl and a 20-year-old man that revealed a massive lower gastrointestinal hemorrhage of unknown origin. In this emergency situation laparotomy was performed in combination with lower endoscopy as rendezvous manouver. In both cases a Meckel's diverticulum with peptic ulceration was the source of hemorrhage, in one case the bleeding was active and visible. After resection of a short small bowel segment and end-to-end anastomosis the postoperative course was uneventful. We prefer in the case of lower gastrointestinal hemorrhage with hemodynamic instability laparotomy with intraoperative endoscopy instead of laparoscopy.     

Zur Differenzialdiagnose der akuten Appendizitis und des Ileus

A 13-year-old female presented with recurrent, right-sided abdominal pain since the age of 2 years. Examination showed a tender, cylindric mass in the right lower quadrant. Ultrasound and MRI revealed an ileocolic intussusception. On laparotomy, there was an ileo-ileal intussusception due to a 3.8-cm polypoid tumor about 40 cm proximal to the ileocoecal valve. Histology showed polypoid heterotopic gastric mucosa with no Meckel's diverticulum. To our knowledge, only 12 cases of intussusception of heterotopic gastric mucosa in the ileum without Meckel's diverticulum have been reported in literature. This case adds to this small list and represents a possible cause of intussusception.     

Posttraumatic small bowel obstruction in children

Background

The diagnosis of intestinal injuries in children after blunt abdominal trauma can be difficult and delayed. Most children who suffer blunt abdominal trauma are managed nonoperatively, making the diagnosis of intestinal injuries more difficult. We sought to gain information about children who develop intestinal obstruction after blunt abdominal trauma by reviewing our experience.

Methods

Review of records from a pediatric tertiary care center over an 11.5-year period revealed 5 patients who developed small bowel obstruction after blunt trauma to the abdomen. The details of these patients were studied.

Results

All patients were previously managed nonoperatively for blunt abdominal trauma. Intestinal obstruction developed 2 weeks to 1 year (median, 21 days) after the trauma. Abdominal x-ray, computerized tomography scan, or barium meal studies were used to establish the diagnosis. The pathology was either a stricture, an old perforation, or adhesions causing the intestinal obstruction. Laparotomy with resection and anastomosis was curative.

Conclusions

Posttraumatic small bowel obstruction is a clinical entity that needs to be watched for in all patients managed nonoperatively for blunt abdominal trauma.     

Jejunal diverticular disease with unborn enterolith presenting as a small bowel obstruction: a case report

Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusception may warrant surgical intervention. An interesting case of an unborn enterolith (enclosed calculus) from a jejunal diverticulum presenting as a small bowel obstruction is presented. The patient is a 66-year- old woman with no prior history of abdominal surgery who presented with a high-grade bowel obstruction. CT with intravenous barium contrast confirmed the presence of a transition point from dilated to decompressed small bowel in the mid jejunum. At laparotomy, a freely mobile mass was found in this area leading to the bowel obstruction. The mass was removed by making a small enterotomy in the jejunum. While running the small bowel proximally, a small segment of jejunum, approximately 8 cm, containing several diverticuli was found. This bowel obstruction was the result of an unborn enterolith from this segment of bowel. The patient's hospitalization was benign and she was discharged home on postoperative day 4.     

Active search for Meckel's diverticulum]

Examination for Meckel's diverticulum is generally performed in each case of laparotomy where the incision allows observation of the small bowel without danger of spreading the infection. In 65 cases, pathologic alterations were found in 14 (= 21,5%). Postoperative bowel obstruction due to resection of Meckel's diverticulum has been found twice (3%), one patient died. It is suggested that Meckel's diverticulum be removed whenever possible.     

Intussusception in the older child- suspect lymphosarcoma.

Examination of the records of 378 children with intussusception at our institution revealed that 29 cases were caused by an identifiable intestinal lesion. A Meckel's diverticulum was the causative agent in 21 children, all of whom were under 2 yr of age. A previously undiagnosed ileal lymphosarcoma produced the intussusception in six other children, all between 6 1/2 and 9 yr of age. Our experience indicates that any child over 6 yr of age with the clinical findings of colicky abdominal pain, bloody stools, and a palpable mass plus the radiographic evidence of intussusception must be considered to have ileal lymphosarcoma until proven otherwise. Hydrostatic reduction of the intussusception must be accompanied by extensive small bowel reflux of barium in order to effectively rule out a small intestinal lesion. If this is not accomplished, surgery should be planned with the suspicion that a malignancy may be present. If this suspicion is confirmed by frozen section, the operation procedure should include wide surgical excision of the lesion along with the regional lymph nodes.