Carcinoid tumor in Meckel's diverticulum

Carcinoid tumor arising in a Meckel's diverticulum is a rare lesion with only 52 cases described in the literature. Most of these tumors are found incidentally at autopsy or during an operation performed for an unrelated reason. The lesion can, however, in about one-third of cases, be the cause of symptoms necessitating surgical intervention; the diagnosis is nearly never apparent till the specimen has been removed. When the signs do not match the symptoms, consideration of uncommon conditions such as this may help in making a correct preoperative diagnosis. Resection of the intestinal segment containing the diverticulum along with its mesentery to the level of the superior mesenteric vessels usually results in cure; however, metastatic disease and even carcinoid syndrome may still occur. Second primary malignancies are often found in patients with carcinoid of Meckel's diverticulum.     

Meckel's diverticulitis secondary to carcinoid tumor: an unusual presentation of the acute abdomen in an adult

This case reports the concomitant findings of carcinoid tumor within a Meckel's diverticulum presenting as an acute abdomen in an adult male. Most Meckel's diverticula remain asymptomatic throughout life, and symptomatic diverticula are virtually nonexistent in older adults. Meckel's diverticulitis is clinically indistinguishable from acute appendicitis, and abnormal or symptomatic diverticula are generally resected. Surgical treatment of Meckel's diverticula is recommended for children during exploration. However, resection is controversial in asymptomatic adults. Carcinoid tumors are the most common primary tumor of the small bowel. The duration of symptoms before diagnosis varies from 2 to 20 years, and half of all patients have incurable abdominal disease at first-look surgery. Metastatic events occur most commonly in the liver with a generally poor prognosis. Surgical resection is the treatment of choice. Both Meckel's diverticula and carcinoid tumor are rare clinical entities, and carcinoid tumors occurring within a Meckel's diverticulum are even more uncommon. Thus, the natural history is difficult to predict and treatment recommendations vary. Solitary, localized, asymptomatic nodules less than 1 cm are generally managed with diverticulectomy or segmental resection. Larger or multiple lesions require wide excision of bowel and mesentery, and hepatic resection may be required for metastatic disease.     

Carcinoid tumor in Meckel's diverticulum: laparoscopic treatment and review of the literature

Meckel's diverticulum is a common anomaly of the small intestine that occurs in approximately 2% of the population, often found incidentally at the time of abdominal exploration. Carcinoid tumors in a Meckel's diverticulum have been reported in only 111 cases. The author describes a patient who presented for elective cholecystectomy and who during laparoscopy was found to have an abnormal-appearing ileal diverticulum. The resected specimen contained a carcinoid tumor. The decision-making process in treating these patients is reviewed along with a discussion of the laparoscopic treatment of intra-abdominal pathologic conditions found incidentally at the time of elective surgery.     

Carcinoid of Meckel's diverticulum: presentation of a clinical case

Clinical findings and surgical treatment of a 68 years old man with carcinoid tumor of Meckel's diverticulum are reported. Carcinoids in Meckel's diverticula are rare tumors, commonly discovered incidentally during surgical procedures for different indications. Symptoms are frequently expression of a metastatic disease. Specific diagnostic and therapeutic tools are discussed.     

Perforated meckel’s diverticulum presenting as a gastrointestinal stromal tumor: A case report

Tumors and perforation of Meckel's diverticulum are rare manifestations. A gastrointestinal stromal tumor in a Meckel's diverticulum causing perforation and subsequent peritonitis in a 75-year-old man is presented. The literature on tumors in Meckel's diverticulum is extensively reviewed and discussed.     

Gastric adenocarcinoma of Meckel's diverticulum as a cause of colonic obstruction

A 45-year-old-female patient with no prior surgical history presented with bowel obstruction. At laparotomy, a bulky tumor arising from the ileum, which completely obstructed the sigmoid colon, was found. A left hemicolectomy followed by a transverse colostomy and a Hartman's pouch were performed. Pathological examination of the specimen revealed gastric adenocarcinoma arising from a Meckel's diverticulum in the ileum. Malignant transformation from a Meckel's diverticulum is an uncommon occurrence. This case illustrates that successful management of a symptomatic Meckel's diverticulum, even with malignant transformation, can be achieved by surgical resection.     

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."     

Meckel's diverticulum. Pro and co routine removal

The following points are made against the background of experience recorded by the author from 115 cases of Meckel's diverticulum: Active intra-operative search for Meckel's diverticulum continues to be justified in the course of all operations in which such search appears to be practicable without traumatisation of the intestine due to the given surgical access route and which would not imply the risk of germ transmission. It is, of course, necessary to remove any macroscopically changed Meckel's diverticulum. Removal of the macroscopically inconspicuous Meckel's diverticulum is recommended, as well, since grave microscopic pathology may be concealed under the surface and because possible damage would be clearly outweighed by the benefit achieved from removal of an even macroscopically inconspicuous Meckel's diverticulum. Any Meckel's diverticulum accidentally discovered in a patient in somewhat advanced age should be removed, since the author's own experience against reports by other authors is likely to suggest that the rate of diverticular complications is relatively high in advanced age groups. It is absolutely imperative to look for Meckel's diverticulum in all cases in which intra-operative findings are in disagreement with clinical examinations prior to surgery, particularly in cases in which signs of acute appendicitis were pre-operatively recorded, whereas bland appendix was found on surgery.     

A case of leiomyosarcoma of Meckel's diverticulum

The authors report a case of mesenchymal tumor (leiomyosarcoma) arising in a Meckel's diverticulum, with an history of digestive bleeding. Different kinds of Meckel's diverticulum tumors, their symptomatology and diagnostic difficulties are then discussed.     

Carcinoid tumor in Meckel's diverticulum

The accidental finding of a carcinoid tumour in Meckel's diverticulum, a very uncommon event, triggered a physiopathological and clinical analysis of this very interesting but very rare association. The value of systematic identification and removal of the diverticulum during laparotomy is underlined.     

Stromal tumor of Meckel's diverticulum--a rare source of gastrointestinal bleeding and a real diagnostic problem

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, complications in adults are rare, especially in the elderly. Lower gastrointestinal bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is unusual among the elderly. The case we report involved a 69 year old man with gastrointestinal hemorrhage found to be due a stromal tumor developed on Meckel's diverticulum. We considered our case interesting because of its rarity and of preoperative diagnosis difficulty.     

手术治疗Meckel’s憩室20例

目的　提高对Meckel’s憩室的诊治水平。方法　回顾性总结经手术及病理证实的Meckel’s憩室 2 0例 ,14例因并发症手术 ,6例在其他手术中发现。结果　 15例行单纯楔形切除 ,5例行肠切除吻合术。术后无并发症发生。结论　Meckel’s憩室属先天性畸形 ,术前不易诊断。其并发症发生率约为 4% ,依次为 :憩室炎 (常合并出血 ) ,肠套叠 ,嵌顿疝 ,肿瘤等 ,手术治疗效果好。     

Meckel's diverticulum in a strangulated femoral hernia. Case report and review of literature

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. In the vast majority of cases it remains asymptomatic throughout life but in about 5% of cases it gives rise to complications, namely, haemorrhage, intestinal obstruction and inflammation. A rare complication is being presented--a femoral hernia containing a strangulated Meckel's diverticulum. This is known as Littre's hernia, which often exhibits subtle variations from the norm in its presentation. Preoperative diagnosis of Littre's hernia containing Meckel's diverticulum is rather difficult; almost always, the strangulated diverticulum is first discovered during operation. The diverticulum was resected and the femoral canal closed by a polypropylene mesh plug. The patient underwent an uneventful recovery and was discharged home on the fourth postoperative day. Complications arising from Meckel's diverticulum usually occur at a young age, with the ectopic tissue present in the diverticulum frequently being the cause of the symptoms. Criteria for the resection of Meckel's diverticulum found incidentally at laparotomy have been suggested.     

Would a Massive Intra-abdominal Malignant Peripheral Nerve Sheath Tumor with Growth into the Inguinal Canal and Scrotum Preclude Surgical Option? A Case Report and Review of Literature

Malignant peripheral nerve sheath tumors (MPNST) are rare spindle-cell sarcomas derived from Schwann cells or pluripotent cells of the neural crest accounting for less than 10 % of all soft tissue sarcomas. They arise from major or minor peripheral nerve fibers or their sheaths. The World Health Organization coined the term MPNST for tumors of neurogenic origin with similar biological behavior replacing all the previous heterogeneous and, often, confusing nomenclature including malignant schwannoma, malignant neurilemmoma, and neurofibrosarcoma. The retroperitoneum and the lower extremities are the most common sites, but MPNST may arise anywhere in the body. Its location in the retroperitoneum in a patient without neurofibromatosis is an exceedingly rare occurrence. Imaging is routinely performed to assess the extent of the disease and to plan surgical resection. Surgical resection is the first line of therapy, ideally with total removal of the tumor. Owing to a high risk of recurrence with incomplete resection, postoperative irradiation and chemotherapy are necessary; however, they are often used as adjuvant therapy even if the tumor is completely resected.     

Carcinoid associated with pancreatic heterotopia in Meckel's diverticulum. The clinical, morphological and ultrastructural aspects of a case

A case of carcinoid tumor associated with pancreatic heterotopy in Meckel's diverticulum, in a 35 years old man is presented. The lesion was not grossly evident. The diagnosis was suspected on histological examination, and confirmed by electron microscopy.     

Carcinoid tumors of the gut: Diagnosis and treatment

Carcinoids are relatively uncommon tumors, which may occur anywhere along the gastrointestinal tract. The appendiceal carcinoid is in autopsy series the most prevalent, but frequently overlooked clinically unless routinely searched for at appendectomy. In the stomach and the rectum the carcinoids often present as simple benign polypous lesions, fortuitously discovered during endoscopy, while the rare colon carcinoid is generally a large, bulky tumor at time of diagnosis. The mid-gut carcinoid is most frequently located in the terminal ileum and tends to prevail in clinical series due to its common association with the carcinoid syndrome. Ventricular, rectal and appendiceal carcinoids are generally benign and the extent of surgery may safely be based on the size of the tumor. Local excision or simple appendectomy is thus generally sufficient and only the larger, invasive or clearly malignant lesions require more extensive surgery. The mid-gut carcinoids on the other hand are frequently malignant, irrespective of tumor size, and surgery should carefully aim to remove mesenteric metastases together with the primary tumor. Also in cases with disseminated mid-gut carcinoids tumor debulking of the larger mesenteric and liver metastases may cause considerable alleviation of symptoms and probably facilitates medical treatment of the carcinoid syndrome. Surgery may also relieve abdominal symptoms due to intestinal entrapment or impaired intestinal circulation, which is frequently encountered in association with the more advanced mid-gut carcinoid.     

术前化疗对胰腺癌细胞凋亡和组织结构的影响

探讨术前选择性动脉化疗对胰腺癌细胞生长的影响，为临床制定合理的胰腺癌化疗方案提供理论依据。方法运用ＤＮＡ末端标记法对３０例胰腺癌患者术前化疗和未化疗和术后病理切片进行肿瘤细胞凋亡的检测，同时对比观察它们ＨＥ染色的组织结构变化 。     

Intestinal obstruction due to meckel's diverticulum: a rare presentation

Meckel's diverticulum occurs in about 1-3% of general population. The majority of them are asymptomatic and incidentally found at laparotomy. The most common complication due to Meckel's diverticulum in adults is intestinal obstruction. The frequency of symptoms decreases with age. Enteroliths are rarely formed in a Meckel's diverticulum and are known to cause intestinal obstruction. These should be considered in the differential diagnosis of radioopaque shadows in the plain abdominal films. We describe a rare presentation of Meckel's diverticulum in an elderly woman.     

Meckel's diverticulum incarcerated in an umbilical hernia--case report

Hernias containing incarcerated Meckel's diverticulum are rare and often asymptomatic. The proper preoperative diagnosis is difficult to establish. The presence of a Meckel's diverticulum incarcerated in a hernia should be consider in a differential diagnosis of abdominal disease that is not sufficiently apparent. We present a case of a 22 years old male patient with a Meckel's diverticulum incarcerated in an umbilical hernia.     

Leiomyosarcoma of the Meckel's diverticulum and multiple diverticulosis of the ileum. Apropos of a case

We report a case of a leiomyosarcoma arising in a Meckel's diverticulum in a man of 90 years, with multiple ileal diverticulosis. The clinical picture was similar to acute appendicitis and diagnosis was not made until resection of an abdominal mass with histological appearance of leiomyosarcoma. 59 cases of leiomyosarcoma of Meckel's diverticulum have previously been reported in the literature. No case until now has been reported in a patient of Caribbean origin neither in association with ileal diverticulosis. Although rare, leiomyosarcoma is the commonest sarcoma of Meckel's diverticulum, and with full resection of the tumor the prognosis is very good.