Jejunal diverticulum with ectopic pancreatic mucosa: Was it really a Meckel's diverticulum?

We report the case of a 72-year-old man who underwent surgery for a jejunal intussusception caused by an infarcted mass on the antimesenteric surface of the small bowel approximately 90 cm from the duodenojejunal flexure. The specimen was reported as an infarcted diverticulum containing heterotopic pancreatic mucosa in keeping with infarcted Meckel's diverticulum. We initially wished to establish when the term "Meckel's diverticulum" should be used. The anatomical site in the present case argues against this being a Meckel's diverticulum, a remnant from the mid-gut loop. Non-Meckelian diverticula are usually acquired and often multiple and generally occur on the mesenteric border of the bowel. It is rare for them to contain ectopic mucosa. The diverticulum in our patient thus has features which suggest it may have been congenital. We believe our patient had a rare occurrence of a congenital, but non-Meckelian, diverticulum with associated ectopic epithelium.     

Giant Meckel's diverticulum associated with a congenital diaphragmatic hernia

Giant Meckel's diverticulum is a very rare lesion and its association with a congenital diaphragmatic hernia has not been reported previously. We report a case of newborn with a giant Meckel's diverticulum and congenital diaphragmatic hernia. A large round atypical air-filled bowel segment was found by chest radiography preoperatively, and a giant Meckel's diverticulum was located within the left hemithorax during surgery.     

Meckel's diverticulum: a review

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. This anomaly is due to the incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation and is classically located 2 feet proximal to the ileocecal valve. Variations of this congenital malformation have been recorded based on location, size, and form. While most of the population may be asymptomatic, clinical manifestation, including gastrointestinal bleed and intestinal obstruction, can emerge. Despite the frequency of Meckel's diverticulum, it is commonly misdiagnosed due to its mimicry of appendicitis. This article aimed to review this derailment of embryological development.     

Appendicitis in a two-months old infant with a peritoneovaginal duct

Acute appendicitis in infants is a very unusual disease, but associated to structural defects like patent peritoneovaginal duct, Meckel's diverticulum, clubfeet, and Moebius syndrome is extremely rare. Case report. A male of two months-old with this association is presented. Left inguinal swelling and acute abdomen syndrome were identified. In laparotomy, iguinal defect and a gangrenous appendicitis were observed. Appendectomy was performed and postoperative recovery was unevenful.     

Malignant melanoma in Meckel's diverticulum

Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct, which is rarely affected by neoplasia. The authors report the first case of malignant melanoma in Meckel's diverticulum in a middle-aged man without skin or ocular lesions. Five other Meckel's diverticuli were evaluated histologically and by immunoperoxidase technics for neural crest elements, which could have given rise to this lesion.     

Laparoscopic management of complicated urachal remnant in a child

A few cases of laparoscopic surgery for urachal remnant in children has been reported in English literature. With recent developments in minimal invasive surgery, laparoscopic approach for urachal remnant in adulthood is recommended by some laparoscopic surgeons because of its technical feasibility and safety as well as cosmesis. Recently we experienced a case of complicated urachal remnant in a 14-month-old girl, who was managed by laparoscopic approach. At presentation, she complained of high fever and lower urinary tract symptoms. After 6 weeks of antibiotics therapy, laparoscopic surgery was performed transperitoneally via 3 ports. Our experience suggests that laparoscopic excision of urachal remnant can be performed easily and safely in children.     

Endotoxin aggression in pathogenesis of DIC-syndrome in children with urgent surgical pathology of the abdomen

The data obtained on 19 children aged 3 months to 14 years with urgent abdominal inflammation (gangrenous appendicitis, perforative Meckel's diverticulum, intestinal obstruction complicated by peritonitis) support suggestion about underlying endotoxin aggression in pathogenesis of disseminated intravascular coagulation.     

Small intestinal ulceration secondary to carcinoid tumour arising in a Meckel's diverticulum.

A solitary small intestinal ulcer associated with a carcinoid tumour in a nearby Meckel's diverticulum was found in a 77 year old man presenting with massive rectal bleeding. Angiography and a radioisotope study localised the bleeding to the ileum. At operation, the Meckel's diverticulum was identified, with bleeding from an ulcer just distal to it. Pathological examination revealed a small carcinoid tumour confined to the Meckel's diverticulum. Close to the opening of the diverticulum, within the ileum, a well demarcated ulcer was present. Histology showed a non-specific ulcer which eroded a large blood vessel. This is the first documented occurrence of solitary small intestinal ulceration in association with a carcinoid tumour. Carcinoid tumour should be added to the list of possible causes of small intestinal ulceration. The ulceration may be secondary to release of cytokines by the tumour.     

Urachal anomalies in children: a single center experience

The objective of this study is to define optimal diagnosis and treatment strategies for patients with urachal anomalies in the pediatric age group. The medical records of 21 children who had undergone surgery for urachal anomalies at Severance Hospital, Yonsei University College of Medicine from January 1990 to April 2005 were reviewed. The subjects included 14 males and 7 females (M:F 2:1). The four types of urachal anomalies confirmed were a urachal cyst in 10 patients (47.6%), a patent urachus in 6 (28.6%), a urachal sinus in 4 (19.0%) and a urachal diverticulum in 1 (4.8%) patient. The most common presenting complaint was umbilical discharge (n = 10, 40.0%), followed by abdominal mass (n = 9, 36.0%). Urachal anomalies were diagnosed by ultrasonography in 18 patients, and 7 of them were additionally examined by computed tomography. The remaining patients were diagnosed solely by surgical exploration. Excision was performed in all patients and was supplemented by partial cystectomy in three. Umbilical discharge was the most common clinical manifestation in our patients, suggesting that ultrasonography should be performed in patients with umbilical discharge to differentiate urachal anomalies. We found the most common anomaly to be the urachal cyst, and all patients were successfully treated by surgical excision.     

Villous adenoma arising in Meckel's diverticulum.

The first well documented case of villous adenoma arising in a Meckel's diverticulum not associated with a carcinoma is reported. A 21 year old man with long history of medically treated ulcerative colitis was admitted to hospital with severe pain and bleeding. Total abdominal colectomy and ileo-anal anastomosis was performed and during this procedure Meckel's diverticulum containing a villous adenoma showing minimal dysplasia was found and resected. The diverticulum was lined partly by ileal and partly by gastric epithelium, and the villous adenoma originated from the gastric mucosa.     

Neoplastic Paneth cells. Occurrence in an Adenocarcinoma of a Meckel's diverticulum.

Neoplasia is the least common complication of Meckel's diverticulum. A case of partial obstruction of the small intestine due to adenocarcinoma arising in a Meckel's diverticulum is presented. The noteworthy feature of this case is the presence of neoplastic Paneth cells in the tumor.     

Bleeding Meckel's diverticulum in an adult

The diagnosis of a symptomatic Meckel's diverticulum in an adult is uncommon. Still more infrequent is the presentation of a bleeding Meckel's diverticulum after childhood. We present a case report of a 24-year-old male with gastrointestinal hemorrhage secondary to a Meckel's diverticulum containing ectopic gastric mucosa. With the exception of a Meckel's Tc 99m pertechnetate scan, all other diagnostic procedures including Tc 99m-labeled red cell scan and angiography were negative.     

Villöses Urachusdivertikeladenom mit Langzeitmukusurie

During embryonic development the urachus connects the bladder with the umbilical cord. The urachus obliterates postnatally. Incomplete obliterations result in urachal cysts which, in the case of a connection to the bladder, are termed urachal diverticula. Urachal tumors are rare.We report on the case of a 46-year-old female patient with a 13-year history of recurrent bladder infections and mucusuria caused by an urachal diverticulum. After surgical resection histologic examination showed a mucus producing, intestinally differentiated adenoma within the diverticulum. This finding explains both the recurrent infections and the 10-year history of mucusuria.     

Urachal malignant fibrous histiocytoma: a case report and review of the literature

Pathologic processes involving the urachus are usually related to inflammatory or sinofistular conditions. Neoplasms rarely arise within this structure, and when they do occur, they are typically epithelial, with mucinous adenocarcinoma being the most common. Mesenchymal lesions, both benign and malignant, have rarely been described in this location. We report the case of a 66-year-old white man who presented with a primary urachal malignant fibrous histiocytoma and died of metastatic disease 20 months after the initial diagnosis. This is an unusual case of malignant fibrous histiocytoma arising in a urachal remnant.     

肥胖病人急性阑尾炎腹腔镜手术与开腹手术临床效果比较分析

目的 分析对肥胖急性阑尾炎病人实施腹腔镜阑尾切除与开腹阑尾切除的临床治疗效果.方法 回顾性分析我院2007年1月至2011年12月期间腹腔镜阑尾切除与开腹阑尾切除相关资料.结果 实施腹腔镜阑尾切除手术病人的总体并发症发生率与致死率均较低,住院时间较短,住院费用较少,两种方法相比差异显著,具有统计学意义.结论 对于肥胖病人实施腹腔镜阑尾切除手术比实施开腹阑尾切除手术更为安全可靠,疗效更好,不论阑尾炎是否穿孔,腹腔镜阑尾切除手术应作为首选方法.     

腹部手术后伴发急性阑尾炎的临床分析

目的探讨腹部手术后并发急性阑尾炎临床特点。方法对腹部手术后伴发急性阑尾炎的病例资料进行回顾性分析。结果 2005—2010年间腹部手术后伴发急性阑尾炎11名患者中,术前根据其临床特点和B超确诊的急性阑尾炎有9例,剖腹探查确诊的有2例,均于原发病术后7～15d行阑尾切除术,术后均恢复良好,痊愈出院。结论对腹部术后出现腹痛、发热等相关阑尾炎表现的患者要有足够的重视,积极排除伴发急性阑尾炎的可能,B超对术后并发急性阑尾炎的诊断有一定的辅助作用,积极手术治疗是其安全有效的治疗方法。     

Stage 0 mucinous adenocarcinoma in situ of the urachus.

Adenocarcinomas of the urinary bladder are rare (1-5% of bladder tumours) and of notoriously poor prognosis. About one third of such tumours arise in urachal remnants related to the bladder. This is believed to be the first report of in situ change in the urachal remnant. The patient presented with mucusuria and computed tomography showed a typical urachal cyst. After excision the cyst was found to contain mucinous adenomatous epithelium but without invasion of the basal lamina. Pathological stage is the best prognostic indicator in urachal tumours. Prompt investigation and management of mucusuria may allow the diagnosis of urachal tumours in this preinvasive stage.     

急性阑尾炎合并艾滋病患者临床病理特点及其对手术方式的影响

目的 探讨艾滋病患者阑尾炎病理分型特点及与临床手术方式选择的关系。方法 将2013年3月~2018年3月在广州市第八人民医院外科住院治疗的37例急性阑尾炎合并艾滋病患者设为实验组,选取同期同科室治疗的非HIV感染阑尾炎患者50例设为对照组,比较两组病理类型、临床表现和手术方式等方面特点。结果 与非HIV感染患者相比较,艾滋病患者急性阑尾炎病理类型包括急性化脓性阑尾炎、急性坏疽性阑尾炎、结核,马尔尼菲蓝状菌病,巨细胞性病毒性肠炎;其中结核,马尔尼菲蓝状菌病,巨细胞病毒性肠炎发病率高于非HIV患者,差异有统计学意义（P＜0.05）,在艾滋病患者中,导致患者腹腔镜手术中转开腹的主要病理类型包括结核、马尔尼菲蓝状菌病和急性坏疽性阑尾炎。结论 艾滋病患者急性阑尾炎病理类型包括急性化脓性阑尾炎、急性坏疽性阑尾炎、结核、马尔尼菲蓝状菌病、巨细胞病毒性肠炎;其中结核、马尔尼菲蓝状菌病和急性坏疽性阑尾炎等是艾滋病患者LA中转开腹的主要病理类型;术前建立合理的评判标准有助于减少中转开腹可能。     

Acute perforated appendicitis: An analysis of risk factors to guide surgical decision making

Introduction: Acute perforated appendicitis is associated with increased post-operative morbidity and mortality. Avoiding delays in surgery in these patients may play a role in reducing observed morbidity. Objective: To analyze the clinico-pathological profile and outcomes in a cohort of patients undergoing emergency appendicectomies for suspected acute appendicitis and to determine factors influencing the risk of perforated appendicitis in order to aid better identification of such patients and develop protocols for improved management of this subset of patients. Materials and Methods: A retrospective analysis of patients undergoing emergency appendicectomies following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011 was conducted. Statistical analyses were performed in SAS 9.2. Results and Discussion: 506 patients underwent emergency appendectomy for acute appendicitis which included equal number of male and female patients with a median age of 25 years. Perforated appendicitis was found in 102 (20%) patients. Post-operative morbidity was significantly higher in patients with perforated appendicitis (28.4% vs 4.7%; P<0.0001). Male sex, patients older than 60 years, along with raised neutrophil counts and C-reactive protein levels were found to be significantly associated with the risk of perforation (P<0.05). Conclusions: Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.     

Diagnosis and treatment of hematochezia: guideline for clinical practice

Hematochezia as an acute and chronic lower gastrointestinal bleeding could be caused by diverticulosis, angiodysplasia, neoplasm, perianal disorders, Meckel's diverticulum, colitis (infectious and non-infectious) intussusception, and many others. Lower gastrointestinal bleeding mostly occurs in older age. Mortality caused by acute and chronic lower gastrointestinal bleeding is very high. On the other hand, there are difficulties in clinical practice to find the cause and making the diagnosis and therapy for hematochezia. Fortunately, the progress and development in medical technology, especially colonoscopy and arteriography, has assisted in clinical practice.