Intussusception in a premature neonate: A rare and often misdiagnosed clinical entity

Intussusception is a very rare cause of intestinal obstruction in neonates. It is of extremely rare occurrence among premature neonates. We present a case of 11-day-old premature neonate who presented with abdominal distension, intolerance to feeds, vomiting, significant bilious aspirate and bleeding per rectum. The initial diagnosis of necrotizing enterocolitis (NEC) led to a delay in the diagnosis. On exploratory laparotomy, it turned out to be a case of ileo-colic intussusception with Meckel''s diverticulum as a lead point. This site of intussusception (ileo-colic) and presence of a lead point among premature neonate is of exceedingly rare occurrence and very few such cases have been reported.In this article, the published work about clinical features and management on intussusceptions in premature neonates has been reviewed. The authors intend to highlight the difficulty in distinguishing the NEC and intussusception. Subtle clinical and radiological features which can help in differentiating the two conditions have been emphasized. This can avoid the delay in diagnosis and management which can prove critical. High index of suspicion with timely intervention is the key for optimizing outcome. A diagnosis of intussusception should always be considered in any preterm infant with suspected NEC.     

完全性胸腹腔内脏反位合并十二指肠壶腹周围癌一例报告与文献复习

目的总结完全性胸腹腔内脏反位合并十二指肠壶腹周围癌的临床诊治方法。方法报道2006年3月收治的1例极为罕见的完全性胸腹腔内脏反位合并十二指肠壶腹周围癌行胰十二指肠切除术的病例,并复习国内外相关文献。结果本例患者病理诊断为十二指肠乳头及壶腹部腺癌Ⅰ-Ⅱ级。术后1周胆红素降至正常;但2周后出现胃-空肠吻合输出袢粘连性不完全性梗阻,经内镜下置管、鼻饲、营养支持、针灸等处理,40d后痊愈出院。经检索,全球自1936-2006年间报道的全胸腹腔内脏反位合并恶性肿瘤的患者仅15例;其中只有5例全胸腹腔内脏反位合并胰头与壶腹周围癌的报道。结论完全性胸腹腔内脏反位合并肿瘤时,若无明显禁忌证,应同样予以积极的外科治疗,术中操作应注意完全相反的解剖学结构。     

Laparoscopic treatment of Meckel's diverticulum

We present two cases in which complication of a Meckel's diverticulum were dealt with, and in one case diagnosed using the laparoscope. One was a large bleeding diverticulum containing ectopic gastric mucosa, with the diagnosis suggested preoperatively, confirmed laparoscopically, and the pathology resected extracorporeally. The second was a partial intermittent small-bowel obstruction due to torsion around the mesodiverticular band, diagnosed and resected via the laparoscope. The literature of Meckel's diverticula and complications is reviewed, with open and laparoscopic treatment options. Although uncommon, many cases of Meckel's diverticulum may be quite suitable for laparoscopic diagnosis and treatment.     

ENDOSCOPIC MANAGEMENT OF A DIEULAFOY‐LIKE LESION IN A DUODENAL DIVERTICULUM

We present a 70‐year‐old man who had two episodes of melena during the preceding 8‐year period. He had a Dieulafoy‐like lesion in a diverticulum in the third portion of the duodenum. While emergency endoscopy revealed neither apparent blood nor clots around the diverticular orifice, there was a non‐bleeding vessel in the fundus of the diverticulum. The vessel ceased bleeding after argon plasma coagulation and, since then, the patient has not experienced bleeding. In cases of gastrointestinal bleeding of obscure origin, duodenal diverticulum should be considered as a possible source of bleeding, even when endoscopy discloses no apparent bleeding.     

Leiomyosarcoma originating in Meckel's diverticulum: Report of a case and a review of 59 cases in the English literature

A 49-year-old woman was referred to our hospital with complaints of epigastric colicky pain and high fever. Abdominal computed tomography and ultrasonography showed a solid tumor in the lower abdomen. Laparotomy revealed a neoplastic mass arising in Meckel's diverticulum; therefore, a segment of the ileum, including the tumor-possessing diverticulum, was resected with a lymph node dissection. A histologic examination confirmed the lesion to be leiomyosarcoma. In the English literature, 59 cases of leiomyosarcoma in Meckel's diverticulum were reported from 1941 to 1994. The majority of patients were in their 4th decade of life, with both sexes equally affected. The most frequent symptoms associated with this disease were abdominal pain with nausea, vomiting, and melena. The majority were larger than egg-size. Although Meckel's diverticulum is difficult to diagnose preoperatively, mesenteric arteriography may at times prove useful. The standard management of this particular tumor is wide segmental resection, including the tumor and diverticulum with lymph node dissection.     

Effect of Helicobacter pylori on ectopic gastric mucosa of Meckel's diverticulum in children after meckelectomy

Ninety-two children underwent meckelectomy in our department over the 10-year period 1981–1990. All histologic speciments of Meckel's diverticula were studied, most of them retrospectively, for evidence of active inflammation or ulceration in any ectopic gastric mucosa present and specifically searching for Helicobacter pylori (HP). Thirty-eight (group A) were excised as being responsible for the main clinical symptoms while 54 (group B) were resected incidentally. Ectopic gastric mucosa was found in 19 cases, 18 in the symptomatic group and 1 in the incidental group. In the 18 cases belonging to group A histologic findings indicating gastritis due to HP were present. Combined operative and laboratory findings in all 92 cases indicated that HP colonizes gastric mucosa electively and leads to infection, which seems to be responsible for the clinical symptoms of meckelitis.Presented at the 15th Annual International Meeting of Greek Association of Pediatric Surgeons, Porto Hydra, Greece, 27–30 September 1990     

Coexistence of a Meckel's diverticulum and a urachal remnant

Meckel's diverticulum, which is a remnant of the omphalomesenteric or vitelline duct, is the most common congenital abnormality of the gastrointestinal system. Urachal abnormalities, resulting from anomalous urogenital development, are not observed frequently and case reports are mainly represented in literature. The presence of these two congenital anomalies together is a very rare pathology. Complications arising from a Meckel's diverticulum or urachal remnant may clinically mimic acute appendicitis and other surgical pathologies. We report on a patient who underwent surgery for acute appendicitis when it was discovered that the symptoms were produced by a perforated Meckel's diverticulitis. In the course of the surgery, a urachal remnant was found to coexist with the diverticulum.     

空回肠结肠多发性憩室的临床X线诊断

目的 探索空回肠结肠多发性憩室的临床X线表现,评价消化道造影的诊断价值。方法 对18例患者的临床及X线表现进行了回顾性分析。结果 空肠多发性憩室12例,其中并发十二指肠多发性憩室10例,2例合并回肠多发性憩室。结肠多发性憩室6例,1例并发回肠多发性憩室及结肠癌。结论 空肠多发性憩室多并发于十二指肠多发性憩室,近－中段是好发部位。结肠多发性憩室多见于右半结肠,可有结肠变形。未见独立发生的回肠多发性憩室。钡餐造影能够确诊,小肠灌钡及钡灌肛可提高发现率。     

老年人壶腹周围癌胰十二指肠切除27例疗效分析

目的 探讨70岁以上壶腹周围癌患者行胰十二指肠切除的指征和疗效。方法 对27例年龄超过70岁的壶腹周围癌患者，行胰十二指肠切除治疗后的临床病例资料进行回顾性分析。结果 术后外科并发症12例(44．4％)，包括腹腔内出血3例，消化道出血2例，胰瘘3例，胃潴留4例，切口裂开及感染3例，其中3例(11．1％)在术后30天内死亡。平均生存15．3个月(除外8例术后18个月仍健在者)。有4例生存超过3年，3年生存率21．0％(4／19)。结论 患者年龄因素不是胰十二指肠切除的禁忌证，胰十二指肠切除是治疗70岁以上患者壶腹周围癌的有效手段。