SciCombinator

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Concept: Meckel's diverticulum

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Although duodenal diverticula are common, periampullary duodenal diverticula are rare. Periampullary duodenal diverticula are usually asymptomatic and may be difficult to diagnose and treat. However, they may present with massive bleeding, requiring prompt diagnosis.

Concepts: Medical terms, Diagnosis, Greek loanwords, Hemostasis, Bleeding, Diverticulum, Meckel's diverticulum

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Meckel’s diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from a Meckel’s diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel’s diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel’s diverticulum and correlation with other radiological imaging.

Concepts: Medical terms, Surgery, Medical imaging, Digestive system, Gastroenterology, Radiology, Subarachnoid hemorrhage, Meckel's diverticulum

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Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and the most common cause of gastrointestinal bleeding in children. Although it usually follows the rule of 2’s, exceptions to this rule are reported in the literature. Often asymptomatic, MD is commonly an incidental finding during surgical interventions. When symptomatic, the most common presentation of this condition is painless rectal bleeding. A myriad of other nonspecific symptoms are however possible, especially in adults, thus making this diagnosis difficult. Meckel diverticulum has been reported to mimic other abdominal pathologies like appendicitis, inflammatory bowel disease, and pancreatitis to name a few.We report a patient with acute abdomen in whom the more common causes of acute abdomen were ruled out and a diagnosis of MD was established on exploratory laparoscopy, only after he developed perforation. This report emphasizes the need for maintaining a high index of suspicion towards a possibility of a complicated MD in patients presenting with an acute abdomen, once other causes of acute abdomen are ruled out.

Concepts: Inflammation, Medical terms, Digestive system, Abdominal pain, Colonoscopy, Gastroenterology, Abdomen, Meckel's diverticulum

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Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the population. It is a true diverticulum occurring on the anti-mesenteric border of the distalileum, typically within 100 cm of the ileo-caecal valve. Neoplasms arising in Meckel’s diverticula are uncommon, and those reported in the literature are mainly carcinoid tumors, followed by gastrointestinal stromal tumors (GIST) and benign leiomyomas. Adenocarcinomas are extremely rare. Tumors in Meckel’s present non-specifically with gastrointestinal complaints, such as bleeding, obstruction, inflammation or perforation. The suspicion of a Meckel’s tumor is often not thought of at the initial. In this article we describe a 57-year-old woman who presented with massive rectal bleeding and severe anemia, later found to be caused by a adenocarcinoma arising from Meckel’s diverticulum. The tumor was unfortunately highly aggressive. Multiple liver metastases had already existed when we discovered the primary mass. Later we performed a partial resection of the ileumto cease the bleeding. Meckel’s diverticulum and the tumor were resected simultaneously. The pathological diagnosis confirmed adenocarcinoma arising from the Meckel’s diverticulum. The final stage was pT4NxM1, stage IV according to the Union for International Cancer Control (UICC) classification. After operation we gave the patient first-line, mFOLFOX6 chemotherapy, but it turned out to be not effective. Rapid progress of the liver metastases and suspicion of multiple lung metastasis in short time after therapy indicated a bad outcome. We believe this is the first case of adenocarcinoma in a Meckel’s diverticulum to be reported in domestic literature. The diagnosis of Meckel’s tumor should be considered as inpatients'acute gastrointestinal complaints; when found incidentally at laparotomy, it should be carefully examined for any gross abnormality and resection should be considered.

Concepts: Cancer, Metastasis, Oncology, Lung cancer, Digestive system, Benign tumor, Gastroenterology, Meckel's diverticulum

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Almost all gastrointestinal tract diverticula require no intervention if they are asymptomatic. There is no clear diagnostic modality of choice for diagnosis and surveillance of diverticulum. Medical treatment should be attempted before surgical intervention because significant morbidity is may be associated with resection.

Concepts: Medicine, Medical terms, Surgery, Gastroenterology, Diverticulum, Meckel's diverticulum

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The reported accuracy of pertechnetate scintigraphy (Meckel scan) in investigating children with a bleeding Meckel’s diverticulum has increased steadily since it was first introduced into clinical practice in 1970. Recent studies have indicated that the examination has a sensitivity of up to 94% and a specificity of up to 97% in this scenario. There have also been several misleading reviews from Departments of Surgery, suggesting that the Meckel scan has a poor predictive value, and should not be relied upon to exclude a bleeding Meckel’s Diverticulum (MD).

Concepts: Meckel's diverticulum

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Quality control and technical issues are essential for high-quality imaging. An important technical parameter of image acquisition is selecting zoom factor according to camera field-of-view dimensions and patient’s body size. Here, we present a case of atypically located Meckel’s diverticulum mimicking bladder on Meckel scan.

Concepts: Quality control, Management, According to Jim, Diverticulum, IMAGE, Photography, Meckel's diverticulum, DC Comics

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A Meckel’s diverticulum is a common anomaly of the gastrointestinal tract. Although the majority of patients do not have any symptoms, malignancies can develop inside these diverticula, with neuroendocrine tumours being the most common. Diverticulectomy is the best option for complicated diverticula but prophylactic resection of asymptomatic diverticula in adults remains controversial. We present a case series of three patients with a neuroendocrine tumour found in a Meckel’s diverticulum. Given the number of asymptomatic diverticula not resected, it seems likely that incidental neuroendocrine tumours are more prevalent than thought previously. With the minimally invasive techniques now available and the low complication rate for incidental diverticulectomy, we believe that the benefits of resection of this high risk area for cancer outweigh the risks of surgery.

Concepts: Cancer, Oncology, Medical terms, Benign tumor, Tumor, Neoplasm, Neuroendocrine tumor, Meckel's diverticulum

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A Littre’s hernia is an unusual phenomenon where a Meckel’s diverticulum protrudes through a potential abdominal opening. We wish to present a unique case of a 79-year-old man with respiratory distress following a fall from standing, initially managed as a haemothorax. After a chest drain was placed, bowel contents were drained from the pleural cavity and he was taken to theatre. He had a history of minimally invasive oesophagectomy for cancer and had subsequently developed a diaphragmatic hernia. A blind ending diverticulum with a perforation at its tip was found in the left oblique lung fissure that was subsequently confirmed histologically as a perforated Meckel’s diverticulum. The patient had a prolonged stay on the intensive care unit with a left-sided empyema that was managed radiologically prior to discharge. Unfortunately 4 months postoperatively, he passed away from hospital-acquired pneumonia on a rehabilitation ward.

Concepts: Pulmonology, Medical terms, Pneumonia, Nosocomial infection, Intensive care medicine, Respiratory system, Pneumothorax, Meckel's diverticulum