Meckel's diverticulum: Value of ectopic tissue

doi:10.1016/0002-9610(86)90576-3

The American Journal of Surgery

Volume 151, Issue 5, May 1986, Pages 631-634

https://doi.org/10.1016/0002-9610(86)90576-3 Get rights and content

Abstract

Cases of symptomatic Meckel's diverticulum treated surgically on an emergency basis during the last decade are reviewed. A series of 18 patients were divided into two groups depending on the presence or absence of ectopic tissue in the diverticulum. Group 1 consisted of five patients (28 percent) without ectopic tissue, and Group 2 consisted of 13 patients (72 percent) with ectopic tissue (8 gastric ectopia, 2 pancreatic ectopia, and 3 both gastric and pancreatic ectopia).

Previous clinical records related to Meckel's diverticulum were found for 54 percent of the patients in Group 2 and for none of those in Group 1. The most common acute manifestations were intestinal occlusion (seven patients), digestive hemorrhage (five patients), and peritonitis (three patients). The postoperative course was 7 days in Group 1 and 15 days in Group 2 regardless of the surgical technique used.

We conclude that the presence of ectopic tissue in patients with Meckel's diverticulum seems to be the main risk for occurrence of an acute nonmechanical complication. This complication appears more frequently and with more severity in young patients.

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There are more references available in the full text version of this article.

Cited by (58)

Meckel's diverticulum associated with volvulus and internal hernia
2022, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
In histopathological examination may also be identified the ectopic epithelium. The presence of ectopic epithelium in MD is associated with the main risk for occurrence of more severity of acute complication that frequently in young patients [9]. The most common type of ectopic epithelium is gastric mucosa that presents in approximately 20% [1].
Meckel's diverticulum (MD) is congenital malformation that usually asymptomatic. MD could be emergency cases in pediatric due to the complication.
We report an interesting and rare case complication of MD in 5 years old children who presented with internal hernia and intestinal volvulus. The type ectopic epithelium that we have identified is an ectopic pancreatic tissue in the histopathology examination of MD resection tissue. Post-operative course, the patient got full recovery.
Symptomatic MD can be present as the complication that can be severe emergency cases. Complication MD that we found is intestinal volvulus with the exceedingly rare associated case of internal hernia.
Optimizing surgical resection of the bleeding Meckel diverticulum in children
2017, Journal of Pediatric Surgery
Meckel diverticula containing gastric heterotopia predispose to local hyperacidity, mucosal ulceration, and gastrointestinal bleeding in children. Eradication of acid-producing oxyntic cells is performed by either of two surgical methods: segmental enterectomy including the diverticulum or diverticulectomy only.
Retrospective review of all children having surgical resection of a Meckel diverticulum at a tertiary-referral children's hospital from 2002 to 2016 was performed. Demographic data, surgical method, pathological specimens, and outcomes were evaluated.
102 children underwent surgical resection of a Meckel diverticulum during the study period. 27 (26.5%) children presented with bleeding, of which 16 (59%) had diverticulectomy only, and 11 (41%) had segmental ileal resection. All Meckel diverticula in children presenting with bleeding contained gastric heterotopia, and resection margins were free of gastric mucosa. Histologically, 19 specimens showed microscopic features of ulceration, on average 2.95 mm (SD 4.49) from the nearest gastric mucosa (range: 0–16 mm). Mean length of hospitalization after ileal resection was 4.0 days (SD 1.2) compared to 1.6 days (SD 0.9) for diverticulectomy only (p < 0.001), with no re-bleeding occurrences.
In the operative management of children having a bleeding Meckel diverticulum, diverticulectomy-only completely eradicates gastric heterotopia without increased risk of continued bleeding or complications and significantly shortens hospitalization.
Treatment Study: Level III.
Imaging of omphalomesenteric duct remnants and related pathologies in children
2015, Current Problems in Diagnostic Radiology
Citation Excerpt :
A large series investigation of 600 patients showed gastric mucosa in more than 62% of Meckel diverticula.14 The presence of ectopic tissue in patients with Meckel diverticulum seems to be the main risk factor for occurrence of acute hemorrhagic or inflammatory complications.15 Hemorrhage is thought to be due to peptic ulcerations in the ectopic gastric mucosa or rarely from adjacent ileal ulcers owing to acid secreted in the Meckel diverticulum.
The omphalomesenteric duct (OMD) or the vitelline duct (VD) is the embryologic communication between the yolk sac and the primitive midgut. OMD or VD anomalies are a group of defects resulting from failure of involution of the OMD. Meckel diverticulum is the most common anomaly that results from failure of resorption of the OMD. Other less common anomalies seen in children include OMD fibrous band, fistula, sinus tract, cyst, and umbilical polyps. These OMD remnants can have variable clinical manifestations such as umbilical discharge, small bowel obstruction, gastrointestinal tract bleeding, or acute abdomen. This pictorial essay reviews the clinical presentation and imaging findings of the common and not so common complications of OMD remnants in the pediatric population.
Diagnostic Pathology: Gastrointestinal
2015, Diagnostic Pathology: Gastrointestinal
Diverse presentations in pediatric Meckel's diverticulum: A review of 100 cases
2014, Pediatrics and Neonatology
Citation Excerpt :
Gastric and pancreatic tissues, respectively, accounted for 97.3% (71/73) and 16.4% (12/73) of ectopic tissue-containing MD. Ectopic pancreas occurs with an incidence of 0.4% in children,32 and it has accounted for 3–23% of ectopic tissues within symptomatic MD.3,11,15,16,33 It has been considered a pathological lead point for intussusception.15,34 MD with intussusception accordingly exhibits higher prevalence of ectopic pancreas than those with other presentations in our series.
Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients.
This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed.
One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001).
Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.
Double Meckel's diverticulum presenting as acute appendicitis: A case report and literature review
2013, Journal of Emergency Medicine
Citation Excerpt :
Although some studies suggest that an asymptomatic diverticulum should not be resected, others suggest the contrary. Artigas et al. concluded that an asymptomatic MD should not be resected due to decreasing prevalence of symptoms with increasing age (12). Cullen et al. concluded that all incidentally discovered diverticula should be resected at any age because the risks of complications from MD do not decrease with age (13).
Meckel’s diverticulum is the most common developmental anomaly of the gastrointestinal tract, affecting 1–3% of the general population. This anomaly is caused by incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation and is located in the last meter of the ileum in 90% of patients. Meckel’s diverticulum is often an incidental finding during a laparotomy for other causes, such as acute appendicitis, and occasional complications are bleeding, obstruction, diverticulitis, and perforation.
Primary aim of this study was to present and share an extremely rare case of double Meckel's diverticulum.
A 20-year-old woman who was admitted due to symptoms of right lower quadrant pain, nausea, and vomiting. A laparotomy with a McBurney’s incision was performed because of a presumed diagnosis of acute appendicitis. The surgical exploration revealed a double Meckel’s diverticulum localized 50 cm proximal to the ileocecal valve, but no acute appendicitis. The operation was finished after a diverticulectomy and appendectomy. No complications occurred during the postoperative follow-up.
We conducted a literature review of studies published in the English language on double Meckel’s diverticulum, accessed via PubMed, Medline, and the Google Scholar databases. We found only five case reports of such a Meckel’s diverticulum variant.

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¹: From the Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma, Barcelona, Spain.

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Meckel's diverticulum: Value of ectopic tissue

Abstract

Am J Surg

Consideraciones sobre 108 casos de Diverticulo de Meckel

Rev Esp Enferm Apar Dig

Diverticulo de Meckel

Rev Esp Enferm Apar Dig

Das Meckelsche divertikel

Ergeb Chir Orthop

Thesaurus anatomicus

Uber dias Divertikel am Darmkanal

Arch Physiol

Uber dias Offene Meckeleshe Divertikel

Wien Klin Wochenschr

A fifty year experience with Meckel's diverticulum

Surg Gynecol Obstet