Complicated Meckel's diverticulum and therapeutic management.

OBJECTIVE This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckel's diverticulum at our clinics. MATERIAL AND METHODS This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckel's diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012. RESULTS Fourteen patients with a diagnosis of Meckel's diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckel's diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%). CONCLUSION Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckel's diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.

[1]  M. Loukas,et al.  Meckel's diverticulum: A review , 2011, Clinical anatomy.

[2]  I. Francis,et al.  Imaging manifestations of Meckel's diverticulum. , 2007, AJR. American journal of roentgenology.

[3]  J. Opitz,et al.  Meckel on developmental pathology , 2006, American journal of medical genetics. Part A.

[4]  John J. Park,et al.  Meckel Diverticulum: The Mayo Clinic Experience With 1476 Patients (1950–2002) , 2005, Annals of surgery.

[5]  Cynthia Ludwig,et al.  Gastrointestinal tract , 2005, The American Journal of Digestive Diseases.

[6]  M. Şahin,et al.  [Complicated Meckel's diverticulum]. , 2003, Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES.

[7]  P. Parrilla,et al.  Surgical management and complications of Meckel's diverticulum in 90 patients. , 2002, The European journal of surgery = Acta chirurgica.

[8]  P. Morel,et al.  Meckel's diverticulum in adults: retrospective analysis of 119 cases and historical review. , 2001, The European journal of surgery = Acta chirurgica.

[9]  A. Fingerhut,et al.  Meckel's diverticulum. , 2001, Journal of the American College of Surgeons.

[10]  R. Beart,et al.  Surgical management of Meckel's diverticulum. , 1995, Annals of surgery.

[11]  J. Peoples,et al.  Incidental Meckel's diverticulectomy in adults. , 1995, Surgery.

[12]  L. Melton,et al.  Surgical Management of Meckel's Diverticulum An Epidemiologic, Population‐Based Study , 1994, Annals of surgery.

[13]  William E. Neville,et al.  Gastrointestinal Tract , 1959 .