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[Acute hemorrhage from Meckel's diverticulum--Laparotomy or laparoscopy?]
M Knoop1, T Vorwerk, K S Friedrichs
1Klinik für Allgemein- und Viszeralchirurgie, Johanniter Krankenhaus der Altmark, Stendal, Akademisches Lehrkrankenhaus der Otto-von-Guericke Universität Magdeburg, Germany. Mdrknoop@aol.com
Zentralblatt Fur Chirurgie
|June 27, 2002
Summary
Massive lower gastrointestinal bleeding in young adults can stem from Meckel's diverticulum with peptic ulceration. Surgical resection via laparotomy with intraoperative endoscopy is preferred for hemodynamic instability.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Pediatric Surgery
Background:
- Meckel's diverticulum is the most common congenital gastrointestinal malformation.
- Complications include obstruction, diverticulitis, and intussusception.
- Peptic ulceration from heterotopic gastric tissue can cause lower gastrointestinal bleeding.
Observation:
- Two cases of massive lower gastrointestinal hemorrhage of unknown origin in a 15-year-old girl and a 20-year-old man.
- Emergency laparotomy with intraoperative endoscopy (rendezvous maneuver) was performed.
- Meckel's diverticulum with peptic ulceration identified as the bleeding source in both patients.
Findings:
- Active bleeding was visible in one case.
- Resection of the affected small bowel segment with end-to-end anastomosis led to an uneventful postoperative course.
- Meckel's diverticulum with peptic ulceration is a critical cause of massive lower GI hemorrhage.
Implications:
- Laparotomy with intraoperative endoscopy is a preferred approach for hemodynamically unstable patients with lower GI hemorrhage.
- This technique allows for rapid diagnosis and definitive treatment in emergency settings.
- Highlights the importance of considering Meckel's diverticulum in undiagnosed massive lower GI bleeding.