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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
[Axial torsion and gangrene of Meckel's diverticulum: case report]
Introduction:
Meckel's diverticulum (MD) is the most prevalent congenital anomaly of small intestine. It develops due to the incomplete obliteration of omphalomesenterict duct which normally undergoes obliteration during the seventh week of gestation. In the majority of cases MD is asymptomatic but it may cause various complications, such as bleeding, intestinal obstruction and inflammation. Cases of umbilical sinuses, fistulas and neoplasms related with MD have been reported, but extremely rare gangrene due to its axial torsion, especially in children, as is the case of our patients.
Case Outline:
An 11-year-old boy admitted to hospital due to 24 hours epigastric pain, vomiting and malaise. After a complete physical examination, and appropriate pre-surgical laboratory and radiographic tests, surgical exploration was performed with a midline abdominal incision. On 60th cm proximal to the ileocecal valve we found a long and in a narrow based ganrenous MD with axial torsion and fibrotic cord extending from the tip of MD to the ileal mesentery. Surrounding ileum had normal appearance. A demarcation and subsequent resection of MD and the surrounding ileum was performed with end-to-end ileal anastomosis. Postoperative recovery was successful and the patient was discharged after six days.
Conclusion:
Axial torsion of MD is presented with non-specific abdominal symptoms and difficult preoperative diagnosis. The choice of diagnosis and therapy is surgical exploration and resection of MD.
Insights
Meckel's diverticulum (MD) axial torsion is a rare cause of abdominal pain in children. Surgical exploration and resection are crucial for diagnosis and treatment of this congenital anomaly.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Background:
- Meckel's diverticulum (MD) is the most common congenital small intestine anomaly, arising from incomplete obliteration of the omphalomesenteric duct.
- While often asymptomatic, MD can lead to complications like bleeding, obstruction, and inflammation.
- Gangrene from axial torsion of MD is exceptionally rare, particularly in pediatric cases.
Observation:
- An 11-year-old boy presented with acute epigastric pain, vomiting, and malaise.
- Surgical exploration revealed a gangrenous Meckel's diverticulum with axial torsion and a fibrotic cord.
- The diverticulum was located 60 cm proximal to the ileocecal valve, with otherwise normal surrounding ileum.
Findings:
- Axial torsion of Meckel's diverticulum presents with non-specific abdominal symptoms.
- Preoperative diagnosis of MD axial torsion is challenging.
- Surgical exploration and resection of the affected Meckel's diverticulum is the definitive diagnostic and therapeutic approach.
Implications:
- Early surgical intervention is critical for managing Meckel's diverticulum complications.
- This case highlights the importance of considering rare presentations of common congenital anomalies.
- Prompt diagnosis and surgical management ensure favorable patient outcomes.
