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Intestinal obstruction caused by mesodiverticular band in children: a cohort study
Xuan Zhang1,2, Hongyan Ping3, Jiuhong Zhang3
1Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China. zhxuan2006@smu.edu.cn.
Insights
Mesodiverticular band (MDB) in children can cause acute intestinal obstruction, often presenting with non-specific symptoms. Early surgical intervention is crucial for preventing complications like bowel necrosis and improving outcomes.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Congenital Anomalies
Background:
- Mesodiverticular band (MDB) is a rare congenital anomaly.
- It arises from the remnant of the vitelline vessel.
- MDB can lead to significant gastrointestinal complications in children.
Purpose of the Study:
- To investigate the clinical features, pathogenesis, diagnosis, and treatment of pediatric intestinal obstruction caused by MDB.
- To analyze outcomes and identify key diagnostic and therapeutic strategies.
Main Methods:
- Retrospective analysis of clinical data from 20 pediatric patients diagnosed with MDB-induced intestinal obstruction.
- Data collected between 1998 and 2020 at a single center in China.
- Review of clinical presentation, surgical findings, pathological examination, and follow-up data.
Main Results:
- The study included 20 children (14 males, 6 females) aged 7 days to 14 years.
- Common symptoms included vomiting, abdominal pain, and distension; 40% had coexisting Meckel's Diverticulum.
- Complications observed were strangulation (6 cases), perforation (1 case), and rupture (1 case); one mortality due to aganglionosis. All survivors recovered after surgery with no long-term complications.
Conclusions:
- MDB is a critical cause of acute intestinal obstruction in children, often presenting without specific symptoms.
- Unexplained abdominal symptoms, particularly in the absence of prior surgery, warrant attention for potential strangulated obstruction.
- Prompt surgical exploration and pathological confirmation are vital for timely diagnosis and management, preventing severe outcomes.
Objective:
To explore clinical characteristics, pathogenesis, diagnosis and treatment of intestinal obstruction due to mesodiverticular band (MDB) in children in a single center in China.
Methods:
The clinical data of 20 children with acute intestinal obstruction due to MDB between 1998 and 2020 were retrospectively analyzed.
Results:
The male-to-female ratio was 14:6 in 20 cases. Except one case of 7-month pregnant stillbirth, the cases were aged from 7 days to 14 years, at the median age of 4.31 years. The common symptoms were vomiting, abdominal pain and/or abdominal distension. About 40% (8/20) of patients had both MDB and Meckel's Diverticulum (MD), while 60% (12/20) of patients had MDB only. Only one case died because of total colonic aganglionosis, while other children recovered after surgery treatment. MDB led to the strangulation of necrotic bowel in six cases, intestinal perforation in one case, and intestinal rupture in one case. Pathologic examination showed thick-walled arteries and or thick venous vascular structures in the cord. All cases had no complications during 1-year follow-up.
Conclusion:
MDB results from the remnant of vitelline vessel, and often causes acute intestinal obstruction without special clinical symptoms. Unexplained abdominal pain and distension without surgery history should be paid attention, especially for strangulated intestinal obstruction. Timely surgical exploration is beneficial to avoid intestinal necrosis or even sudden death, and the pathological examination is important for the diagnosis.
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