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Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case
Yi-Meng Sun1, Wang Xin2, Yu-Fang Liu3
1School of Clinical Medicine, Weifang Medical University, Weifang 261000, Shandong Province, China.
Insights
Meckel's diverticulum complications mimic appendicitis in children, making diagnosis difficult. Laparoscopic surgery offers a favorable outcome for these challenging cases.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Malformations
- Diagnostic Challenges
Background:
- Meckel's diverticulum is a common congenital small intestine malformation.
- Complications include obstruction, perforation, and inflammation, often presenting similarly to appendicitis in children.
- Preoperative diagnosis is frequently imprecise due to nonspecific imaging and overlapping clinical features with pediatric appendicitis.
Observation:
- This report details three pediatric cases (ages 11-12) initially presenting with acute appendicitis.
- The appendicitis was complicated by intestinal obstruction due to Meckel's diverticulum-related fibrous bands, perforation, or inflammation.
- All patients underwent successful laparoscopic surgery.
Findings:
- Laparoscopic exploration is crucial for patients with poor disease control to prevent serious complications like intestinal necrosis or bleeding.
- Histopathologic analysis confirmed Meckel's diverticulum and associated complications in all cases.
- The study highlights the diagnostic difficulty in differentiating Meckel's diverticulum from appendicitis preoperatively.
Implications:
- Early and accurate diagnosis of Meckel's diverticulum in children is essential to avoid severe outcomes.
- Laparoscopy, potentially combined with laparotomy, is a valuable tool for both diagnosing and treating Meckel's diverticulum and its complications.
- Increased awareness and diagnostic vigilance are necessary for pediatricians and surgeons managing appendicitis-like presentations.
Background:
Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding.
Case Summary:
This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided.
Conclusion:
Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.
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