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Diverting opinions: surgical debate around method of Meckel's resection
Katharine Ji1,2, Melanie Crispin3, Janindu Goonawardena3
1General Surgery, Box Hill Hospital, Box Hill, Victoria, Australia kaji0496@uni.sydney.edu.au.
Abstract:
Meckel's diverticulum (MD) is the most common congenital anomaly of the GI tract and can present with obstruction, inflammation or haemorrhage, which requires surgical intervention. Primary malignancies of MD are rare with a reported incidence of 0.5%-3.2%. The standard treatment of symptomatic MDs is resection. However, there is no standard protocol regarding the type of resection. Similarly, for asymptomatic MDs, there is no standard management. We report our experience with a patient in her 60s who required emergent surgery for perforated MD where histology revealed a plexiform fibromyxoma at the junction of the ileum and MD. Current surgical resection techniques for MDs vary from linear or wedge diverticulectomy to segmental bowel resection. This case of an unexpected tumour supports segmental bowel resection in the treatment of MD and raises the question of whether incidental asymptomatic MDs should also be resected due to the risk of tumour or malignancy.
Insights
Meckel
Area of Science:
- Gastroenterology and Surgical Oncology
Background:
- Meckel's diverticulum (MD) is a common congenital GI anomaly often requiring surgery.
- Malignancies arising from MD are rare (0.5%-3.2%), but symptomatic MDs necessitate resection.
Purpose of the Study:
- To present a case of Meckel's diverticulum with an unexpected tumor.
- To discuss the implications for surgical management of both symptomatic and asymptomatic MDs.
Main Methods:
- Case report of a patient undergoing emergent surgery for perforated MD.
- Histological examination of the resected specimen.
Main Results:
- A plexiform fibromyxoma was discovered at the ileum-MD junction in a patient with perforation.
- The case highlights the potential for unexpected pathology within MDs.
Conclusions:
- Segmental bowel resection may be preferable for MD treatment due to potential unexpected tumors.
- The risk of malignancy in asymptomatic MDs warrants consideration for prophylactic resection.
