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Meckel Diverticulitis


Presentation

  • Session Number: Poster – Poster Presentations Program Number: P537 View Poster Post Views: 326 Related « Return to SAGES 2012 abstract archive[sages.org]
  • Nuclear medicine (pertechnetate scan) Ectopic gastric mucosa, if present, can be picked up on this scan, but again does not usually play a role in the acute presentation.[radiopaedia.org]
  • We present a 6-year-old boy with perforated acute Meckel diverticulitis that mimicked Crohn disease both clinically and by CT imaging and was definitively diagnosed using MR enterography.[ncbi.nlm.nih.gov]
  • Mild inflammatory changes were present in the adjacent mesentery in all patients with visualized diverticula, and in seven patients a small amount of mesenteric fluid was present.[ajronline.org]
Fever
  • The ER physician had just examined an ill looking seven-year old boy with right sided abdominal pain, nausea, vomiting and fever. The ER doctor wanted me to come and give a surgical opinion.[nbharwani.com]
  • […] with sneezing, coughing, and deep breathing Loss of appetite Slight fever Diagnosis If you have symptoms, the doctor will ask about your symptoms and medical history.[cancercarewny.com]
  • Fever is uncommon and most patients have had previous painful ovulation. In pelvic inflammatory disease, including salpingitis and tubo-ovarian abscess, there is a longer duration of symptoms, higher fever, greater leucocytosis and more pelvic pain.[surgwiki.com]
  • . — 54-year-old man with abdominal pain and fever.[ajronline.org]
  • His abdominal pain was initially transient but increased in intensity and was associated with nausea and vomiting but no fever.[karger.com]
Tachypnea
  • His vitals were significant for tachycardia and tachypnea and his labs were significant for lactic acidosis of 2.3 mmol/L, hypokalemic hypochloremic metabolic acidosis (consistent with history of vomiting), as well as a leukocytosis of 15.2 K/uL without[ijcasereportsandimages.com]
Abdominal Pain
  • Because patients with non-Meckel small intestine diverticulitis can present with acute abdominal pain, non-Meckel small intestine diverticulitis should be considered in the differential diagnosis of patients with acute abdominal pain, and computed tomography[karger.com]
  • View larger version (82K) Fig. 5B. — 54-year-old man with abdominal pain and fever.[ajronline.org]
  • Abstract A thirteen-year old girl presented with acute right lower quadrant abdominal pain for which evaluation suggested appendicitis.[ncbi.nlm.nih.gov]
  • The authors report a 71-year-old man who developed a sudden onset of right lower quadrant abdominal pain, without bleeding, and was diagnosed as having Meckel's diverticulitis via computed tomography.[journals.lww.com]
  • CT CT is the main modality employed in imaging patients with acute abdominal pain and signs of inflammation. Meckel diverticula are round or tubular fluid/air filled structures communicating with small bowel with a wall-to-wall diameter of 1.5-6 cm.[radiopaedia.org]
Vomiting
  • Case Report A 64 year old lady presented to the emergency room with right lower quadrant pain, nausea and vomiting. CT scan of the abdomen showed an inflammatory mass in the mid-abdomen with a normal appendix. Meckel’s diverticulitis was suspected.[sages.org]
  • The ER physician had just examined an ill looking seven-year old boy with right sided abdominal pain, nausea, vomiting and fever. The ER doctor wanted me to come and give a surgical opinion.[nbharwani.com]
  • His abdominal pain was initially transient but increased in intensity and was associated with nausea and vomiting but no fever.[karger.com]
  • His vitals were significant for tachycardia and tachypnea and his labs were significant for lactic acidosis of 2.3 mmol/L, hypokalemic hypochloremic metabolic acidosis (consistent with history of vomiting), as well as a leukocytosis of 15.2 K/uL without[ijcasereportsandimages.com]
  • Symptoms and Signs In all ages, intestinal obstruction is manifested by cramping abdominal pain, nausea, and vomiting.[msdmanuals.com]
Nausea
  • Case Report A 64 year old lady presented to the emergency room with right lower quadrant pain, nausea and vomiting. CT scan of the abdomen showed an inflammatory mass in the mid-abdomen with a normal appendix. Meckel’s diverticulitis was suspected.[sages.org]
  • The ER physician had just examined an ill looking seven-year old boy with right sided abdominal pain, nausea, vomiting and fever. The ER doctor wanted me to come and give a surgical opinion.[nbharwani.com]
  • His abdominal pain was initially transient but increased in intensity and was associated with nausea and vomiting but no fever.[karger.com]
  • Symptoms may include: Pain in the abdomen that can be mild or severe Blood in the stool Nausea and vomiting Symptoms often occur during the first few years of life. However, they may not start until adulthood.[medlineplus.gov]
  • Symptoms Symptoms may include: Pain in the abdomen that can be mild or severe Blood in the stool Nausea and vomiting Symptoms often occur during the first few years of life. However, they may not start until adulthood.[ufhealth.org]
Acute Abdomen
  • Despite this, it is an uncommon cause of acute abdomen and is often not correctly diagnosed pre-operatively. This article focuses on Meckel diverticulitis.[radiopaedia.org]
  • A Meckel diverticulum should be suspected when the work-up of a patient with lower gastrointestinal bleed or acute abdomen reveals no abnormalities.[amboss.com]
  • We report a case of a 59-year-old male who was admitted under the surgical service at Blackpool Victoria Hospital with suspected appendicitis that turned out to be a Meckel's diverticulitis, a rare presentation of an acute abdomen.[ncbi.nlm.nih.gov]
Abdominal Tenderness
  • On physical examination there was abdominal tenderness, a palpable mass in the lower abdomen, rebound tenderness and increased bowel sounds.[sonoworld.com]
  • The patient appeared uncomfortable with a soft but distended abdomen with mild right lower quadrant abdominal tenderness.[ijcasereportsandimages.com]
  • Abdominal tenderness and pain is localized and felt around the navel. It is often similar to that of appendicitis except for site of tenderness or pain. Children may have repeated episodes of bleeding from the rectum without any pain.[news-medical.net]
  • On clinical examination, abdominal tenderness of the right lower quadrant was noted, and there were sounds of peristalsis on auscultation. The results of a digital rectal examination were normal.[consultant360.com]
  • Marked abdominal tenderness was noted along the left lower quadrant of the abdomen. Sounds in the intestine were noted, and there was no sign of any lesion or organ enlargement.[karger.com]
Flushing
  • Clinically, he appeared flushed and in pain. His abdomen was not distended but tender and guarding in the right upper and lower quadrants. Right flank tenderness was also elicited. There were no hernias and his chest was clear.[ncbi.nlm.nih.gov]
Meningism
  • Ferri’s popular "5 books in 1" format provides quick guidance on short QT syndrome, microscopic polyangiitis, fungal meningitis, and much more. This medical reference makes the answers you need even easier to find - anytime, anywhere.[books.google.com]

Workup

  • No further workup was done. Resuscitation was initiated immediately in the emergency department with intravenous fluids. Nasogastric tube was placed.[ijcasereportsandimages.com]
  • (It would not be included in the workup of GI bleeding, which would be from the inside of the intestine.)[mdmag.com]
Ischemic Changes
  • A congested area with patchy serosal ischemic changes, which included a large indurated Meckel’s diverticulum, was identified (Figure 1A, and B).[ijcasereportsandimages.com]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • Usually the diagnosis of acute appendicitis is made, and this wrong diagnosis will stimulate the right surgical treatment as it does in many other rare abdominal diseases.[jamanetwork.com]
  • The gold standard treatment is laparoscopic surgical resection.[websurg.com]

Prognosis

  • You may need a blood transfusion if you have a lot of bleeding, Outlook (Prognosis) Most people recover fully from surgery and will not have the problem come back. Complications from the surgery are also unlikely.[ufhealth.org]
  • Prognosis With surgery, full recovery can be expected.[drugs.com]
  • Outlook (Prognosis) Most people who have this surgery have a good outcome. But the results of any surgery depend on your overall health. Talk with your doctor about your expected outcome. References Harris JW, Evers BM. Small intestine.[mountsinai.org]
  • Prognosis The outcome after surgery is usually excellent. The source of bleeding, pain, or obstruction is removed so the symptoms also disappear. A Meckel's diverticulum will not return.[medical-dictionary.thefreedictionary.com]

Etiology

  • Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills.[websurg.com]
  • Definition / general Most prevalent congenital abnormality of GI tract, in 2% of normal population Usually asymptomatic but also abdominal pain of unknown etiology ( Rev Esp Enferm Dig 2011;103:250 ) Due to persistence (failure to involute) of proximal[pathologyoutlines.com]
  • DISCUSSION Etiologies of small bowel obstruction (SBO) can be extrinsic (Adhesions, hernia, extrinsic masses, cancer), intrinsic or intra luminal (intestinal tumors, gallstone and foreign bodies, stricture). Obstruction can be partial or complete.[ijcasereportsandimages.com]
  • Because of the now obvious etiology (a small bowel volvulus) of his abdominal symptoms, no biopsy was performed and a gastroscopy was foreseen after the patient recuperated from surgery. The patient recovered well.[consultant360.com]

Epidemiology

  • Meckel’s diverticulum: a high-risk region for malignancy in the ileum—insights from a population-based epidemiological study and implications in surgical management . Ann Surg 2011 ;253(2):223–230.[pubs.rsna.org]
  • Epidemiology Prevalence : most common congenital gastrointestinal tract anomaly ( 2% of the population) Sex: ( 2:1 ) Age: 2 years of age References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • The broad coverage under Part One encompasses basic science, including applied physiology, genetics and epidemiology, through societal aspects of chronic pain and disability, to patient assessment, diagnostic procedures and outcome measures.[books.google.ro]
Sex distribution
Age distribution

Pathophysiology

  • Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills.[websurg.com]
  • Pathophysiology and Rationale for Treatment 197 Chapter 10 The Physiology of Anesthesia and Pain 213 Chapter 11 Sepsis and the Syndrome of Multiple Organ Failure 227 Chapter 12 Application of Cellular and Molecular Biology in Modern Surgical Practice[books.google.ro]
  • Pathophysiology The omphalomesenteric (vitelline or vitellointestinal) duct is a patent tubular structure connecting the yolk sac to the alimentary tract in the embryo. The duct is normally obliterated by the 6 th week of intrauterine life.[amboss.com]
  • Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications.[wjes.biomedcentral.com]
  • Detailed knowledge of the pathophysiological properties is essential in dealing with the life-threatening complications of Meckel's diverticulum. [15] References [ edit ] Elsayes KM, Menias CO, Harvin HJ, Francis IR (July 2007).[en.wikipedia.org]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • However, saline lavage washed the residual activity out of the bladder, and prevented a false-positive diagnosis.[journals.lww.com]
  • Prevention There are no current guidelines to prevent Meckel diverticulum since the cause is unknown. References: Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ 3rd. Surgical management of Meckel’s diverticulum.[cancercarewny.com]
  • Other authors argue that there is little or no additional morbidity from resection of a Meckel diverticulum at the time of another operation and that incidentally discovered diverticula should be resected to prevent the possibility of future bleeding,[pubs.rsna.org]

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