Appendicitis combined with Meckel’s diverticulum obstruction, perforation, and inflammation in children: Three case reports

BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.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 diver-ticulum 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 diver-ticular 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,dia-gnostic 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.

Single-center retrospective study of the diagnostic value of doubleballoon enteroscopy in Meckel’s diverticulum with bleeding

BACKGROUND The study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel’s diverticulum(MD)complicated by digestive tract hemorrhage.Moreover,we aimed to evaluate the value of double-balloon enteroscopy(DBE)in MD diagnosis and the prognosis after laparoscopic diverticula resection.AIM To evaluate the value of DBE in the diagnosis and the prognosis after laparoscopic diverticula resection for MD with bleeding.METHODS The study retrospectively analyzed relevant data from 84 MD patients treated between January 2015 and March 2022 and recorded their clinical manifestations,auxiliary examination,and follow-up after laparoscopic resection of diverticula.RESULTS(1)Among 84 MD patients complicated with hemorrhage,77 were male,and 7 were female with an average age of 31.31±10.75 years.The incidence was higher in men than in women of different ages;(2)Among the 84 MD patients,65(78.40%)had defecated dark red stools,and 50(58.80%)had no accompanying symptoms during bleeding,indicating that most MD bleeding appeared a dark red stool without accompanying symptoms;(3)The shock index of 71 patients(85.20%)was<1,suggesting that the blood loss of most MD patients was less than 20%–30%,and only a few patients had a blood loss of>30%;(4)The DBE-positive rate was 100%(54/54),99mTcpertechnetate-positive scanning rate was 78%(35/45)compared with capsule endoscopy(36%)and small intestine computed tomography(19%).These results suggest that DBE and 99mTc-pertechnetate scans had significant advantages in diagnosing MD and bleeding,especially DBE was a highly precise examination method in MD diagnosis;(5)A total of 54 MD patients with hemorrhage underwent DBE examination before surgery.DBE endoscopy revealed many mucosal manifestations including normal appearance,inflammatory changes,ulcerative changes,diverticulum inversion,and nodular hyperplasia,with ulcerative changes being the most common(53.70%).This suggests that diverticular mucosal ulcer was the main cause of MD and bleeding;and(6)Laparoscopic dissection of diverticulae was performed in 76 patients,The patients who underwent postoperative follow-up did not experience any further bleeding.Additionally,follow-up examination of the 8 cases who had declined surgery revealed that 3 of them experienced a recurrence of digestive tract bleeding.These findings indicate that laparoscopic diverticula resection in MD patients complicated by bleeding had a favorable prognosis.CONCLUSION Bleeding associated with MD was predominantly observed in male adolescents,particularly at a young age.DBE was a highly precise examination method in MD diagnosis.Laparoscopic diverticula resection effectively prevented MD bleeding and had a good prognosis.

A Darcy-Law Based Model for Heat and Moisture Transfer in a Hill Cave

A hill can be regarded as an environmental carrier of heat.Water,rocks and the internal moisture naturally pre-sent in such environment constitute a natural heat accumulator.In the present study,the heat and moisture trans-fer characteristics in a representative hill cave have been simulated via a method relying on the Darcy’s law.The simulations have been conducted for both steady and unsteady conditions to discern the influence of permeability and geometric parameters on the thermal and moisture transfer processes.The reliability of the simulation has been verified through comparison of the numerical results with the annual observation data.As revealed by the numericalfindings,the internal temperature of the hill accumulator is proportional to the permeability,outside surface temperature,overground height,underground constant temperature layer depth,and underground tem-perature of the hill,and it is inversely proportional to the horizontal size of the hill.Moreover,in the considered case,the order of magnitude of the permeability of the hill is contained in the range 10-15–10-13,and displays a certain sensitivity to the rainwater seepage.

Distant metastasis of hepatocellular carcinoma to Meckel’s cave and cranial nerves:A case report and review of literature

BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less common metastatic site.CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus,Meckel’s cave,and the petrous bone involving multiple cranial nerves in an 82-year-old woman.At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(MRI)revealed multiple HCC nodules in both right and left lobes.Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC.Molecular targeted therapy with Lenvatinib(8 mg/d for 94 d,per os)and Ramucirumab(340 mg/d and 320 mg/d,two times by intravenous injection)were administered for 4 mo,resulting in progression of the disease.Three months after the start of molecular target therapy,the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye,indicating disturbances in the right trigeminal and abducens nerves.Brain MRI disclosed a mass involving the cavernous sinus,Meckel’s cave and the petrous bone.Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus,Meckel’s cave,and the petrous bone was made based on neurological findings and imaging studies including MRI,but not on histological examinations.Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

多层螺旋CT对小肠Meckel’s憩室的诊断价值

目的探讨多层螺旋CT对小肠Meckel’s憩室的诊断价值。方法搜集经手术及病理证实的7例小肠Meckel’s憩室患者的临床与CT检查资料,回顾性分析检查方法对诊断结果的影响。结果 7例患者术前均做了多层螺旋CT增强扫描,其中3例做了肠道准备并行三维重建者,明确诊断为Meckel’s憩室2例,其中1例表现为回肠壁上的不规则盲管状含气突起,其壁较厚,增强扫描时显著强化,另1例表现为肠壁局限性向下突起的含液指状憩室,其内可见小结节状软组织影,增强扫描憩室壁及憩室内小结节均明显强化。3例未做肠道准备也未行三维重建者及1例未做肠道准备但行三维重建者均未发现憩室。结论多层螺旋CT增强扫描及三维重建图像后处理可全面、直观地显示Meckel’s憩室的位置、形态及其与邻近肠管的关系,对该病的诊断有很大的帮助,CT扫描前充分的肠道准备则是其必要条件。

Sonic hedgehog在小鼠胚胎下颌突Meckel's软骨发育过程中的表达

目的:研究Sonic hedgehog(Shh)基因在小鼠胚胎颌面部Meckel's软骨发育不同阶段的表达,探讨Shh基因在下颌骨体发育骨化中的功能。方法:利用原位杂交和免疫组化技术检测Shh基因mRNA在小鼠胚胎11～14.5 dpc(days post coitum)阶段下颌突Meckel's软骨中的表达情况。结果:在颌面形成的早期阶段(11～12.5 dpc),Shh基因mRNA和蛋白在Meckel's软骨有表达且有增强趋势,但在颌面发育完成(14.5 dpc)后表达消失。结论:Shh基因可能参与下颌骨体早期发育。

甲状旁腺激素相关蛋白对发育中的Meckel’s软骨作用的研究

目的观察SD大鼠下颌骨发育过程中甲状旁腺激素相关蛋白(PTHrP)在Meckel’s软骨上时空的变化,初步探讨PTHrP在Meckel’s软骨发育中的意义.方法用免疫组化染色法及原位杂交染色法检测E13-19dSD胎鼠的下颌骨发育过程中,PTHrP及PTHrPmRNA在Meckel’s软骨上的表达.结果 E13-15d在Meckel’s软骨前段PTHrP蛋白强阳性表达,在细胞核、胞浆均表达,在肥大软骨细胞核上表达更明显,而且PTHrPmRNA强阳性表达的位置与PTHrP蛋白一致.E17-19d Meckel’s软骨前段骨化,E17d在临近成骨处的Meckel’s软骨软骨细胞PTHrP蛋白弱阳性表达,且位于肥大软骨细胞核内,PTHrPmRNA阴性表达.E19dPTHrP临近成骨处蛋白染色阴性表达,PTHrPmRNA阴性表达;在前段远离骨化处PTHrPmRNA,PTHrP蛋白强阳性表达,细胞核上表达明显.结论 PTHrP在Meckel’s软骨前段软骨细胞中的表达存在时空特异变化,提示PTHrP蛋白可能由SD大鼠Meckel's软骨软骨细胞合成,并作为一种自分泌因子调节Meckel’s软骨细胞的增殖和分化.

经乳突入路Meckel’s囊及其毗邻结构的应用解剖

目的:为临床手术中Meckel’s囊的切开提供解剖学资料。方法:经10%甲醛固定成人尸头标本15具30侧,模拟乙状窦前(迷路后)入路及乙状窦后入路,内窥镜下观察Meckel’s囊口及毗邻结构。而后开颅取脑,三叉神经自Meckel’s囊处切断。解剖Meckel’s囊,观察其与周围结构的关系,测量Meckel’s囊口的前后径、宽度,Meckel’s囊的组成,与Dorello管外口、岩静脉、内耳道的距离。结果:Meckel’s囊口的最长径为(9.53±1.66)mm、最宽径为(2.99±0.43)mm,Meckel’s囊口上端到Dorello管口的距离为(6.99±1.30)mm。Meckel’s囊口到内耳道、岩静脉、岩上窦-乙状窦交点的最近距离分别为(9.80±1.61)mm、(9.40±1.65)mm、(38.41±2.49)mm。结论:部分Meckel’s外侧壁两层硬膜之间夹有独立的骨片,增加了Meckel’s囊区域操作的难度,解剖中测量的数据为Meckel’s囊附近的手术提供了参考。

三叉神经节和Meckel's腔原发性肿瘤的MRI表现

目的研究三叉神经节和Meckel's腔原发肿瘤的MRI表现。方法对14例经病理证实的三叉神经节和Meckel's腔原发肿瘤患者包括4例三叉神经鞘瘤,5例脑膜瘤,1例脂肪瘤,以及4例表皮样囊肿的MRI表现进行了分析。结果三叉神经鞘瘤在T1WI上呈均匀低信号,在T2WI上呈高信号。5例脑膜瘤中的3例在T1WI和T2WI上与周围脑组织信号一致,1例在T1WI上呈低信号,在T2WI上呈高信号,另1例在CT图像上有丰富的钙质沉着而在T1WI和T2WI上均呈低信号。脂肪瘤信号均匀且与眶内和皮下脂肪信号一致。4例表皮样囊肿的2例在T1WI和T2WI上呈非常高的信号,另外2例呈匍匐性生长并且占位效应较轻。肿瘤侵犯三叉神经能很好的显示其范围。结论发生自三叉神经节和Meckel's腔的不同原发肿瘤具有各自的信号特征,可通过MR成像予以鉴别。

小儿Meckel's憩室内翻套入回肠并发肠套叠及穿孔1例

小儿Meckel's憩室并发肠套叠及穿孔是儿科急腹症之一,一经确诊应及早外科手术。本文介绍小儿Meckel's憩室内翻套入回肠并发肠套叠及穿孔1例。

小儿Meckel’s憩室24例临床分析

目的:探讨小儿Meckel’s憩室的临床表现、诊断方法及与组织形态的关系。方法:回顾性分析本院近10年经手术病理证实为Meckel’s憩室的小儿患者24例。结果:Meckel’s憩室并发下消化道出血15例、肠梗阻4例,下消化道出血患儿中14例行99mTcO-4腹部显像,与病理符合率为57%。结论:下消化道出血是小儿Meckel’s憩室的常见并发症,核素显像是术前诊断的主要方法,活动期出血、血管畸形可导致假阳性率增加。

Lipoma within inverted Meckel’s diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage: A case report and review of literature

Lipoma within an inverted Meckel's diverticulum presen- ting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum. According to our knowledge, this is the first case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.

手术治疗Meckel’s憩室20例

目的 提高对Meckel’s憩室的诊治水平。方法 回顾性总结经手术及病理证实的Meckel’s憩室 2 0例 ,14例因并发症手术 ,6例在其他手术中发现。结果 15例行单纯楔形切除 ,5例行肠切除吻合术。术后无并发症发生。结论 Meckel’s憩室属先天性畸形 ,术前不易诊断。其并发症发生率约为 4% ,依次为 :憩室炎 (常合并出血 ) ,肠套叠 ,嵌顿疝 ,肿瘤等 ,手术治疗效果好。

Inverted Meckel's diverticulum as a cause of occult lower gastrointestinal hemorrhage

Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly,but rarely it can present with hemorrhage.Over the last few years inverted Meckel's diverticulum has been reported in the literature with increasing frequency as an occult source of lower gastrointestinal hemorrhage.Here,we report a case of a 54-year-old male,who was referred for surgical evaluation with persistent anemia and occult blood per rectum after a work up which failed to localize the source over 12 mo,including upper and capsule endoscopy,colonoscopy,enteroclysis,Meckel scan,and tagged nuclear red blood cell scan.An abdominal computed tomography scan showed a possible mid-ileal intussusception and intraluminal mass.During the abdominal exploration,inverted Meckel's diverticulum was diagnosed and resected.We review the literature,discuss the forms in which the disease presents,the diagnostic modalities utilized,pathological findings,and treatment.Although less than 40 cases have been reported in the English literature from 1978 to 2005,19 cases have been reported in the last 6 years alone(2006-2012) due to improved diagnostic modalities.Successful diagnosis and treatment of this disease requires a high index of clinical suspicion,which is becoming increasingly relevant to general gastroenterologists.

Intestinal obstruction caused by torsed gangrenous Meckel's diverticulum encircling terminal ileum

Meckel's diverticulum(MD)is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage,obstruction,and inflammation.Obstruction of various types is the most common presenting symptom in the adult population.Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications.The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies.Delay in the diagnosis of a complicated MD can lead to signifi- cant morbidity and mortality.Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum.To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.

Inverted Meckel’s diverticulum manifested as adult intussusception: Age does not matter

Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.

Meckel's diverticulum bleeding diagnosed with magnetic resonance enterography:A case report

Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postopera-tive pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.