Meckel's diverticulum surgery: Difference between revisions
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=== Asymptomatic Meckel’s diverticulum === | === Asymptomatic Meckel’s diverticulum === | ||
* An [[asymptomatic]] Meckel's diverticulum is discovered incidentally on [[Abdomen|abdominal]] [[imaging]] or [[exploration]]( [[Laparoscopic surgery|laparoscopy]] or [[laparotomy]]) for an indication such as a presumptive diagnosis of [[acute cholecystitis]]. | * An [[asymptomatic]] Meckel's diverticulum is discovered incidentally on [[Abdomen|abdominal]] [[imaging]] or [[exploration]]( [[Laparoscopic surgery|laparoscopy]] or [[laparotomy]]) for an indication such as a presumptive diagnosis of [[acute cholecystitis]]. | ||
* Generally, [[Resection|surgical resection]] is avoided in cases of [[asymptomatic]] [[Diverticular|diverticula]] as in order to benefit a single patient, 800 incidental [[Diverticular|diverticula]] need to be removed. | * Generally, [[Resection|surgical resection]] is avoided in cases of [[asymptomatic]] [[Diverticular|diverticula]] as in order to benefit a single patient, 800 incidental [[Diverticular|diverticula]] need to be removed.<ref name="pmid952346">{{cite journal |vauthors=Soltero MJ, Bill AH |title=The natural history of Meckel's Diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period |journal=Am. J. Surg. |volume=132 |issue=2 |pages=168–73 |year=1976 |pmid=952346 |doi= |url=}}</ref> | ||
* In elderly patients, resection of [[diverticulum]] may be preferred to prevent complications. | * In elderly patients, resection of [[diverticulum]] may be preferred to prevent complications. | ||
* Removal of an [[asymptomatic]] [[diverticulum]] is not advised in the presence of complications such as: | * Removal of an [[asymptomatic]] [[diverticulum]] is not advised in the presence of complications such as: | ||
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* The decision regarding [[resection]] is made by the surgeon based on appearance of the [[diverticulum]]. | * The decision regarding [[resection]] is made by the surgeon based on appearance of the [[diverticulum]]. | ||
* Indications for [[resection]] include: | * Indications for [[resection]] include:<ref name="pmid21135700">{{cite journal |vauthors=Thirunavukarasu P, Sathaiah M, Sukumar S, Bartels CJ, Zeh H, Lee KK, Bartlett DL |title=Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management |journal=Ann. Surg. |volume=253 |issue=2 |pages=223–30 |year=2011 |pmid=21135700 |pmc=4129548 |doi=10.1097/SLA.0b013e3181ef488d |url=}}</ref><ref name="pmid7944666">{{cite journal |vauthors=Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ |title=Surgical management of Meckel's diverticulum. An epidemiologic, population-based study |journal=Ann. Surg. |volume=220 |issue=4 |pages=564–8; discussion 568–9 |year=1994 |pmid=7944666 |pmc=1234434 |doi= |url=}}</ref><ref name="pmid26435520">{{cite journal |vauthors=Gezer HÖ, Temiz A, İnce E, Ezer SS, Hasbay B, Hiçsönmez A |title=Meckel diverticulum in children: Evaluation of macroscopic appearance for guidance in subsequent surgery |journal=J. Pediatr. Surg. |volume=51 |issue=7 |pages=1177–80 |year=2016 |pmid=26435520 |doi=10.1016/j.jpedsurg.2015.08.066 |url=}}</ref> | ||
** Absence of a wide mouth | ** Absence of a wide mouth | ||
** [[Diverticular|Diverticula]] with fibrous bands | ** [[Diverticular|Diverticula]] with fibrous bands | ||
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=== Symptomatic Meckel diverticulum === | === Symptomatic Meckel diverticulum === | ||
* Absolute indications for [[resection]] of a [[symptomatic]] Meckel's diverticulum include complications such as: | * Absolute indications for [[resection]] of a [[symptomatic]] Meckel's diverticulum include complications such as:<ref name="pmid17375785">{{cite journal |vauthors=McKay R |title=High incidence of symptomatic Meckel's diverticulum in patients less than fifty years of age: an indication for resection |journal=Am Surg |volume=73 |issue=3 |pages=271–5 |year=2007 |pmid=17375785 |doi= |url=}}</ref> | ||
* [[Bleeding|Hemorrhage]] | * [[Bleeding|Hemorrhage]] | ||
* Umbilicoileal [[Fistula|fistulas]] | * Umbilicoileal [[Fistula|fistulas]] | ||
Revision as of 21:14, 4 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgical treatment consists of a resection of the affected portion of the bowel.[1][2][3][4]
Asymptomatic Meckel’s diverticulum
- An asymptomatic Meckel's diverticulum is discovered incidentally on abdominal imaging or exploration( laparoscopy or laparotomy) for an indication such as a presumptive diagnosis of acute cholecystitis.
- Generally, surgical resection is avoided in cases of asymptomatic diverticula as in order to benefit a single patient, 800 incidental diverticula need to be removed.[5]
- In elderly patients, resection of diverticulum may be preferred to prevent complications.
- Removal of an asymptomatic diverticulum is not advised in the presence of complications such as:
- The decision regarding resection is made by the surgeon based on appearance of the diverticulum.
- Indications for resection include:[6][7][8]
- Absence of a wide mouth
- Diverticula with fibrous bands
- Presence of ectopic gastric tissue
- Length of diverticulum more than 2cm
- Narrow neck of diverticulum may undergo twisting or obstruction
- Presence of intramural pathology
- Thickened, inflamed diverticulum
- Children
- Elderly patients
Symptomatic Meckel diverticulum
- Absolute indications for resection of a symptomatic Meckel's diverticulum include complications such as:[9]
- Hemorrhage
- Umbilicoileal fistulas
- Inflammation of diverticulum: Diverticulitis
- Bowel obstruction
Surgery
References
- ↑ Zani A, Eaton S, Rees CM, Pierro A (2008). "Incidentally detected Meckel diverticulum: to resect or not to resect?". Ann. Surg. 247 (2): 276–81. doi:10.1097/SLA.0b013e31815aaaf8. PMID 18216533.
- ↑ Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR (2005). "Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002)". Ann. Surg. 241 (3): 529–33. PMC 1356994. PMID 15729078.
- ↑ Lohsiriwat V, Sirivech T, Laohapensang M, Pongpaibul A (2014). "Comparative study on the characteristics of Meckel's diverticulum removal from asymptomatic and symptomatic patients: 18-year experience from Thailand's largest university hospital". J Med Assoc Thai. 97 (5): 506–12. PMID 25065089.
- ↑ Robinson JR, Correa H, Brinkman AS, Lovvorn HN (2017). "Optimizing surgical resection of the bleeding Meckel diverticulum in children". J. Pediatr. Surg. 52 (10): 1610–1615. doi:10.1016/j.jpedsurg.2017.03.047. PMID 28359587.
- ↑ Soltero MJ, Bill AH (1976). "The natural history of Meckel's Diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period". Am. J. Surg. 132 (2): 168–73. PMID 952346.
- ↑ Thirunavukarasu P, Sathaiah M, Sukumar S, Bartels CJ, Zeh H, Lee KK, Bartlett DL (2011). "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. 253 (2): 223–30. doi:10.1097/SLA.0b013e3181ef488d. PMC 4129548. PMID 21135700.
- ↑ Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ (1994). "Surgical management of Meckel's diverticulum. An epidemiologic, population-based study". Ann. Surg. 220 (4): 564–8, discussion 568–9. PMC 1234434. PMID 7944666.
- ↑ Gezer HÖ, Temiz A, İnce E, Ezer SS, Hasbay B, Hiçsönmez A (2016). "Meckel diverticulum in children: Evaluation of macroscopic appearance for guidance in subsequent surgery". J. Pediatr. Surg. 51 (7): 1177–80. doi:10.1016/j.jpedsurg.2015.08.066. PMID 26435520.
- ↑ McKay R (2007). "High incidence of symptomatic Meckel's diverticulum in patients less than fifty years of age: an indication for resection". Am Surg. 73 (3): 271–5. PMID 17375785.