quiz Meckel diverticulum

[Admin]

A three-year old boy presents with painless and episodic bright red blood per rectum. After adequate resuscitation, a technetium-99m pertechnetate scan demonstrates uptake in the right lower quadrant. Diagnostic laparoscopy shows a three cm diverticulum with a 1.3 cm base with thickening at the tip. Compared to segmental resection, simple Meckel diverticulectomy is associated with

A increased risk of bleeding.

B increased stricture rate.

C longer hospital stay.

D shorter operative time.

E increased leak rate.

[Admin]

D

correct

Meckel diverticulum (MD) is the congenital persistence of all or part of the omphalomesenteric or vitelline duct. The most common symptoms of MD are bleeding, obstruction and inflammation. Among all children with gastrointestinal (GI) hemorrhage, roughly half are attributable to MD. Patients with a bleeding MD will often present with painless and episodic bright red blood per rectum. A technetium-99m pertechnetate scintiscan (i.e. Meckel scan) is often used to diagnose MD as the source of GI bleeding. The isotope is taken up by gastric mucosal cells found in the MD. Administration of H2 receptor blocker inhibits the release of the tracer from cells and may enhance the sensitivity of the scan.

The mainstay of management for a bleeding MD after appropriate resuscitation is surgical excision. Controversy exists regarding the optimal surgical therapy - namely whether segmental ileal resection is required versus diverticulectomy. A recent study by Robinson reviewed all MD in children presenting with bleeding from 2002 to 2016 at their institution [1]. Sixteen of the 27 patients underwent diverticulectomy and 11 had segmental ileal resection. All specimens contained ectopic gastric mucosa and all specimens demonstrated complete resection of the ectopic tissue. Ulcers were seen in 19 of 27 patients at an average distance 2.95 mm from the nearest ectopic gastric tissue. There were no rebleeding occurrences in either group. The diverticulectomy group had shorter operative times and shorter length of hospitalization (1.6 days versus 4.0 days, p< 0.001). Thus in patients with a narrow diverticulum, a transverse diverticulectomy is the most appropriate management as a longitudinal diverticulectomy risks narrowing of the ileum. A wedge resection of the ileum may be required if the diverticulum is shorter and with a broad base. Some suggest that a diameter to height ratio greater than 2 may not be amenable to simple diverticulectomy.

[Sharon]

D

[Admin]

D

correct

Meckel diverticulum (MD) is the congenital persistence of all or part of the omphalomesenteric or vitelline duct. The most common symptoms of MD are bleeding, obstruction and inflammation. Among all children with gastrointestinal (GI) hemorrhage, roughly half are attributable to MD. Patients with a bleeding MD will often present with painless and episodic bright red blood per rectum. A technetium-99m pertechnetate scintiscan (i.e. Meckel scan) is often used to diagnose MD as the source of GI bleeding. The isotope is taken up by gastric mucosal cells found in the MD. Administration of H2 receptor blocker inhibits the release of the tracer from cells and may enhance the sensitivity of the scan.

The mainstay of management for a bleeding MD after appropriate resuscitation is surgical excision. Controversy exists regarding the optimal surgical therapy - namely whether segmental ileal resection is required versus diverticulectomy. A recent study by Robinson reviewed all MD in children presenting with bleeding from 2002 to 2016 at their institution [1]. Sixteen of the 27 patients underwent diverticulectomy and 11 had segmental ileal resection. All specimens contained ectopic gastric mucosa and all specimens demonstrated complete resection of the ectopic tissue. Ulcers were seen in 19 of 27 patients at an average distance 2.95 mm from the nearest ectopic gastric tissue. There were no rebleeding occurrences in either group. The diverticulectomy group had shorter operative times and shorter length of hospitalization (1.6 days versus 4.0 days, p< 0.001). Thus in patients with a narrow diverticulum, a transverse diverticulectomy is the most appropriate management as a longitudinal diverticulectomy risks narrowing of the ileum. A wedge resection of the ileum may be required if the diverticulum is shorter and with a broad base. Some suggest that a diameter to height ratio greater than 2 may not be amenable to simple diverticulectomy.