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Perforated Meckel's diverticulum presenting with combined bowel and urinary obstruction and mimicking Crohn's disease: a case report
Banny S Wong, David W Larson, Thomas C Smyrk, Amy S Oxentenko
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-264
Abstract: We describe the case of a 21-year-old man with a history of recurrent papillary thyroid cancer, but no prior abdominal surgeries, who presented with a one-month history of rectal pain and new-onset obstipation with urinary retention. He reported night sweats and weight loss, and had a second-degree relative with known Crohn's disease. A digital rectal examination was notable and revealed marked tenderness with proximal induration. A computed tomography scan of the patient's abdomen revealed a large, complex, circumferential perirectal abscess compressing the rectal lumen and base of the urinary bladder, associated with terminal ileal thickening and an ileocecal fistula. A flexible sigmoidoscopy with an endorectal ultrasound scan displayed a complex abscess with extensive mucosal and surrounding inflammation. An exploratory laparotomy revealed a Meckel's diverticulum with a large perforation at its base, positioned near the ileocecal fistula and immediately superior to the perirectal abscess. The section of small bowel containing the Meckel's diverticulum, the terminal ileum, and the cecum, were all resected, and the abscess was debrided.Pre-operative diagnosis of Meckel's diverticulum can be difficult. If the nature of the complication makes ultimate surgical management likely, an early laparoscopic or open exploration should be performed to prevent the morbidity and mortality associated with late complications.Meckel's diverticulum is a congenital anomaly found in approximately 2% of the general population. Complications develop in only 4% of patients with this malformation, with most cases presenting in childhood [1]. Complications of Meckel's diverticulum include hemorrhage, bowel obstruction, inflammation, and perforation. All of these complications can be challenging to diagnose because patients may present with non-specific symptoms, which produce a clinical picture that can mimic other more common gastrointestinal disorders [2]. We report an unusual case of a
Eventration of Diaphragm Presenting as Small Bowel Obstruction  [PDF]
Muhammad Ahmed,Bilal Mirza,Afzal Sheikh
APSP Journal of Case Reports , 2010,
Abstract: Eventration of Diaphragm Presenting as Small Bowel Obstruction
Perforated Appendicitis Presenting as Small Bowel Obstruction in an Infant  [cached]
Bilal Mirza
APSP Journal of Case Reports , 2011,
Abstract: A case of Perforated Appendicitis Presenting as Small Bowel Obstruction in an Infant is being reported
Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report
Aziz Sumer,Ozgur Kemik,Aydemir Olmez,A. Cumhur Dulger,Ismail Hasirci,Umit Iliklerden,Erol Kisli,Cetin Kotan
Case Reports in Medicine , 2010, DOI: 10.1155/2010/901456
Abstract: Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.
Acute small bowel obstruction as a result of a Meckel's diverticulum encircling the terminal ileum: A case report
Avnesh S Thakor, Siong S Liau, Dermot C o'Riordan
Journal of Medical Case Reports , 2007, DOI: 10.1186/1752-1947-1-8
Abstract: In the present report, we present a rare case where a fit and healthy 74-year-old gentleman, with no previous history of abdominal surgery, presented with the cardinal symptoms and signs of small bowel obstruction as the result of a Meckel's diverticulum encircling his terminal ileum. Initial investigations included a supine abdominal x-ray showing dilated loops of small bowel and computerised tomographic imaging of the abdomen, which revealed a stricture in the terminal ileum of unknown aetiology. At laparotomy, multiple loops of distended small bowel were seen from the duodeno-jeujenal junction to the terminal ileum, which was encircled by a Meckel's diverticulum. The Meckel's diverticulum was then divided to release the obstruction, mobilised and subsequently removed. Finally, the small bowel contents were decompressed into the stomach and the nasogastric tube aspirated, before returning the loops of bowel into the abdomen in sequence. The patient made a good postoperative recovery and was discharged home 5 days later.This report highlights the importance of considering a Meckel's diverticulum as a cause of small bowel obstruction in individuals from all age groups and especially in a person with no previous abdominal pathology or surgery.In the developed world, small bowl obstruction accounts for 20% of all acute surgical admissions. The aetiology of small bowel obstruction includes several pathological factors, with the most common cause being postoperative adhesions followed by herniae [1]. However, in patients who present with the symptoms and signs of bowel obstruction and who have had no previous abdominal surgery, or any detectable herniae on physical examination, other causes such as a Meckel's diverticulum should be considered.A Meckel's diverticulum is a congenital pouch on the wall of the distal ileum, usually about 2 inches from the ileocecal valve. It represents a vestigial remnant of the omphalomesenteric duct and occurs in approximately 2% of the p
Case Report - Intussusception caused by an inverted Meckel’s diverticulum: A rare cause of small bowel obstruction in adults
M Bouassida, B Feidi, MB Ali, MF Chtourou, M Krifa, S Sassi, F Chebbi, MM Mighri, H Touinsi, S Sassi
Pan African Medical Journal , 2011,
Abstract: Adult intussusception due to Meckel’s diverticulum 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 one case of intussusception due to Meckel’s diverticulum in an adult. A 22-year-old patient was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness. We diagnosed an acute small bowel obstruction and performed emergency surgery. The intra operative findings were distention of the small bowel and intussusception of ileus due to an inverted Meckel’s diverticulum located 70 cm from the ileocecal valve. 30 cm ischemic loop was identified. A segmental small bowel resection and hand-sewn anastomosis was performed. Histopathology distinguished Meckel’s diverticulum measuring 5 cm x 3.5 cm x 1 cm and no signs of malignancy.
Angiodysplasia Presenting with Multiple Polypoid Lesions: An Unusual Cause of Small Bowel Obstruction  [PDF]
Yoshiharu Takenaka, Takahiro Sasaki, Nobuyoshi Miyajima, Takehito Otsubo
Case Reports in Clinical Medicine (CRCM) , 2014, DOI: 10.4236/crcm.2014.311128
Abstract: Angiodysplasia (AD), a morphologic vascular abnormality, is a common cause of gastrointestinal bleeding. We present a rare case of polypoid AD lesions. Three years after treatment for adhesive bowel obstruction, a 57-year-old man was admitted with recurrent abdominal distension, anorexia, and lower extremity edema. Computed tomography showed his dilated proximal and collapsed distal small bowel loops had disparate calibers. The transition point demonstrated mucosal enhancement and mesenteric lymphadenopathy. We observed small intestinal wall outpouching with strong mucosal enhancement and polypoid lesions dotting the dilated intestine. Intraoperative findings revealed a hard but elastic intraluminal nodule causing small bowel obstruction and the outpouching’s occurrence on the ileum’s antimesenteric border. We performed partial resection of the small intestine involving the nodule and Meckel’s diverticulum. Macroscopically, the nodule, diverticulum, and intestinal mucosa had polypoid lesions. Histopathologically, these lesions had foci within dilated thin- or thick-walled vascular channels in the submucosa, without specific histological abnormalities. These features led to a diagnosis of AD.
Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report
Mohammad Tayeb, Faiz Khan, Fozia Rauf, M Mumtaz Khan
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-482
Abstract: A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery.Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction.Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract [1]. Previous gastric resection, gastrojejunostomy, pyloroplasty, ingestion of high-fiber foods, persimmon fruit ingestion, incomplete mastication habits, and autonomic neuropathies in patients with diabetes are predisposing factors for bezoar formation [2].Different types of phytobezoars have been reported in the literature. The most common type is the diospyrobezoar, which occurs as a result of the ingestion of persimmons [3]. Pharmacobezoars caused by medicine, shellac bezoars in furniture workers, lactobezoars in neonates, and trichobezoars in psychiatric patients or young girls are other types of bezoars [3,4].Small-bowel bezoars normally come from stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel disease such as diverticula, strictures, or tumors [5]. Primary small-bowel bezoars almost always present as intestinal obstructions, although they are a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series [6].Jejunal diverticula are rare, with an incidence of less than 0.5% [7]. They are usually pseudodiverticula of pulsion type, comprised of only mucosa and submucosa arising from the mesenteric border at vascular entry sites. Despite the fact that most patients with jejunal diverticulosis remain completely asymptomatic, complications are reported in 10% to 30% of patients [8-10]. These include chronic abdo
Superior Mesenteric Venous Thrombosis after Laparoscopic Exploration for Small Bowel Obstruction  [PDF]
Hideki Katagiri,Shozo Kunizaki,Mayu Shimaguchi,Yasuo Yoshinaga,Yukihiro Kanda,Alan T. Lefor,Ken Mizokami
Case Reports in Surgery , 2013, DOI: 10.1155/2013/952383
Abstract: Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms. 1. Introduction Mesenteric venous thrombosis is an unusual cause of intestinal ischemia and potentially life-threatening because it can result in intestinal infarction. Mesenteric venous thrombosis accounts for 5 to 15% of all mesenteric ischemic events and usually involves the superior mesenteric vein [1–4]. Several cases of mesenteric venous thrombosis after abdominal surgery have been reported; however, mesenteric venous thrombosis after surgery for abdominal sepsis is especially uncommon. We report a case of superior mesenteric venous thrombosis after abdominal abscess with small intestinal perforation, successfully treated by systemic anticoagulation therapy. 2. Case Presentation A 68-year-old woman with a history of previous abdominal surgery presented with abdominal pain and vomiting. One day prior to admission, she noted the gradual onset of abdominal pain. She had one bowel movement but the abdominal pain persisted. The pain was intermittent and gradually worsened. She vomited several times. She underwent a hernia repair 15 years previously and had a lower midline incision, although the details of that procedure were unavailable. On physical examination, her lower abdomen was slightly distended with mild tenderness to palpation. Dilated intestine was palpable, but there were no signs of peritonitis. Nasogastric suction was initiated but inadequate and the abdominal pain persisted. Abdominal CT scan
A gastrointestinal stromal tumour presenting incidentally with haemorrhage and perforation associated with a Meckel's diverticulum: a case report
Richard Woolf, Natalie Blencowe, Karim Muhammad, David Paterson, Geoff Pye
Journal of Medical Case Reports , 2009, DOI: 10.4076/1752-1947-3-7423
Abstract: A 59-year-old Caucasian man presented with acute right iliac fossa pain with localized peritonism. At surgery, he was found to have a perforated and haemorrhagic Meckel's diverticulum, associated with a gastrointestinal stromal tumour within the apex of the diverticulum. The absence of necrosis and a low mitotic rate indicated primary resection with subsequent computed tomography surveillance to be the most appropriate management strategy.We report a unique triad of complications associated with the presentation of a Meckel's diverticulum. This article reviews this common congenital abnormality and discusses the management of a gastrointestinal tumour. Meckel's diverticulum will mimic other intra-abdominal pathologies in presentation and should therefore often be considered as a differential diagnosis.This is the first reported case of perforation and haemorrhage of a Meckel's diverticulum leading to the incidental finding of a gastrointestinal stromal tumour within the diverticulum. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis and perforation. Tumours within a Meckel's diverticulum are a rare but recognised complication.A 59-year-old Caucasian man presented with peri-umbilical pain that had localized to the right iliac fossa. On examination, he was tender in the right iliac fossa, with localized peritonism. His white cell count was 10.2 × 109 (neutrophils 8.1 × 109) and with C-reactive protein (CRP) <5. Acute appendicitis was diagnosed clinically and a diagnostic laparoscopy performed.A perforated Meckel's diverticulum was found, associated with free intra-abdominal fluid and haemorrhage. At subsequent laparotomy, 75 mm of small bowel was resected and primary anastamosis was performed. Histology confirmed a Meckel's diverticulum and with a 25 mm area of perforat
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