Laparoscopic management of Meckel's diverticulum in children

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Abstract

Background

Rectal bleeding, recurrent abdominal pain, nausea, and vomiting in children could present a diagnostic as well as therapeutic challenge. Meckel's diverticulum (MD) is one of the causes. The objective of the current study was to evaluate the feasibility and outcome of laparoscopic management of MD.

Methods

The clinical data of 33 children admitted with rectal bleeding and/or recurrent abdominal pain with no identifiable cause were reviewed over a period of 8 years. There were 23 boys and 10 girls with a mean age of 5.12 ± 2 years (range, 3-12 years). In 21 cases, MD was an incidental finding on laparoscopic appendectomy and symptomatic in 12 cases. Patients with rectal bleeding were subjected to upper gastrointestinal endoscopy; colonoscopy, and technetium Tc 99m–labeled pertechnetate scan (MS). All patients were subjected to routine laboratory investigations and diagnostic laparoscopy.

Results

Of the 1200 appendectomies, incidental MD was found in 21 (1.9%) patients and symptomatic in 12 cases. Upper gastrointestinal endoscopy and colonoscopy did not show a bleeding source in 7 patients presented with bleeding per rectum. Four cases showed a positive MS uptake. Of these, 3 were found on laparoscopy to have an MD. Three cases showed a negative scan. Of these, 2 had an MD. In 5 cases with recurrent abdominal pain nausea, vomiting, and abdominal distention, diagnostic laparoscopy revealed Meckel's diverticulitis in 3 cases and intussusception secondary to MD in 1 case. Laparoscopic Meckel's diverticulectomy and laparoscopic-assisted Meckel's diverticulectomy was done for 18 and 12 cases, respectively. Ectopic gastric mucosa was present in 13 cases (44%).

Conclusions

Laparoscopy is safe, cost-effective, and efficient for the diagnosis and definitive treatment of MD. Compared with conventional laparotomy, it has the advantage of precise operative diagnosis, less traumatic access, fewer intraoperative and postoperative complications, and shorter recovery period.

Section snippets

Patients and methods

The clinical data of 33 children admitted with rectal bleeding and/or recurrent abdominal pain, nausea, vomiting, and abdominal distension were reviewed over a period of 8 years (between December 1996 and May 2003). All patients were subjected to clinical examinations and routine laboratory investigations. Seven patients with rectal bleeding were subjected to upper gastrointestinal endoscopy, colonoscopy, and MS. All patients were subjected to diagnostic laparoscopy (DL) irrespective of the

Results

The clinical data of 33 cases with rectal bleeding and/or recurrent abdominal pain, nausea, and vomiting were reviewed. There were 23 males and 10 females with a mean age of 5.12 ± 2 years (range, 3-12 years). There was no significant difference in demographic data of symptomatic and incidental MDs. Table 1 summarizes the patients' demographic, clinical, and histological data. The outcome measurements for the study are presented in (Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5). Of 1200 LAs,

Statistical analysis

The data were analyzed using Systac 9.0 software (SPSS Inc, Chicago, Ill). Proportions and percentages were used to summarize categorical variables, whereas descriptive statistics such as means and SDs were used for numerical variables.

Discussion

Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract, occurring in up to 2% to 4% of the population. It results from failure of complete obliteration of vitelline duct. Only 4% of MDs are symptomatic and most cases are asymptomatic and discovered incidentally [8], [9]. A high index of suspicion is necessary for the prompt diagnosis and treatment. The diagnostic modalities including MS are effective in only 60% to 70% of all cases [10]. A positive

References (26)

  • L. Sarli et al.

    Laparoscopic resection of Meckel's diverticulum: report of two cases

    Surg. Today

    (2001)
  • J.F. Arnold et al.

    Meckel's diverticulum: a ten-year experience

    Am. Surg.

    (1997)
  • M. Kapischke et al.

    Meckel's diverticulum: a disease associated with a colored clinical picture

    Surg. Endosc.

    (2003)
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