Evola Giuseppe, Caramma Sebastiano, Caruso Giovambattista, Schillaci Riccardo, Reina Carlo, Reina Giuseppe Angelo
General and Emergency Surgery Department, Garibaldi Hospital, Catania, Italy.
General Surgery Department, San Salvatore Hospital, Paternò, Catania, Italy.
Int J Surg Case Rep. 2021 May;82:105897. doi: 10.1016/j.ijscr.2021.105897. Epub 2021 Apr 20.
Meckel's diverticulum (MD) is a vestigial remnant of the omphalomesenteric duct, representing the most common congenital malformation of the gastrointestinal tract. Diagnosis of MD is a challenge because of its rarity and frequent asymptomaticity. Radiological exams generally aren't useful for its diagnosis. Intestinal obstruction represents the most common complication of MD in adults. Surgery is the appropriate treatment of complicated MD.
A 70-year-old Caucasian male was admitted to the Emergency Department with a two-day history of abdominal pain associated with inability to pass gas or stool, nausea and vomiting. Physical examination revealed abdominal distention and abdominal pain without Blumberg's sign. Abdominal contrast-enhanced computed tomography (CECT) showed small bowel obstruction caused by suspected MD. Laboratory tests reported high serum levels of glycemia, LDH, C-reactive protein and leukocytosis. After diagnosis of intestinal obstruction, the patient underwent exploratory laparotomy: a segmental resection of ischemic distal ileum bearing a necrotic MD was performed. The postoperative course of patient was uneventful.
MD is found in 2%-4% of the population in large autopsy and surgical series. MD is mostly asymptomatic and incidentally discovered if not complicated; a debate exist about management of asymptomatic MD. Surgery represents the definitive treatment of complicated MD.
MD is a true diverticulum rarely discovered in adults. Diagnosis of MD is difficult even with the help of radiological exams. Although surgical resection represents the correct treatment of symptomatic MD, nowadays there is no consensus on the optimal treatment of asymptomatic and incidentally discovered MD.
梅克尔憩室（MD）是卵黄管的残余遗迹，是胃肠道最常见的先天性畸形。由于MD罕见且常无症状，其诊断具有挑战性。放射学检查通常对其诊断无用。肠梗阻是成人MD最常见的并发症。手术是治疗复杂性MD的恰当方法。
一名70岁的白种男性因腹痛两天伴无法排气或排便、恶心和呕吐入院急诊科。体格检查发现腹胀和腹痛，无反跳痛。腹部增强计算机断层扫描（CECT）显示疑似MD导致的小肠梗阻。实验室检查报告血糖、乳酸脱氢酶、C反应蛋白血清水平升高及白细胞增多。诊断为肠梗阻后，患者接受了剖腹探查术：对一段带有坏死MD的缺血性回肠末端进行了节段性切除。患者术后恢复顺利。
在大型尸检和手术系列中，MD在2%-4%的人群中被发现。MD大多无症状，若不并发则偶然发现；关于无症状MD的管理存在争议。手术是复杂性MD的确定性治疗方法。
MD是一种真正的憩室，在成人中很少被发现。即使借助放射学检查，MD的诊断也很困难。尽管手术切除是有症状MD的正确治疗方法，但目前对于无症状和偶然发现的MD的最佳治疗方法尚无共识。
