Chan Clarissa K, Pham Tiffany, Bhagat Yash V, Fulton William, Kianmajd Majid
Surgery, NorthBay Medical Center, Fairfield, USA.
Internal Medicine, NorthBay Medical Center, Fairfield, USA.
Cureus. 2022 Aug 2;14(8):e27625. doi: 10.7759/cureus.27625. eCollection 2022 Aug.
Meckel's diverticulum (MD), the most common congenital disease of the small bowel, commonly presents with symptoms of painless rectal bleeding and intestinal obstruction. The treatment of symptomatic MD involves resection of the lesion regardless of patient age; however, the excision of asymptomatic and incidentally identified MDs in adults remain controversial. On one hand, the complications arising from MDs decrease with age, leading to a lower benefit than risk ratio with prophylactic resection. On the other hand, malignancies, such as neuroendocrine tumors, may arise over time from untreated MDs. This can lead to poor prognostic complications, such as liver or lymph node metastases. In this case report, we describe an incidental Meckel's diverticulum discovered during an exploratory laparotomy for acute sigmoid diverticulitis in an adult male. Later biopsy findings discovered the lesion to contain a grade 1 neuroendocrine tumor. Based on our literature review findings, resection of the incidental Meckel's diverticulum was a reasonable approach given the low complication risks of the procedure and the possibility of malignant transformation and progression.
梅克尔憩室(MD)是小肠最常见的先天性疾病,通常表现为无痛性直肠出血和肠梗阻症状。有症状的MD的治疗包括切除病变,无论患者年龄如何;然而,成人无症状且偶然发现的MD的切除仍存在争议。一方面,MD引起的并发症随年龄增长而减少,导致预防性切除的获益风险比降低。另一方面,未经治疗的MD可能随着时间推移发生恶性肿瘤,如神经内分泌肿瘤。这可能导致预后不良的并发症,如肝转移或淋巴结转移。在本病例报告中,我们描述了一名成年男性在因急性乙状结肠憩室炎进行剖腹探查时偶然发现的梅克尔憩室。后来的活检结果发现病变含有1级神经内分泌肿瘤。根据我们的文献综述结果,鉴于该手术并发症风险低以及存在恶性转化和进展的可能性,切除偶然发现的梅克尔憩室是一种合理的方法。