Department of Pediatrics, Hangzhou Normal University, Hangzhou, China.
Department of Pediatrics, Suzhou Hospital of Anhui Medical University, Suzhou, Anhui, China.
BMC Surg. 2024 Jan 30;24(1):40. doi: 10.1186/s12893-024-02323-4.
The aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children.
We retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel's diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded.
A total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1-13 years). Perforated Meckel's diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix.
The most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.
本研究旨在总结 20 例术前诊断为急性阑尾炎的复杂 Meckel 憩室（MD）的临床表型和组织学结果，以提高儿童复杂 MD 的诊断和治疗水平。
回顾性分析 2012 年 1 月至 2019 年 1 月我院收治的术前诊断为急性阑尾炎的 20 例复杂 MD 患者的临床资料。根据手术结果将患者分为穿孔型 MD 组和憩室炎型 MD 组。记录患者的一般资料、临床表现、实验室检查、辅助检查、手术方式及异位组织检出情况。
共发现 20 例复杂 MD（穿孔或憩室炎）患者。患儿年龄 313 岁，平均 7.75 岁（中位数 7.75 岁；范围 113 岁）。穿孔型 MD 占 20 例（25%）。穿孔型 MD 与憩室炎型 MD 患者在年龄、干预时间、住院时间和回盲瓣距离方面无统计学差异。所有患者的组织病理学均证实存在异位组织，包括 10 例胃黏膜、3 例同时存在胃黏膜和胰腺组织、2 例胰腺组织。所有患者均在腹腔镜或剖腹手术下行憩室切除术或部分回肠切除术；因阑尾轻度炎症而行阑尾切除术 2 例。
有症状的 MD 最常见的表现为无痛性直肠出血，但也可表现为类似急性阑尾炎的急性腹痛症状。憩室切除术的关键是彻底切除异位黏膜。
