Complicated Meckel's diverticulum and therapeutic management

Abstract

Objective: In this study we aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who encountered complications due to inflammation of the Meckel's diverticulum in our clinic. Material and Methods: Between October 2007 and October 2012, 14 patients were retrospectively analysed who had been operated on in the General Surgery Department, Ege University Medical Faculty Hospital, because of an acute abdomen and mechanical intestinal obstruction, and Meckel's diverticulitis (MD) was identified as an etiological factor perioperatively and histopathologically. Results: Fourteen patients were retrospectively analysed who were operated on for Meckel's diverticulitis and its complications. Radiologically, in abdominal computed tomography pathologies compatible with mechanical intestinal obstruction, Meckel's diverticulitis and peridivertiküler abscess were reported, and free air in the abdomen was detected on direct abdominal X-ray. Fourteen patients were operated on because of complicated Meckel's diverticula (obstruction, diverticulitis, perforation) and diverticulum excision was performed on 3 (21.4%) patients; right hemicolectomy + ileotransversostomi was performed on 1 (7.1%) patient and partial small bowel resection and end-to-end anastomosis was performed on 10 (71.5%) patients. Conclusion: Meckel's diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular anomaly that contains three layers of the small bowel. If Meckel's diverticula are detected, incidental complications may occur such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation, surgical excision should be performed. Meckel's diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckel's diverticulitis, especially if a definite diagnosis is not reached during the preoperative period, should be considered in the differential diagnosis. The presence of a complicated diverticulum indicates the appropriate approach should be emergency surgical intervention. © Copyright 2013 by Turkish Surgical Association.