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Meckel's Diverticulum in a Strangulated Umbilical Hernia

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Meckel's Diverticulum in a Strangulated Umbilical Hernia Letters to the Editor Meckel’s diverticulum in a strangulated umbilical hernia Access this article online Quick Response Code: Website: www.afrjpaedsurg.org DOI: 10.4103/0189-6725.86079 PMID: ***** Sir, Meckel’s diverticulum (MD) was determined by Meckel on a small bowel diverticula in 1800.[1] It is the most common anomaly of gastrointestinal tract and reported to occur in 1-3% of general population and autopsy [2] series. The co-occurence of MD and umbilical Figure 1: The congestive vascular structures and the massive hemorrhagic hernia (UH) is very rare in the literature.[3] Although fi ndings under the surface epithelium of the small bowel (H and E, 40×) Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract affecting 1-3% of general population, Meckel’s diverticulum in a strangulated UH is very rare. The most common complication of Meckel’s diverticulum is bleeding in children, unlike intestinal obstruction in the adult population. Although it is rare, a clinician should be vigilant for this entity especially in the case of an abdominal emergency of a non-trauma origin. The clinical features of strangulated Meckel’s diverticulum in an UH are documented.[3] Recently, we managed a 42-year-old Turkish female who had a MD in a strangulated UH. She had been ill 2 week prior to admission. She had had a painful abdominal swelling, without vomiting. Although there was no fever, on the physical examination the skin over the mass was Figure 2: The massive ulceration on the surface epithelium of the small bowel warm. She underwent an exploratory laparotomy. At (H and E, 40×) the surgery, she had a gangrenous MD and a normal appendix. Excision of the diverticulomesenteric band of diverticulomesenteric fibrous bands which are was done and diverticulectomy was performed with an associated with intestinal mesentery or abdominal end-to-end ileoileal anastomosis. wall suffices in the treatment of symptomatic MD, segmental ileal resection (sometimes involving Histological examinations of the MD specimen the removal of 8 cm of the smal bowel at both revealed the mucosal infarctions in some places, sides of MD after the diverticulectomy) may be with the heterotopic small intestinal mucosa required in complicated cases such as bleeding, the [Figures 1 and 2]. Neither the complication nor the diverticulum including a tumor, inflammation of the recurrence has been detected during the 45 months base of the diverticulum or perforation.[4] Komlatsè follow-up.[1] et al[3] presented a gangrenous MD in a strangulated UH in an 18-month girl. They resected 8 cm of the small There are different opinions regarding the treatment bowel at both sides of the MD, with an immediate of incidental (asymptomatic) MD.[4] Although just end-to-end anostomosis. We thought that it is because diverticulectomy without ileal resection and dissection of the presence of a completely gangrenous MD, 256 May-August 2011 / Vol 8 / Issue 2 African Journal of Paediatric Surgery Letters to the Editor probably having an inflamed base, in a febrile patient, Address for correspondence: Dr. Ilker Sengul, than, is a complicated-symptomatic case. However, Giresun Universitesi Tip Fakültesi Dekanligi, Dekan Yardımcısı ve Genel we did not prefer to perform any bowel removal due Cerrahi Anabilim Dali Kurucu Baskani, Nizamiye Yerleskesi, to not detecting any inflammation of the base of the 28100 Giresun, Turkey. diverticulum, bleeding, tumor or perforation. E-mail: [email protected] In conclusion, academic surgeons must lead the effort to REFERENCES awaken and renew interest in highlighting the clinical 1. Sengul I, Sengul D, Avcu S, Parlak O. Gangrenous meckel’s features of diseases and essential role of surgery to diverticulum in a strangulated umbilical hernia in a 42 year-old the health of the population.[5] So, the possibility of a woman: A case report. Cases J 2010;3:10. gangrenous MD as a content of a sac of strangulated 2. Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL. Meckel’s UH has the mentionable importance and it should be diverticulum. J Am Coll Surg 2001;192:658-62. borne in mind while evaluating a child or adult with 3. Komlatsè AG, Komla G, Komla A, Azanledji BM, Abossisso SK, Hubert T. Meckel’s diverticulum strangulated in an umbilical hernia. symptomatic UH. Afr J Paediatr Surg 2009;6:118-9. 4. Tavakkolizadeh A, Whang EE, Ashley SW, Zinner MJ. Small intestine. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Ilker Sengul, Demet Sengul1 Matthews JB, Pollock RE, editors. Schwartz’s Principles of Surgery. Department of General Surgery, Giresun University Faculty of 9th ed. USA: The McGraw-Hill Companies; 2010. p. 979-1012. Medicine, 1Department of Pathology, Prof. Dr. A. Ilhan Ozdemir State 5. Uba FA. African Journal of Paediatric Surgery: Between legacies of Hospital, 28100 Giresun, Turkey the past and challenges for the future. Afr J Paediatr Surg 2010;7:1. Spontaneous rupture of an umbilical hernia Access this article online of these (including the current case) occurred in black Quick Response Code: Website: Nigerians. www.afrjpaedsurg.org We report a five-week-old previously healthy male child DOI: 10.4103/0189-6725.86081 with a spontaneous rupture of his umbilical hernia with evisceration. The five-week-old term male infant PMID: presented to us via the children’s emergency room ***** with a six-hour history of protrusion of the intestines through the umbilicus. The mother discovered the Sir, protrusion of the intestines from the umbilicus on Umbilical hernia is one of the commonest problems lifting the child from his sleeping prone position. The affecting children. It is the commonest of the childhood mother complained that the child frequently suffered hernias.[1,2] It is estimated that one out of every six from abdominal “colic”, for which she has been [3] children has umbilical hernia. Male and females are administering oral herbal medications as well as laying equally affected. It is commoner in the blacks, especially the child prone frequently. in prematurely born babies. Most (75%) of the affected [1] infants weigh less than 1.5 kg. There was no preceding history of cough, or excessive straining during micturition or defecation. There was Development of umbilical hernia is believed to no prior change in bowel habit, abdominal swelling have a molecular basis, as genetic heterogeneity or vomiting, no previous ulceration of umbilicus. accounts for the persistence of the ring after cord Umbilical swelling was noticed two weeks after the separation.[4] The natural course of umbilical hernia is to stump fell off on the seventh day of birth without any close spontaneously. Only about 10% of non-corrected feature of infection. cases persist into adulthood.[1] Complications were thought to be rare, but report by Ameh et al., suggested The family history was unremarkable. Examination a higher complication rate in Africans.[2] revealed a calm 3.8-kg baby with no clinical evidence of umbilical infection or trauma. Spontaneous rupture with evisceration in children is rare,[2,5-7] with only 18 reported cases worldwide. Nine Following resuscitation and initial care, the gut was African Journal of Paediatric Surgery May-August 2011 / Vol 8 / Issue 2 257 Copyright of African Journal of Paediatric Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use..
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