Meckel¡¯s diverticular complications in children: is laparoscopy the order of the day?

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• 作者：T. R. Sai Prasad ; Chan Hon Chui ; Fatima Reyaz Singaporewalla ; Choo Phaik Caroline Ong ; Yee Low ; Te Lu Yap and Anette Sundfor Jacobsen
• 关键词：Meckel&#8217 ; s diverticulum ; Complications ; Laparoscopy ; Children
• 刊名：Pediatric Surgery International
• 出版年：2007
• 出版时间：February, 2007
• 年：2007
• 卷：23
• 期：2
• 页码：141-147
• 全文大小：220 KB

文摘

Meckel’s diverticulum (MD), a seemingly innocuous anomaly of the gastrointestinal tract, presents distinctive challenges to a clinician, as it is prone to varied complications that are frequently elusive to diagnosis with conventional diagnostic modalities. This case series illustrates the diverse presentations and advantages of laparoscopic-assisted management of Meckel’s diverticular complications in children. Between October 2002 and April 2006, 36 patients (27 males and 9 females) aged 1.5 to 16 years (median 10 years) underwent laparoscopic-assisted trans-umbilical Meckel’s diverticulectomy (LATUM). Sixteen (44.4 % ) patients presented with lower gastrointestinal bleeding (14 with painless bleed and 2 with perforated peptic ulcer in the ileum adjacent to the MD), six (16.7 % ) patients presented with intestinal obstruction (four due to a mesodiverticular band and one each due to intussusception and floppy giant cystic dilatation of MD causing intestinal compression) and four (11.1 % ) patients presented with features masquerading as appendicitis (one with Meckel’s diverticulitis and perforation, one with perforated peptic ulcer adjacent to MD and two with a torted and gangrenous MD). In ten (27.8 % ) patients, incidental MD with a narrow base was noted at laparoscopic exploration for suspected appendicitis. All patients underwent successful LATUM along with appendicectomy in 15 (41.7 % ) patients. The operative duration ranged from 72 to 266 min (mean 125.9 ¡À 48.4). There were no intra-operative complications and none required conversion to open surgery. The hospital stay was 3 to 9 days (mean 5.3 ¡À 1.2). There were three (8.3 % ) cases of postoperative adhesive intestinal obstruction; two underwent successful laparoscopic adhesiolysis and one necessitated conversion to suprapubic laparotomy to release the pelvic adhesions. There were no other complications during the follow-up (median 16 months). LATUM is a safe, effective and an esthetic procedure offering timely diagnosis and cure for diverse Meckel’s diverticular complications. The technique also allows palpation of the MD and avoids usage of expensive staplers.