Intestinal obstruction caused by Meckel’s diverticulum in children

Meckel’s diverticulum is the most common variant of anomalies of incomplete obliteration of the yolk duct. Among the various malformations of the digestive tract, which can cause intestinal obstruction, Meckel’s diverticulum ranks first and is 1.7%. Purpose – to generalize the results of treatment of children with intestinal obstruction caused by Meckel’s diverticulum. Materials and methods. The experience of treating 183 children with Meckel’s diverticulum and related pathology is summarized. The main complications of Meckel’s diverticulum were intestinal obstruction, bleeding from a peptic ulcer, diverticulitis. In 100 children, the diverticulum was asymptomatic and was an accidental finding during surgery on the abdominal organs for other pathologies. Results. Intestinal obstruction caused by Meckel’s diverticulum accounted for 20.8% of all cases and 45.7% of all diverticulum-related complications. Strangulative intestinal obstruction was diagnosed in 18 patients: in 16 Meckel’s diverticulum caused internal compression, in 1 – torsion of the loops of the small intestine around the fixed diverticulum, in 1 – nodulation. In 5 observations, Meckel’s diverticulum caused the phenomenon of partial intestinal obstruction. Intussusception was detected in 15 children (small intestinal in 6 cases and ileocecal in 9). Clinical cases demonstrating the difficulties in diagnosing intesti nal intussusception caused by Meckel’s diverticulum in older children and small bowel entrapment in the mesodiverticular ligament are presented. A method of subserous diverticulectomy and one-step decompression of the small intestine was proposed. Conclusions. Meckel’s diverticulum should be considered as a probable cause of acute intestinal obstruction in children older than 2 years and who have not previously undergone surgery on the abdominal organs. In the surgical treatment of pathology caused by Meckel’s diverticulum, it is possible to use one-time decompression of the small intestine by diverticulotomy and subserous removal of the diverticulum. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Meckel’s diverticulum, intestinal obstruction, children.

Delayed Presentation of Congenital Jejunal Web beyond the Neonatal Period

Congenital web of the gastrointestinal tract is a rare anomaly which may present at any site of the gastrointestinal tract. In cases with an intact membrane, the presenting symptoms may take the form of complete intestinal obstruction while in other cases with a fenestrated membrane, it may present with partial intestinal obstruction such as failure to thrive, volume depletion, or poor body-weight gain, representing a chronic condition. It is very rare for a jejunal web to present with retention of accidently ingested foreign body. In this report, we document a case of 14-month boy with retention of accidently ingested button battery who was found to have a jejunal web on surgical exploration. This case report stresses on the importance of prevention of ingestion of inanimate foreign bodies especially in young infants and that the absence of symptoms does not preclude presence of foreign body in children. Also, surgeons should be prepared to deal with other unsuspected findings intraoperatively. After a review of the literature, jejunal web should be considered in the differential diagnosis of chronic partial intestinal obstruction even in adults.

Inflammatory cap polyp of the sigmoid colon: a case report

Background Inflammatory cap polyp is a very rare benign entity of the distal left colon, characterized by inflammatory polyp with a “cap” of fibrinopurulent exudates. They are usually multiple and commonly present with bleeding per rectum or mucoid discharge. Solitary polyp presenting with intermittent intussusceptions is rare. Case presentation We report the case of a 45-year-old Nepalese male with a solitary inflammatory sigmoid colon polyp. The patient presented with a 1-month history of rectal bleeding, mucoid discharge, and severe colicky abdominal pain due to intussusceptions. On colonoscopy, there was an exophytic mass with surface exudates. Colonic resection and anastomosis were performed, due to recurring partial intestinal obstruction. At a 6-month follow-up, the patient was asymptomatic. Conclusion Inflammatory cap polyp is a benign entity, and it should be kept in mind as an important differential diagnosis of exophytic colonic mass with surface exudates.

Ileal Atresia in a 10-day-old male baby: A case report

Ileal Atresia is noted to be the commonest cause of intestinal obstruction in neonates worldwide but still under diagnosed in Sub-Saharan countries with scarce data reported on its occurrence. It is likely under diagnosed due to low index of suspicion. Advancement in foetal ultrasound during prenatal period will increase index of suspicion and hence early diagnosis and correction. This is the first case report in our setup highlighting this condition. We present a case of a 10-day-old male baby referred to us due to vomiting since birth. Clinically was in distress with a palpable supraumbilical mass that was firm and non-tender. Abdominal ultrasound scan showed poor peristalsis and minimal dilation of bowels suggestive of partial intestinal obstruction. Abdominal X-ray showed dilated bowels with multiple air-fluid levels, empty rectum with features suggestive of intestinal obstruction. Patient was successfully operated but unfortunately on day 3 post-surgery succumbed.

Phytobezoar Within Meckel’s Diverticulum Presenting With Partial Intestinal Obstruction

Introduction: Meckel’s Diverticulum (MD) affects approximately 2% of the population. Phytobezoar is defined as a vegetable and fiber-based ball in the gastrointestinal tract. We report a rare case of phytobezoar within MD presenting with partial intestinal obstruction. Case Reports: We hereby present a 20-year-old man who referred to the Emergency Department of a hospital with a two-day history of nausea, vomiting, abdominal pain, and constipation. He underwent a midline laparotomy with surgical exploration, which revealed an MD 60 cm proximal to ileocecal valve containing phytobezoar. Histopathology reported the extracted specimen as an MD without ectopic tissue. Conclusion: Meckel’s diverticulum can be affected by bezoars as well as other parts of the gastrointestinal tract. We recommend that phytobezoar within MD be considered among differential diagnosis of bowel obstruction.

A RARE CASE OF THE COMBINATION OF OMPHALOCELE WITH ISOLATED ENTEROCYSTS IN A NEWBORN

The authors describe an extremely rare combination of omphalocele and isolated segments of the small intestine with enetercystomas having their own mesentery. This pathology was manifested by a syndrome of partial intestinal obstruction during 50 days after suturing the anterior abdominal wall because of omphalocele. During relaparotomy, a pair of separated intestinal fragments with hypertension in their inner content was removed. The patient recovered completely.

Intestinal stones: A rare cause of bowel obstruction

Enterolithiasis or intestinal stones are uncommonly reported. Enterostasis is the cause of stone formation mainly secondary to tuberculous strictures. Although it is unusual, enteroliths can cause intestinal obstruction. We report a case of a mechanical partial intestinal obstruction in a patient with ulcerative colitis previously treated with total colectomy, with the rare diagnosis of multiple primary enterolithiasis.

Interdependency between mechanical parameters and afferent nerve discharge in hypertrophic intestine of rats

Partial intestinal obstruction causes smooth muscle hypertrophy, enteric neuronal plasticity, motility disorders, and biomechanical remodeling. In this study we characterized the stimulus-response function of afferent fibers innervating the partially obstructed jejunum. A key question is whether changes in afferent firing arise from remodeled mechanical tissue properties or from adaptive afferent processes. Partial obstruction was created by placing a polyethylene ring for 2 wk in jejunum of seven rats. Sham obstruction was made in six rats and seven rats served as normal controls. Firing from mesenteric afferent nerve bundles was recorded during mechanical ramp, relaxation, and creep tests. Stress-strain, spike rate increase ratio (SRIR), and firing rate in single units were assessed for evaluation of interdependency of the mechanical stimulations, histomorphometry data, and afferent nerve discharge. Partial intestinal obstruction resulted in hypertrophy and jejunal stiffening proximal to the obstruction site. Low SRIR at low strains during fast distension and at high stresses during slow distension was found in the obstructed rats. Single unit analysis showed increased proportion of mechanosensitive units but absent high-threshold (HT) units during slow stimulation, decreased number of HT units during fast stimulation, and shift from HT sensitivity towards low threshold sensitivity in the obstructed jejunum. Biomechanical remodeling and altered afferent response to mechanical stimulations were found in the obstructed jejunum. Afferents from obstructed jejunum preserved their function in encoding ongoing mechanical stimulation but showed changes in their responsiveness. The findings support that mechanical factors rather than adaption are important for afferent remodeling.