Meckel's diverticulum surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Surgical treatment consists of a [[resection]] of the affected portion of the bowel. | Surgical treatment consists of a [[resection]] of the affected portion of the bowel.<ref name="pmid18216533">{{cite journal |vauthors=Zani A, Eaton S, Rees CM, Pierro A |title=Incidentally detected Meckel diverticulum: to resect or not to resect? |journal=Ann. Surg. |volume=247 |issue=2 |pages=276–81 |year=2008 |pmid=18216533 |doi=10.1097/SLA.0b013e31815aaaf8 |url=}}</ref><ref name="pmid15729078">{{cite journal |vauthors=Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR |title=Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002) |journal=Ann. Surg. |volume=241 |issue=3 |pages=529–33 |year=2005 |pmid=15729078 |pmc=1356994 |doi= |url=}}</ref><ref name="pmid25065089">{{cite journal |vauthors=Lohsiriwat V, Sirivech T, Laohapensang M, Pongpaibul A |title=Comparative study on the characteristics of Meckel's diverticulum removal from asymptomatic and symptomatic patients: 18-year experience from Thailand's largest university hospital |journal=J Med Assoc Thai |volume=97 |issue=5 |pages=506–12 |year=2014 |pmid=25065089 |doi= |url=}}</ref><ref name="pmid28359587">{{cite journal |vauthors=Robinson JR, Correa H, Brinkman AS, Lovvorn HN |title=Optimizing surgical resection of the bleeding Meckel diverticulum in children |journal=J. Pediatr. Surg. |volume=52 |issue=10 |pages=1610–1615 |year=2017 |pmid=28359587 |doi=10.1016/j.jpedsurg.2017.03.047 |url=}}</ref> | ||
=== Asymptomatic Meckel’s diverticulum === | === Asymptomatic Meckel’s diverticulum === | ||
An asymptomatic Meckel diverticulum is discovered incidentally on abdominal imaging or exploration( laparoscopy or laparotomy) for | * An [[asymptomatic]] Meckel's diverticulum is discovered incidentally on [[Abdomen|abdominal]] [[imaging]] or [[exploration]]( [[Laparoscopic surgery|laparoscopy]] or [[laparotomy]]) for an indication such as a presumptive diagnosis of [[acute cholecystitis]]. | ||
* Generally, [[Resection|surgical resection]] is avoided in cases of [[asymptomatic]] [[Diverticular|diverticula]] as in order to benefit a single patient, 800 incidental [[Diverticular|diverticula]] need to be removed. | |||
* In elderly patients, resection of [[diverticulum]] may be preferred to prevent complications. | |||
* Removal of an [[asymptomatic]] [[diverticulum]] is not advised in the presence of complications such as: | |||
** [[Inflammatory bowel disease|Inflammatory Bowel Disease]]: | |||
*** [[Ulcerative colitis]] | |||
*** [[Crohn's disease]] | |||
** [[Peritonitis]] | |||
* The decision regarding [[resection]] is made by the surgeon based on appearance of the [[diverticulum]]. | |||
* Indications for [[resection]] include: | |||
** Absence of a wide mouth | |||
** [[Diverticular|Diverticula]] with fibrous bands | |||
** Presence of [[Ectopia|ectopic]] [[Stomach|gastric]] [[Tissue (biology)|tissue]] | |||
** Length of [[diverticulum]] more than 2cm | |||
** Narrow neck of [[diverticulum]] may undergo twisting or [[obstruction]] | |||
** Presence of intramural pathology | |||
** Thickened, [[Inflammation|inflamed]] [[diverticulum]] | |||
** Children | |||
** Elderly patients | |||
=== Symptomatic Meckel diverticulum === | |||
* Absolute indications for [[resection]] of a [[symptomatic]] Meckel's diverticulum include complications such as: | |||
* [[Bleeding|Hemorrhage]] | |||
* Umbilicoileal [[Fistula|fistulas]] | |||
* [[Inflammation]] of [[diverticulum]]: [[Diverticulitis]] | |||
* [[Intestine|Bowel]] [[obstruction]] | |||
==Surgery== | ==Surgery== | ||
Revision as of 21:08, 4 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgical treatment consists of a resection of the affected portion of the bowel.[1][2][3][4]
Asymptomatic Meckel’s diverticulum
- An asymptomatic Meckel's diverticulum is discovered incidentally on abdominal imaging or exploration( laparoscopy or laparotomy) for an indication such as a presumptive diagnosis of acute cholecystitis.
- Generally, surgical resection is avoided in cases of asymptomatic diverticula as in order to benefit a single patient, 800 incidental diverticula need to be removed.
- In elderly patients, resection of diverticulum may be preferred to prevent complications.
- Removal of an asymptomatic diverticulum is not advised in the presence of complications such as:
- The decision regarding resection is made by the surgeon based on appearance of the diverticulum.
- Indications for resection include:
- Absence of a wide mouth
- Diverticula with fibrous bands
- Presence of ectopic gastric tissue
- Length of diverticulum more than 2cm
- Narrow neck of diverticulum may undergo twisting or obstruction
- Presence of intramural pathology
- Thickened, inflamed diverticulum
- Children
- Elderly patients
Symptomatic Meckel diverticulum
- Absolute indications for resection of a symptomatic Meckel's diverticulum include complications such as:
- Hemorrhage
- Umbilicoileal fistulas
- Inflammation of diverticulum: Diverticulitis
- Bowel obstruction
Surgery
References
- ↑ Zani A, Eaton S, Rees CM, Pierro A (2008). "Incidentally detected Meckel diverticulum: to resect or not to resect?". Ann. Surg. 247 (2): 276–81. doi:10.1097/SLA.0b013e31815aaaf8. PMID 18216533.
- ↑ Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR (2005). "Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002)". Ann. Surg. 241 (3): 529–33. PMC 1356994. PMID 15729078.
- ↑ Lohsiriwat V, Sirivech T, Laohapensang M, Pongpaibul A (2014). "Comparative study on the characteristics of Meckel's diverticulum removal from asymptomatic and symptomatic patients: 18-year experience from Thailand's largest university hospital". J Med Assoc Thai. 97 (5): 506–12. PMID 25065089.
- ↑ Robinson JR, Correa H, Brinkman AS, Lovvorn HN (2017). "Optimizing surgical resection of the bleeding Meckel diverticulum in children". J. Pediatr. Surg. 52 (10): 1610–1615. doi:10.1016/j.jpedsurg.2017.03.047. PMID 28359587.