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Laparoscopy-assisted Approach for Meckel’s Diverticulum in Pediatric Age

Fig. 1: Meckel’s diverticulum with its tip attached to the cecum Fig. 2: Meckel’s diverticulum exteriorized from the umbilicus

Table 1: Demographic data and presentations
Number Percentage
Mean age 8.3 years
Male 11 64.7
Female 6 35.2
Rectal bleeding 11 64.7
Acute appendicitis 3 17.6
Intestinal obstruction 2 11.7
Chronic abdominal pain 1 5.8
Meckel’s scan 13 76.4
CT 3 17.6
Abd US 4 23.5

was 8.3 years (range 5–14 years). The ratio of male to female was
11:6 (Table 1). Fig. 3: Meckel’s diverticulum forming inflammatory mass attached to
All patients were operated by a laparoscopy-assisted excision. the cecum
Four patients underwent wedge excision and 13 patients
underwent segmental bowel resection, in 1 patient, the resection The median hospital stay was 3.8 days (range 4–7 days).
of the diverticulum was performed with a linear stapler. Eleven
patients had painless rectal bleeding, while one had chronic dIscussIon
abdominal pain, and the CT study showed cystic mass attached to Recently, the use of laparoscopy in pediatric surgery has much
the umbilicus. Three patients were presented by picture similar to more increased. 7,8
acute appendicitis and CT showed picture of acute appendicitis with Complicated MD can be presented at any age. Infants and
dilated bowel loop in these cases the tip of the MD was inflamed children are at highest risk, and >50% of symptomatic Meckel’s
and attached to the cecum and compressing the bowel (Fig. 3), diverticula occurring in children <2 years. Also, younger children
and in one case the tip was perforated and forming inflammatory (<4 years) are most commonly present with obstruction, as opposed
mass around the cecum (Fig. 4) and two patients were presented to older patients who tend to present with bleeding. 9
by intestinal obstruction (Fig. 5). In our study, the most common presentation was bleeding
Meckel’s scan was performed for 13 cases and was sensitive and, the median age at diagnosis was 5.4 years (range 5–14 years).
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in 82.3% (Fig. 6). In a study performed by Palanivelu et al., the age ranges from 6
10
The mean operative time was 71.4 minutes (ranges from 65 to 43 years. Also, Rho et al. reported an age ranges from 7 days
to 115 minutes). There was no intraoperative or postoperative to 19 years.
complications, except for one patient, whose initial exploration Tc99m pertechnetate scan has been the investigation of choice
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was negative but the patient rebleed again after discharge and in children with MD containing heterotopic gastric mucosa (HGM).
readmitted and diagnostic laparoscopy was repeated and the MD Premedication with histamine-2 blockers or proton-pump inhibitors
was identified and resected. Two patients had low-grade fever has been described to increase the diagnostic accuracy of the scan,
on the second day that was from minor atelectasis and resolved the reported sensitivity of the Meckel’s scan ranges from 60 to 90%
spontaneously with conservative treatment (Table 2). with the specificity ranges from 90 to 98%. 10,11
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Histopathology of the specimens showed ectopic gastric Menezes et al. published a retrospective study and assessed
mucosa in 12 patients, and focal ulceration in 4 of them (Table 3). the sensitivity of the Meckel’s scan in patients with severe GIT
66 World Journal of Laparoscopic Surgery, Volume 13 Issue 2 (May–August 2020)