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

Fig. 4: Perforated Meckel’s diverticulum Fig. 5: Computed tomography scan showing irregular thick wall fluid
collection with inflamed mesenteric fat plan (complicated urachal cyst
vs Meckel’s diverticulum)

Fig. 6: Ectopic uptake of Tc99 by Meckel’s diverticulum

Table 2: Types of surgery and complications Table 3: Histology results
Number Percentage Histology Number Percentage
Type of surgery Ectopic gastric tissue 14 82.3
Wedge resection 4 23.5 Ectopic pancreatic 1 5.8
Segmental resection 13 76.4 Gastric and pancreatic 2 11.7
Complications
1—Conversion to minilaparotomy 1 5.8 The incidence of heterotopic mucosa in MD varies from 15 to
2—Reexploration 1 5.8 50%. Shalaby et al. reported that the incidence of HGM in MD
12
3—Adhesive intestinal obstruction 1 5.8 was 77.8% in symptomatic and is much higher than asymptomatic
cases of MD.
bleeding. They report a sensitivity of 66.6% with a false-negative In our study, the incidence of ectopic gastric mucosa was 82.3%.
rate of 33.3%. In our study, MS was positive in nine patients (75%). This result could be attributed to the high incidence of bleeding
False-negative results may be due to the absence of ectopic gastric MD in which the HGM varies from 80 to 100%. 12
mucosa, insufficient gastric mucosa to capture Tc99, or “wash out” As Meckel’s scan has false-negative and -positive rates,
phenomenon caused by accentuated intestinal transit time. 11 laparoscopy may have a great value for the diagnosis and surgical
In our study, Meckel’s scan was the first choice in cases treatment.
presented by lower GIT bleeding which has been performed in The use of laparoscopy for the treatment of MD was first
13
13 patients and was positive in 10 (76.9%) cases with bleeding per described by Attwood et al. who did laparoscopy-assisted
rectum and one case of chronic recurrent abdominal pain. diverticulectomy using a linear stapler device. Also it can be
CT scan has been performed in three cases, one case who was performed with the application of Roeder’s loop on the base of the
presented by chronic abdominal pain and showed periumbilical diverticulum, or with resection and intracorporeal suturing. 5,12–15
mass that could be urachal cyst. The advantage of laparoscopy-assisted excision of MD includes
The other two cases were presented by acute abdominal pain exteriorization of the bowel through the umbilical wound and
and were diagnosed as acute appendicitis, so in the three cases, palpation on the base of the diverticulum for the presence of
CT did not confirm the diagnosis. ectopic mucosa, also the intestinal anastomosis can be performed

World Journal of Laparoscopic Surgery, Volume 13 Issue 2 (May–August 2020) 67