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Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature

INTRODUCTION: In 1809, Johann Friedrich Meckel described the embryology of a small bowel diverticulum, which now bears his name. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, with a prevalence ranging from 1% to 4% of the population. The majority...

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Autores principales: Seth, Ajai, Seth, Jai
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073917/
https://www.ncbi.nlm.nih.gov/pubmed/21443776
http://dx.doi.org/10.1186/1752-1947-5-118
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author Seth, Ajai
Seth, Jai
author_facet Seth, Ajai
Seth, Jai
author_sort Seth, Ajai
collection PubMed
description INTRODUCTION: In 1809, Johann Friedrich Meckel described the embryology of a small bowel diverticulum, which now bears his name. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, with a prevalence ranging from 1% to 4% of the population. The majority are clinically silent and are incidentally identified at surgery or at autopsy. The lifetime risk of complications is estimated at 4%, with most of these complications occurring in adults. It is these cases that can cause problems for the clinician, as the diagnosis can be elusive and the consequences extremely serious. CASE PRESENTATION: We present the case of a 68-year-old Caucasian man with axial torsion of a Meckel's diverticulum around its base, a rare complication. He presented with acute, severe abdominal pain, and a clinical diagnosis of perforated acute appendicitis was made. Laparotomy revealed a torted Meckel's diverticulum with distal necrosis and perforation, which was resected. His recovery was uncomplicated, and he was discharged to home six days post-operatively. CONCLUSION: Torsion is an extremely rare complication of Meckel's diverticulum. Its presentation can be elusive, and it can mimic a number of different, more common intra-abdominal pathologies. Imaging appears to be an unreliable diagnostic tool, and the diagnosis is usually made intra-operatively. Factors pre-disposing these patients to axial torsion of Meckel's diverticulum include the presence of mesodiverticular bands, a narrow base, excessive length, and associated neoplastic growth or inflammation of the diverticulum. The importance of searching for a diseased Meckel's diverticulum at laparotomy in appropriate circumstances is highlighted. Once identified, prompt surgical excision generally leads to an uncomplicated recovery.
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spelling pubmed-30739172011-04-12 Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature Seth, Ajai Seth, Jai J Med Case Reports Case Report INTRODUCTION: In 1809, Johann Friedrich Meckel described the embryology of a small bowel diverticulum, which now bears his name. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, with a prevalence ranging from 1% to 4% of the population. The majority are clinically silent and are incidentally identified at surgery or at autopsy. The lifetime risk of complications is estimated at 4%, with most of these complications occurring in adults. It is these cases that can cause problems for the clinician, as the diagnosis can be elusive and the consequences extremely serious. CASE PRESENTATION: We present the case of a 68-year-old Caucasian man with axial torsion of a Meckel's diverticulum around its base, a rare complication. He presented with acute, severe abdominal pain, and a clinical diagnosis of perforated acute appendicitis was made. Laparotomy revealed a torted Meckel's diverticulum with distal necrosis and perforation, which was resected. His recovery was uncomplicated, and he was discharged to home six days post-operatively. CONCLUSION: Torsion is an extremely rare complication of Meckel's diverticulum. Its presentation can be elusive, and it can mimic a number of different, more common intra-abdominal pathologies. Imaging appears to be an unreliable diagnostic tool, and the diagnosis is usually made intra-operatively. Factors pre-disposing these patients to axial torsion of Meckel's diverticulum include the presence of mesodiverticular bands, a narrow base, excessive length, and associated neoplastic growth or inflammation of the diverticulum. The importance of searching for a diseased Meckel's diverticulum at laparotomy in appropriate circumstances is highlighted. Once identified, prompt surgical excision generally leads to an uncomplicated recovery. BioMed Central 2011-03-28 /pmc/articles/PMC3073917/ /pubmed/21443776 http://dx.doi.org/10.1186/1752-1947-5-118 Text en Copyright ©2011 Seth and Seth; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Seth, Ajai
Seth, Jai
Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature
title Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature
title_full Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature
title_fullStr Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature
title_full_unstemmed Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature
title_short Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature
title_sort axial torsion as a rare and unusual complication of a meckel's diverticulum: a case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073917/
https://www.ncbi.nlm.nih.gov/pubmed/21443776
http://dx.doi.org/10.1186/1752-1947-5-118
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