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LETTER TO THE EDITOR Table of Contents   
Year : 2011  |  Volume : 8  |  Issue : 2  |  Page : 256-257
Meckel's diverticulum in a strangulated umbilical hernia


1 Department of General Surgery, Giresun University Faculty of Medicine, 28100 Giresun, Turkey
2 Department of Pathology, Prof. Dr. A. Ilhan Ozdemir State Hospital, 28100 Giresun, Turkey

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Date of Web Publication14-Oct-2011
 

How to cite this article:
Sengul I, Sengul D. Meckel's diverticulum in a strangulated umbilical hernia. Afr J Paediatr Surg 2011;8:256-7

How to cite this URL:
Sengul I, Sengul D. Meckel's diverticulum in a strangulated umbilical hernia. Afr J Paediatr Surg [serial online] 2011 [cited 2019 Sep 15];8:256-7. Available from: http://www.afrjpaedsurg.org/text.asp?2011/8/2/256/86079
Sir,

Meckel's diverticulum (MD) was determined by Meckel on a small bowel diverticula in 1800. [1] It is the most common anomaly of gastrointestinal tract and reported to occur in 1-3% of general population and autopsy series. [2] The co-occurence of MD and umbilical hernia (UH) is very rare in the literature. [3] Although Meckel's diverticulum is the most common anomaly of the gastrointestinal tract affecting 1-3% of general population, Meckel's diverticulum in a strangulated UH is very rare. The most common complication of Meckel's diverticulum is bleeding in children, unlike intestinal obstruction in the adult population. Although it is rare, a clinician should be vigilant for this entity especially in the case of an abdominal emergency of a non-trauma origin. The clinical features of strangulated Meckel's diverticulum in an UH are documented. [3]

Recently, we managed a 42-year-old Turkish female who had a MD in a strangulated UH. She had been ill 2 week prior to admission. She had had a painful abdominal swelling, without vomiting. Although there was no fever, on the physical examination the skin over the mass was warm. She underwent an exploratory laparotomy. At the surgery, she had a gangrenous MD and a normal appendix. Excision of the diverticulomesenteric band was done and diverticulectomy was performed with an end-to-end ileoileal anastomosis.

Histological examinations of the MD specimen revealed the mucosal infarctions in some places, with the heterotopic small intestinal mucosa [Figure 1] and [Figure 2]. Neither the complication nor the recurrence has been detected during the 45 months follow-up. [1]
Figure 1: The congestive vascular structures and the massive hemorrhagic findings under the surface epithelium of the small bowel (H and E, 40×)

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Figure 2: The massive ulceration on the surface epithelium of the small bowel (H and E, 40×)

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There are different opinions regarding the treatment of incidental (asymptomatic) MD. [4] Although just diverticulectomy without ileal resection and dissection of diverticulomesenteric fibrous bands which are associated with intestinal mesentery or abdominal wall suffices in the treatment of symptomatic MD, segmental ileal resection (sometimes involving the removal of 8 cm of the smal bowel at both sides of MD after the diverticulectomy) may be required in complicated cases such as bleeding, the diverticulum including a tumor, inflammation of the base of the diverticulum or perforation. [4] Komlatsè et al[3] presented a gangrenous MD in a strangulated UH in an 18-month girl. They resected 8 cm of the small bowel at both sides of the MD, with an immediate end-to-end anostomosis. We thought that it is because of the presence of a completely gangrenous MD, probably having an inflamed base, in a febrile patient, than, is a complicated-symptomatic case. However, we did not prefer to perform any bowel removal due to not detecting any inflammation of the base of the diverticulum, bleeding, tumor or perforation.

In conclusion, academic surgeons must lead the effort to awaken and renew interest in highlighting the clinical features of diseases and essential role of surgery to the health of the population. [5] So, the possibility of a gangrenous MD as a content of a sac of strangulated UH has the mentionable importance and it should be borne in mind while evaluating a child or adult with symptomatic UH.

 
   References Top

1.Sengul I, Sengul D, Avcu S, Parlak O. Gangrenous meckel's diverticulum in a strangulated umbilical hernia in a 42 year-old woman: A case report. Cases J 2010;3:10.  Back to cited text no. 1
    
2.Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL. Meckel's diverticulum. J Am Coll Surg 2001;192:658-62.   Back to cited text no. 2
    
3.Komlatsè AG, Komla G, Komla A, Azanledji BM, Abossisso SK, Hubert T. Meckel's diverticulum strangulated in an umbilical hernia. Afr J Paediatr Surg 2009;6:118-9.  Back to cited text no. 3
    
4.Tavakkolizadeh A, Whang EE, Ashley SW, Zinner MJ. Small intestine. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz's Principles of Surgery. 9 th ed. USA: The McGraw-Hill Companies; 2010. p. 979-1012.  Back to cited text no. 4
    
5.Uba FA. African Journal of Paediatric Surgery: Between legacies of the past and challenges for the future. Afr J Paediatr Surg 2010;7:1.  Back to cited text no. 5
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Correspondence Address:
Ilker Sengul
Giresun Universitesi Tip Fakültesi Dekanligi, Dekan Yardimcisi ve Genel Cerrahi Anabilim Dali Kurucu Baskani, Nizamiye Yerleskesi, 28100 Giresun
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.86079

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