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LETTER TO THE EDITOR Table of Contents   
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 56-57
Meckel's diverticulum: Is this the time for a large multicentric study?


S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy

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Date of Web Publication28-Feb-2019
 

How to cite this article:
Bertozzi M, Appignani A. Meckel's diverticulum: Is this the time for a large multicentric study?. Afr J Paediatr Surg 2018;15:56-7

How to cite this URL:
Bertozzi M, Appignani A. Meckel's diverticulum: Is this the time for a large multicentric study?. Afr J Paediatr Surg [serial online] 2018 [cited 2019 May 21];15:56-7. Available from: http://www.afrjpaedsurg.org/text.asp?2018/15/1/56/253255
Sir,

We read with interest the article of Rattan et al.[1] published in the last issue of the journal.

First of all, we would like to congratulate the authors for their large 12-year experience about symptomatic Meckel's diverticulum (MD). Our attention has been attracted by 3 data: 14 patients operated for symptomatic MD under 1 year of age, 7 patients with MD who caused internal hernia and the surgical technique used for the excision of the MD.

In the article, the authors reported a 20-day-old patient. It would be interesting to know how many patients were newborn. In our recent article, we performed a review of the English literature of symptomatic MD in newborn and we described only 20 cases.[2] Eight patients were affected by occlusion while 12 were perforated MD. An accurate description of newborn patients would be interesting to increase the knowledge of paediatric surgeons about manifestations of MD in this particular age.

When the authors described the 12.5% of cases (7 patients) with internal hernia, we thought that this was due to a mesodiverticular band. The mesodiverticular band is an embryologic remnant of the vitelline circulation, which carries the arterial supply to the MD. In the event of an error of involution, a patent or nonpatent arterial band persists and extends from the mesentery to the apex of the antimesenteric diverticulum. This creates a snare-like opening through which bowel loops may herniate and become obstructed. Internal hernia due to mesodiverticular can cause obstruction and gangrene of small bowel herniated. Literature reports this last complication as a cause of sudden infants death syndrome.

We thought that seven patients describing this rare malformation in paediatric age would be the most large casuistic never reported, and a deepening of clinical history of these patients would be useful for better understanding of this rare malformation.

The last point is the surgical approach. We understand that interventions were done in all cases by open surgery. Is this a choice? Why laparoscopy was not used? Laparoscopy or laparoscopic-assisted surgery became a more and more adopted technique by paediatric surgeons for different pathologies,[4] including MD[5] with excellent results. Furthermore, the authors reported that intestinal obstruction was observed in 86.1% (56 cases) of MD operated. Although the use of laparoscopy for the treatment of small-bowel obstruction is not firmly established in literature, in our experience, laparoscopy appears safe and effective in this condition and may be chosen in patients with mild abdominal distension without a surgical or traumatic history. In these cases, obstruction may be due to mesodiverticular bands and MD intussusceptions, easy to treat with laparoscopy. In conclusion, this letter was to encourage the authors to perform large multicenter study to address this disease with so many different clinical presentations as best as possible based on evidence and to minimize its morbidity and mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Rattan KN, Singh J, Dalal P, Rattan A. Meckel's diverticulum in children: Our 12-year experience. Afr J Paediatr Surg 2016;13:170-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Bertozzi M, Melissa B, Radicioni M, Magrini E, Appignani A. Symptomatic meckel's diverticulum in newborn: Two interesting additional cases and review of literature. Pediatr Emerg Care 2013;29:1002-5.  Back to cited text no. 2
    
3.
Pfalzgraf RR, Zumwalt RE, Kenny MR. Mesodiverticular band and sudden death in children. A report of two cases. Arch Pathol Lab Med 1988;112:182-4.  Back to cited text no. 3
    
4.
Bertozzi M, Prestipino M, Nardi N, Appignani A. Preliminary experience with a new approach for infantile hypertrophic pyloric stenosis: The single-port, laparoscopic-assisted pyloromyotomy. Surg Endosc 2011;25:2039-43.  Back to cited text no. 4
    
5.
Chan KW, Lee KH, Mou JW, Cheung ST, Tam YH. Laparoscopic management of complicated Meckel's diverticulum in children: A 10-year review. Surg Endosc 2008;22:1509-12.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Mirko Bertozzi
S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria Della Misericordia Hospital, Perugia
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajps.AJPS_12_17

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