MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE

Yıl 2022, , 373 - 381, 31.08.2022

Ahmet Ertürk , Sabri Demir , Can İhsan Öztorun , Elif Erten , Doğuş Güney , Süleyman Arif Bostancı , Fahrı Akkaya , Müjdem Nur Azılı , Fatih Akbıyık , Emrah Şenel

https://doi.org/10.24938/kutfd.1112722

Öz

Objective: We aimed to investigate the epidemiological and characteristic features of patients with Meckel’s diverticulum (MD) treated in our clinic and share our experiences.

Material and Methods: Records of patients were reviewed retrospectively. Demographic and clinical data, the treatments modalities, appearance and location of MD and results of histopathological examination were investigated. Patients were compared according to gender and whether they were symptomatic. Statistical analysis evaluated with SPSS version 21. P<0.05 was considered significant.

Results: A total of 59 patients (14 female, 45 male) were included in the study. There was no difference between genders in terms of age, length-of-hospital stay and location MD (p=0.60, p=0.072 and p=0.765, respectively). Abdominal pain was the most common reason for admission in both genders. There were 45 patients in the symptomatic group and 14 patients in the incidental group. MD in the symptomatic group was located more proximal (p=0.041) but there was no difference between the groups in terms of other parameters. The scintigraphy was positive in eight of nine patients, while it was negative in one. The most common ectopic tissue detected in patients was gastric mucosa (70%). Forty-seven patients were operated on with open surgical technique. Appearance of MD was normal in 23 patients (39.0%), and the diverticulitis was seen in 17 (28.8%). In five patients who were diagnosed incidentally during appendectomy, MD was not resected because they were asymptomatic. Diverticulectomy was performed in 34 patients (57.6%), while anastomosis was performed with segmental-ileal-resection in others. None of patients died.

Conclusion: Most patients present with symptoms resulting from complications of MD. Since these complications cause acute abdomen, MD should be kept in mind in the differential diagnosis of children presenting with abdominal pain. In addition, it should be known that MD can be seen in children older than the classical age-range described in literature.

Anahtar Kelimeler

Meckel diverticulum, children, diverticulectomy, ectopic tissue

Çocuklarda Meckel Divertikülleri: Tek Merkez Deneyimi

Öz

Amaç: Meckel divertikülü (MD) gastrointestinal kanalın en sık görülen konjenital anomalisidir. Çalışmamızın amacı MD hastalarımızın epidemiyolojik ve karakteristik özelliklerini araştırmak ve konuyla ilgili tecrübelerimizi paylaşmaktır.

Gereç ve Yöntemler: MD hastalarının dosyaları retrospektif olarak incelendi. Hastaların demografik ve klinik verileri, uygulanan tedaviler, divertikülün görünümü, lokasyonu ve histopatolojik inceleme sonuçları araştırıldı. Hastalar önce cinsiyetlerine sonra semptomatik olup olmadığına göre gruplandırılarak karşılaştırıldı. İstatistiksel analizler SPSS version 21 ile yapıldı. P<0,05 anlamlı olarak kabul edildi.

Bulgular: Çalışmaya 14 kız ve 45 erkek olmak üzere (F/M=1/3) 59 hasta dahil edildi. Cinsiyetler arasında yaş, hastanede kalma süreleri ve divertikülün lokasyonu açılarından fark bulunmadı (sırasıyla p=0.60, p=0.072 ve p=0.765). Her iki cinsiyette de en sık hastaneye başvuru nedeni karın ağrısı idi. Semptomatik hasta grubunda 45, insidental hasta grubunda 14 hasta vardı. Semptomatik hasta grubundakilerin divertikülleri daha proksimal yerleşimli olup (p=0.041) diğer parametreler açısından gruplar arasında fark bulunmadı. Sintigrafisi yapılan dokuz hastanın sekizinde test pozitif sonuçlanırken bir hastada negatif olarak sonuçlandı. Tüm hastalarda en sık tespit edilen ektopik doku gastrik doku (%70) idi. Hastaların 47’si açık cerrahi teknik ile opere edildi. Yirmi üç hastada (%39.0) divertikülün görünümü normal, 17 hastada (%28.8) ise makroskopik olarak divertikülit görünümü vardı. Apendektomi yapılırken insidental olarak tanı konulan beş hasta asemptomatik oldukları için divertiküllerine müdahale edilmedi. Otuz dört hastada (%57.6) divertikülektomi yapılırken diğer hastalarda segmental ileal rezeksiyon ile anastomoz yapıldı. Hastalardan hayatını kaybeden olmadı.

Sonuç: MD hastalarının çoğu, hastalığın komplikasyonları sonucu meydana gelen semptomlarla başvurur. Bu komplikasyonlar akut batın tablosuna neden oldukları için karın ağrısı şikayetiyle başvuran çocuklarda ayırıcı tanıda MD akılda tutulmalıdır. Ayrıca literatürde tariflenen klasik yaş aralığından daha büyük çocuklarda da MD görülebileceği bilinmelidir.

Anahtar Kelimeler

Meckel divertikülü, çocuklar, divertikülektomi, ektopik doku

Kaynakça

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