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

Yıl 2022, Cilt: 24 Sayı: 2, 373 - 381, 31.08.2022
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.

Kaynakça

  • 1. Sagar J, Kumar V, Shah DK. Meckel's diverticulum: a systematic review. J R Soc Med. 2006;99(10):501-5.
  • 2. Synder CL. Meckel Diverticulum. In: Coran AG, Adzick NS, Krummel TM, Laberge JM, Shamberger RC, Caldamone AA, eds. Pediatric Surgery. 7th. ed. Philadelphia. Elsevier, 2012:1085-92.
  • 3. Leys CM. Meckel Diverticulum. In: Holcomb GW, Murphy JP, St. Peter SD, eds. Holcomb and Ashcraft's Pediatric Surgery. 7th. ed. Edinburgh. Elsevier, 2020:641-6.
  • 4. Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR. Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002). Ann Surg. 2005;241(3):529-33.
  • 5. St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H. Meckel's diverticulum in children: a 20-year review. J Pediatr Surg. 1991;26(11):1289-92.
  • 6. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ, 3rd. Surgical management of Meckel's diverticulum. An epidemiologic, population-based study. Ann Surg. 1994;220(4):564-8.
  • 7. Menezes M, Tareen F, Saeed A, Khan N, Puri P. Symptomatic Meckel's diverticulum in children: a 16-year review. Pediatr Surg Int. 2008;24(5):575-7.
  • 8. Tseng YY, Yang YJ. Clinical and diagnostic relevance of Meckel's diverticulum in children. Eur J Pediatr. 2009;168(12):1519-23.
  • 9. Francis A, Kantarovich D, Khoshnam N, Alazraki AL, Patel B, Shehata BM. Pediatric Meckel's diverticulum: report of 208 cases and review of the literature. Fetal Pediatr Pathol. 2016;35(3):199-206.
  • 10. Irvine I, Doherty A, Hayes R. Bleeding meckel's diverticulum: A study of the accuracy of pertechnetate scintigraphy as a diagnostic tool. Eur J Radiol. 2017;96(11):27-30.
  • 11. Huang CC, Lai MW, Hwang FM, Yeh YC, Chen SY, Kong MS et al. Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol. 2014;55(5):369-75.
  • 12. Chen Q, Gao Z, Zhang L, Zhang Y, Pan T, Cai D et al. Multifaceted behavior of Meckel's diverticulum in children. J Pediatr Surg. 2018;53(4):676-81.
  • 13. Rahmat S, Sangle P, Sandhu O, Aftab Z, Khan S. Does an Incidental Meckel's diverticulum warrant resection? Cureus. 2020;12(9):e10307.
  • 14. Robijn J, Sebrechts E, Miserez M. Management of incidentally found Meckel's diverticulum a new approach: resection based on a risk score. Acta Chir Belg. 2006;106(4):467-70.
  • 15. Mackey WC, Dineen P. A fifty year experience with Meckel's diverticulum. Surg Gynecol Obstet. 1983;156(1):56-64.
  • 16. Leijonmarck CE, Bonman-Sandelin K, Frisell J, Räf L. Meckel's diverticulum in the adult. Br J Surg. 1986;73(2):146-9.
  • 17. Lüdtke FE, Mende V, Köhler H, Lepsien G. Incidence and frequency or complications and management of Meckel's diverticulum. Surg Gynecol Obstet. 1989;169(6):537-42.
  • 18. Caracappa D, Gullà N, Lombardo F, Burini G, Castellani E, Boselli C et al. Incidental finding of carcinoid tumor on Meckel's diverticulum: case report and literature review, should prophylactic resection be recommended? World J Surg Oncol. 2014;12(1):144.
  • 19. Burjonrappa S, Khaing P. Meckel's diverticulum and ectopic epithelium: Evaluation of a complex relationship. J Indian Assoc Pediatr Surg. 2014;19(2):85-9.
  • 20. Baysoy G, Balamtekin N, Uslu N, Karavelioglu A, Talim B, Özen H. Double heterotopic pancreas and Meckel's diverticulum in a child: do they have a common origin? The Turkish Journal of Pediatrics. 2010;52(3):336.

Çocuklarda Meckel Divertikülleri: Tek Merkez Deneyimi

Yıl 2022, Cilt: 24 Sayı: 2, 373 - 381, 31.08.2022
https://doi.org/10.24938/kutfd.1112722

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.

Kaynakça

  • 1. Sagar J, Kumar V, Shah DK. Meckel's diverticulum: a systematic review. J R Soc Med. 2006;99(10):501-5.
  • 2. Synder CL. Meckel Diverticulum. In: Coran AG, Adzick NS, Krummel TM, Laberge JM, Shamberger RC, Caldamone AA, eds. Pediatric Surgery. 7th. ed. Philadelphia. Elsevier, 2012:1085-92.
  • 3. Leys CM. Meckel Diverticulum. In: Holcomb GW, Murphy JP, St. Peter SD, eds. Holcomb and Ashcraft's Pediatric Surgery. 7th. ed. Edinburgh. Elsevier, 2020:641-6.
  • 4. Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR. Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002). Ann Surg. 2005;241(3):529-33.
  • 5. St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H. Meckel's diverticulum in children: a 20-year review. J Pediatr Surg. 1991;26(11):1289-92.
  • 6. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ, 3rd. Surgical management of Meckel's diverticulum. An epidemiologic, population-based study. Ann Surg. 1994;220(4):564-8.
  • 7. Menezes M, Tareen F, Saeed A, Khan N, Puri P. Symptomatic Meckel's diverticulum in children: a 16-year review. Pediatr Surg Int. 2008;24(5):575-7.
  • 8. Tseng YY, Yang YJ. Clinical and diagnostic relevance of Meckel's diverticulum in children. Eur J Pediatr. 2009;168(12):1519-23.
  • 9. Francis A, Kantarovich D, Khoshnam N, Alazraki AL, Patel B, Shehata BM. Pediatric Meckel's diverticulum: report of 208 cases and review of the literature. Fetal Pediatr Pathol. 2016;35(3):199-206.
  • 10. Irvine I, Doherty A, Hayes R. Bleeding meckel's diverticulum: A study of the accuracy of pertechnetate scintigraphy as a diagnostic tool. Eur J Radiol. 2017;96(11):27-30.
  • 11. Huang CC, Lai MW, Hwang FM, Yeh YC, Chen SY, Kong MS et al. Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol. 2014;55(5):369-75.
  • 12. Chen Q, Gao Z, Zhang L, Zhang Y, Pan T, Cai D et al. Multifaceted behavior of Meckel's diverticulum in children. J Pediatr Surg. 2018;53(4):676-81.
  • 13. Rahmat S, Sangle P, Sandhu O, Aftab Z, Khan S. Does an Incidental Meckel's diverticulum warrant resection? Cureus. 2020;12(9):e10307.
  • 14. Robijn J, Sebrechts E, Miserez M. Management of incidentally found Meckel's diverticulum a new approach: resection based on a risk score. Acta Chir Belg. 2006;106(4):467-70.
  • 15. Mackey WC, Dineen P. A fifty year experience with Meckel's diverticulum. Surg Gynecol Obstet. 1983;156(1):56-64.
  • 16. Leijonmarck CE, Bonman-Sandelin K, Frisell J, Räf L. Meckel's diverticulum in the adult. Br J Surg. 1986;73(2):146-9.
  • 17. Lüdtke FE, Mende V, Köhler H, Lepsien G. Incidence and frequency or complications and management of Meckel's diverticulum. Surg Gynecol Obstet. 1989;169(6):537-42.
  • 18. Caracappa D, Gullà N, Lombardo F, Burini G, Castellani E, Boselli C et al. Incidental finding of carcinoid tumor on Meckel's diverticulum: case report and literature review, should prophylactic resection be recommended? World J Surg Oncol. 2014;12(1):144.
  • 19. Burjonrappa S, Khaing P. Meckel's diverticulum and ectopic epithelium: Evaluation of a complex relationship. J Indian Assoc Pediatr Surg. 2014;19(2):85-9.
  • 20. Baysoy G, Balamtekin N, Uslu N, Karavelioglu A, Talim B, Özen H. Double heterotopic pancreas and Meckel's diverticulum in a child: do they have a common origin? The Turkish Journal of Pediatrics. 2010;52(3):336.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Ahmet Ertürk 0000-0003-0286-362X

Sabri Demir 0000-0003-4720-912X

Can İhsan Öztorun 0000-0002-5408-2772

Elif Erten 0000-0002-3666-295X

Doğuş Güney 0000-0001-7168-2123

Süleyman Arif Bostancı 0000-0002-7512-3895

Fahrı Akkaya 0000-0002-1372-0213

Müjdem Nur Azılı 0000-0002-5137-7209

Fatih Akbıyık 0000-0002-2194-5041

Emrah Şenel 0000-0002-0383-4559

Yayımlanma Tarihi 31 Ağustos 2022
Gönderilme Tarihi 5 Mayıs 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 24 Sayı: 2

Kaynak Göster

APA Ertürk, A., Demir, S., Öztorun, C. İ., Erten, E., vd. (2022). MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 24(2), 373-381. https://doi.org/10.24938/kutfd.1112722
AMA Ertürk A, Demir S, Öztorun Cİ, Erten E, Güney D, Bostancı SA, Akkaya F, Azılı MN, Akbıyık F, Şenel E. MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE. Kırıkkale Üni Tıp Derg. Ağustos 2022;24(2):373-381. doi:10.24938/kutfd.1112722
Chicago Ertürk, Ahmet, Sabri Demir, Can İhsan Öztorun, Elif Erten, Doğuş Güney, Süleyman Arif Bostancı, Fahrı Akkaya, Müjdem Nur Azılı, Fatih Akbıyık, ve Emrah Şenel. “MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24, sy. 2 (Ağustos 2022): 373-81. https://doi.org/10.24938/kutfd.1112722.
EndNote Ertürk A, Demir S, Öztorun Cİ, Erten E, Güney D, Bostancı SA, Akkaya F, Azılı MN, Akbıyık F, Şenel E (01 Ağustos 2022) MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24 2 373–381.
IEEE A. Ertürk, “MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE”, Kırıkkale Üni Tıp Derg, c. 24, sy. 2, ss. 373–381, 2022, doi: 10.24938/kutfd.1112722.
ISNAD Ertürk, Ahmet vd. “MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24/2 (Ağustos 2022), 373-381. https://doi.org/10.24938/kutfd.1112722.
JAMA Ertürk A, Demir S, Öztorun Cİ, Erten E, Güney D, Bostancı SA, Akkaya F, Azılı MN, Akbıyık F, Şenel E. MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE. Kırıkkale Üni Tıp Derg. 2022;24:373–381.
MLA Ertürk, Ahmet vd. “MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, c. 24, sy. 2, 2022, ss. 373-81, doi:10.24938/kutfd.1112722.
Vancouver Ertürk A, Demir S, Öztorun Cİ, Erten E, Güney D, Bostancı SA, Akkaya F, Azılı MN, Akbıyık F, Şenel E. MECKEL’S DIVERTICULUM IN CHILDREN: A SINGLE-CENTER EXPERIENCE. Kırıkkale Üni Tıp Derg. 2022;24(2):373-81.

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