Erişkin hastalarda semptomatik Meckel Divertikülü: Tek merkez 6 yıllık klinik deneyim ve sonuçlarımız

Yıl 2023, Cilt: 14 Sayı: 4, 690 - 695, 30.12.2023

Burak Uçaner , Mehmet Sabri Çiftçi

https://doi.org/10.18663/tjcl.1321925

Öz

Amaç: Meckel divertikülü (MD), doğum sonrasında omfalomezenterik veya vitellin kanalın tam olmayan obliterasyonu sonucunda oluşan embriyolojik bir kalıntıdır ve gastrointestinal sistemin en sık gözlenen konjenital anomalisidir. MD genellikle asemptomatik olup; genellikle çocuk hasta popülasyonunda semptom vermektedir. Bu çalışmada; akut batının ayırıcı tanısında önemli yeri olan, preoperatif dönemde tanı konulmasının zor olduğu MD’nin güncel literatür bilgileri eşliğinde klinikopatolojik özelliklerinin analizi ve sonuçların incelenmesi amaçlandı.
Gereç ve Yöntemler: Ocak 2017 - Ocak 2023 tarihleri arasında genel cerrahi kliniğinde Meckel divertikülü tanısı alan ve ameliyat edilen hastalar retrospektif olarak tarandı. Çalışmaya 18 yaşın altındaki hastalar ve inflamatuar bağırsak hastalığı tanısı olan hastalar dahil edilmedi. Hastaların preoperatif, intraoperatif ve postoperatif verileri incelenerek analiz edildi.
Bulgular: Çalışmaya dahil edilen 22 olgunun yaş ortalaması 44,6 ± 14,6 yaş (20-74 yaş) idi. 16 olgu erkek, 6 olgu ise kadındı. Erkek/kadın oranı 2,7/1 idi. 7 olguda komorbid hastalık mevcuttu. Karın ağrısı (%72.7) en sık gözlenen semptom iken histopatolojik değerlendirmede 9 olguda heterotopik doku izlendi. Postoperatif cerrahi komplikasyon 6 hastada izlenirken en sık gözlenen komplikasyonun ileus (3 hasta) olduğu saptandı. Postoperatif süreçte bir hastada mortalite gözlendi.
Sonuç: MD akut batında ayırıcı tanıda her zaman akılda bulundurulması gereken patolojilerdendir. Tanıda gecikilmesi ve ameliyat esnasında gözden kaçması özellikle semptomatik olan hastalarda ve başka akut batın sebepleri ile ilişkilendirilebilen patolojilerde mortalite ve morbidite oranlarını artırmaktadır.

Anahtar Kelimeler

Meckel divertikülü, divertikülit, akut batın, ince bağırsak rezeksiyonu

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Symptomatic Meckel's Diverticulum in adult patients: our single center 6-year clinical experience and results

Öz

Aim: Meckel's diverticulum (MD) is an embryological remnant that results from the incomplete obliteration of the omphalomesenteric or vitelline duct after birth and it is the most common congenital anomaly of gastrointestinal tract. MD is usually asymptomatic and presents in the pediatric population. In this study, it was aimed to analyze the clinicopathological characteristics of MD, which has an important place in the differential diagnosis of acute abdomen and is difficult to diagnose in the preoperative period, in the light of current literature and to examine the results
Material and Methods: Patients diagnosed with Meckel's diverticulum and underwent surgery between January 2017 and January 2023 in the general surgery clinic were retrospectively scanned. Preoperative, intraoperative and postoperative data of the patients were examined and analyzed.
Results: Sixteen of the cases were male and 6 of them were female. Comorbid disease was present in 7 cases. Abdominal pain (72.7%) was the most common symptom, while heterotopic tissue was observed in 9 cases in histopathological evaluation. Postoperative surgical complication was observed in 6 patients and the most common complication was found to be ileus (3 patients). Mortality was observed in one patient in the postoperative period.
Conclusion: Meckel's diverticulum should always be kept in mind in the differential diagnosis of acute abdominal pain. Delay in diagnosis and going unnoticed during surgery increase mortality and morbidity rates, especially in symptomatic patients and pathologies associated with other causes of acute abdomen.

Anahtar Kelimeler

Meckel, diverticulitis, acute abdomen, small bowel resection

Proje Numarası

-

Kaynakça

• Lequet J, Menahem B, Alves A, Fohlen A, Mulliri A. Meckel's diverticulum in the adult. J Visc Surg. 2017 Sep;154(4):253-259. doi: 10.1016/j.jviscsurg.2017.06.006.
• Carneiro F, Chaves P, Ensari A. Pathology of the Gastrointestinal Tract, Edition 1, 2017:494.
• Sagar J, Kumar V, Shah DK. Meckel’s diverticulum: a systematic review. J R Soc Med 2006;99:501-5.
• Hansen CC, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century. Medicine (Baltimore). 2018 Aug;97(35):e12154. doi: 10.1097/MD.0000000000012154.
• Kuru S, Kismet K. Meckel's diverticulum: clinical features, diagnosis and management. Rev Esp Enferm Dig. 2018 Nov;110(11):726-732. doi: 10.17235/reed.2018.5628/2018.
• Choi SY, Hong SS, Park HJ, Lee HK, Shin HC, Choi GC. The many faces of Meckel's diverticulum and its complications. J Med Imaging Radiat Oncol. 2017 Apr;61(2):225-231. doi: 10.1111/1754-9485.12505. Epub 2016 Aug 4.
• Dikić S, Dragojević S, Zdravković D, Djordjević M, Kovcin V, Milovanović A. A case of intussuscepted and incarcerated Meckel's diverticulum in to the cecum. Acta Chir Iugosl. 2011;58(4):107-9.
• Hançerlioğulları O, Buldanlı MZ, Uçaner B, Çiftçi MS, Kesikli SA. Acute appendicitis over the age of 50: The evaluation of the impact of clinical variables on operative and post-operative outcomes. Ulus Travma Acil Cerrahi Derg. 2022 Oct;28(10):1419-1427. English. doi: 10.14744/tjtes.2022.86229.
• Lindeman RJ, Søreide K. The Many Faces of Meckel's Diverticulum: Update on Management in Incidental and Symptomatic Patients. Curr Gastroenterol Rep. 2020 Jan 13;22(1):3. doi: 10.1007/s11894-019-0742-1.
• Rangan V, Lamont JT. Small bowel diverticulosis: Pathogenesis, clinical management, and new concepts. Curr Gastroenterol Rep. 2020;22(1):4.
• Srisajjakul S, Prapaisilp P, Bangchokdee S. Many faces of Meckel's diverticulum and its complications. Jpn J Radiol. 2016 May;34(5):313-20. doi: 10.1007/s11604-016-0530-x.
• Sagar J, Kumar V, Shah DK. Meckel's diverticulum: a systematic review. J R Soc Med. 2006 Oct;99(10):501-5. doi: 10.1177/014107680609901011. Erratum in: J R Soc Med. 2007 Feb;100(2):69.
• Bhattarai HB, Bhattarai M, Shah S, Singh A, Yadav SK, Yadav BK, Uprety M, Subedi A, Singh PB, Priya A. Meckel's diverticulum causing acute intestinal obstruction: A case series. Clin Case Rep. 2022 Nov 6;10(11):e6518. doi: 10.1002/ccr3.6518.
• Kamal E. Bani-Hani, Nawaf J. Shatnawi. Meckel’s Diverticulum: Comparison of Incidental and Symptomatic Cases. World J. Surg.2004; 28: 917–920,
• Ma P, Cao Y, Gao F, Qiao Z. An uncommon case of gastrointestinal bleeding: Meckel's diverticulum with ectopic gastric mucosa. Rev Esp Enferm Dig. 2022 Oct;114(10):624. doi: 10.17235/reed.2022.8831/2022.
• Rayan MN, Tang X, Khazem M, Clements W, Bray C. Case for Thought: Meckel's Diverticulum in the Adult Population. Cureus. 2022 Apr 26;14(4):e24494. doi: 10.7759/cureus.24494.
• Mohammed AA, Rasheed Mohammed M. Emergency Presentations of Meckel's Diverticulum in Adults. Surg Res Pract. 2022 Aug 25;2022:6912043. doi: 10.1155/2022/6912043.
• Tang XB, Wang X, Ma Y, Bai YZ. Radiological and clinical characteristics of intussuscepted, inverting, and inverted Meckel's diverticulum: A case series. Eur J Radiol. 2022 Dec;157:110611. doi: 10.1016/j.ejrad.2022.110611. Epub 2022 Nov 14.
• Brenes RA, Abbas HM, Palesty JA, Tripodi G. Difficulty in identifying a bleeding Meckel's diverticulum: case report and review of the literature. Conn Med. 2010 Jun-Jul;74(6):333-5.
• Izzo P, Messineo D, D'Onghia G, Izzo S, Izzo L. Meckel's diverticulum as an occasional finding during major surgery. What to do? Case report and literature review. Ann Ital Chir. 2021 Sep 13;92:S2239253X21036616.
• Tree K, Kotecha K, Reeves J, Aitchison L, Noeline Chui J, Gill AJ, Mittal A, Samra JS. Meckel's diverticulectomy: a multi-centre 19-year retrospective study. ANZ J Surg. 2023 Feb 23. doi: 10.1111/ans.18351. Epub ahead of print.