Laparoscopic management of Meckel's diverticulum in children.
BACKGROUND
Rectal bleeding, recurrent abdominal pain, nausea, and vomiting in children could present a diagnostic as well as therapeutic challenge. Meckel's diverticulum (MD) is one of the causes. The objective of the current study was to evaluate the feasibility and outcome of laparoscopic management of MD.


METHODS
The clinical data of 33 children admitted with rectal bleeding and/or recurrent abdominal pain with no identifiable cause were reviewed over a period of 8 years. There were 23 boys and 10 girls with a mean age of 5.12 +/- 2 years (range, 3-12 years). In 21 cases, MD was an incidental finding on laparoscopic appendectomy and symptomatic in 12 cases. Patients with rectal bleeding were subjected to upper gastrointestinal endoscopy; colonoscopy, and technetium Tc 99m-labeled pertechnetate scan (MS). All patients were subjected to routine laboratory investigations and diagnostic laparoscopy.


RESULTS
Of the 1200 appendectomies, incidental MD was found in 21 (1.9%) patients and symptomatic in 12 cases. Upper gastrointestinal endoscopy and colonoscopy did not show a bleeding source in 7 patients presented with bleeding per rectum. Four cases showed a positive MS uptake. Of these, 3 were found on laparoscopy to have an MD. Three cases showed a negative scan. Of these, 2 had an MD. In 5 cases with recurrent abdominal pain nausea, vomiting, and abdominal distention, diagnostic laparoscopy revealed Meckel's diverticulitis in 3 cases and intussusception secondary to MD in 1 case. Laparoscopic Meckel's diverticulectomy and laparoscopic-assisted Meckel's diverticulectomy was done for 18 and 12 cases, respectively. Ectopic gastric mucosa was present in 13 cases (44%).


CONCLUSIONS
Laparoscopy is safe, cost-effective, and efficient for the diagnosis and definitive treatment of MD. Compared with conventional laparotomy, it has the advantage of precise operative diagnosis, less traumatic access, fewer intraoperative and postoperative complications, and shorter recovery period.
Shalaby
Rafik Y
RY
Pediatric Surgical Department, Al-Azhar University Hospitals, Cairo, Egypt. rafikshalaby@hotmail.com
Soliman
Soliman M
SM
Fawy
Mohamed
M
Samaha
Abdelhady
A
D015746:Abdominal Pain / Q000209:etiology; D000714:Anastomosis, Surgical; D001062:Appendectomy; D002648:Child; D002675:Child, Preschool; D002828:Choristoma / Q000175:diagnosis / Q000601:surgery; D016145:Endoscopy, Digestive System; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008467:Meckel Diverticulum / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D009325:Nausea / Q000209:etiology; D012007:Rectum; D016896:Treatment Outcome