title: Meckel's diverticular complications in children: is laparoscopy the order of the day?
abstract: Meckel's diverticulum (MD), a seemingly innocuous anomaly of the gastrointestinal tract, presents distinctive challenges to a clinician, as it is prone to varied complications that are frequently elusive to diagnosis with conventional diagnostic modalities. This case series illustrates the diverse presentations and advantages of laparoscopic-assisted management of Meckel's diverticular complications in children. Between October 2002 and April 2006, 36 patients (27 males and 9 females) aged 1.5 to 16 years (median 10 years) underwent laparoscopic-assisted trans-umbilical Meckel's diverticulectomy (LATUM). Sixteen (44.4%) patients presented with lower gastrointestinal bleeding (14 with painless bleed and 2 with perforated peptic ulcer in the ileum adjacent to the MD), six (16.7%) patients presented with intestinal obstruction (four due to a mesodiverticular band and one each due to intussusception and floppy giant cystic dilatation of MD causing intestinal compression) and four (11.1%) patients presented with features masquerading as appendicitis (one with Meckel's diverticulitis and perforation, one with perforated peptic ulcer adjacent to MD and two with a torted and gangrenous MD). In ten (27.8%) patients, incidental MD with a narrow base was noted at laparoscopic exploration for suspected appendicitis. All patients underwent successful LATUM along with appendicectomy in 15 (41.7%) patients. The operative duration ranged from 72 to 266 min (mean 125.9+/-48.4). There were no intra-operative complications and none required conversion to open surgery. The hospital stay was 3 to 9 days (mean 5.3+/-1.2). There were three (8.3%) cases of postoperative adhesive intestinal obstruction; two underwent successful laparoscopic adhesiolysis and one necessitated conversion to suprapubic laparotomy to release the pelvic adhesions. There were no other complications during the follow-up (median 16 months). LATUM is a safe, effective and an esthetic procedure offering timely diagnosis and cure for diverse Meckel's diverticular complications. The technique also allows palpation of the MD and avoids usage of expensive staplers.
authors.affiliation: KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore. trsai@rediffmail.com
authors.forename: T R
authors.initials: TR
authors.lastname: Sai Prasad
authors.forename: Chan Hon
authors.initials: CH
authors.lastname: Chui
authors.forename: Fatima Reyaz
authors.initials: FR
authors.lastname: Singaporewalla
authors.forename: Choo Phaik Caroline
authors.initials: CP
authors.lastname: Ong
authors.forename: Yee
authors.initials: Y
authors.lastname: Low
authors.forename: Te Lu
authors.initials: TL
authors.lastname: Yap
authors.forename: Anette Sundfor
authors.initials: AS
authors.lastname: Jacobsen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D008467:Meckel Diverticulum / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000209:etiology; D012189:Retrospective Studies