<p>Sir,</p> <p>A 3-month-old male presented with bilious vomiting and abdominal distention since 15 days. On examination, vitals were stable and abdomen was distended with visible coils of intestines and his blood counts, urea, creatinine, sodium, and potassium were normal. Abdominal X-ray revealed multiple fluid levels suggestive of intestinal obstruction <xref ref-type="fig" rid="F1">Figure 1</xref>. Emergency laparotomy showed acutely inflamed Meckel′s diverticulum (MD) and the tip was adherent to mesentery acting as a band around which a loop of ileum had undergone volvulus with gangrenous changes <xref ref-type="fig" rid="F1">Figure 1</xref>. The gangrenous ileal loop with MD was resected and end- to -end anastomosis was done. Histopathology showed features of acute inflammation of MD. MD is the most common encountered congenital anomaly of the small intestine, occurs in 2%. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>MD is frequently diagnosed as an incidental finding during a surgical procedure performed for other reasons and most patients are asymptomatic. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Symptomatic is virtually synonymous with complications. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>The life time risk of complications is was 4-6% and may present at any age with most of complications occurring in adults. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>Bleeding is the most common complication occurring in children and most adults present with obstruction, diverticulitis or both. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>MD occurs in 10-20% of symptomatic patients and is more common in older patients. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Meckles diverticulitis can lead to adhesions, which can cause intestinal obstruction. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>In our case, inflamed MD tip was adherent to mesentery acting as a band around which a loop of ileum had undergone volvulus with gangrenous changes. In children, intestinal obstruction is observed in 20-25% of all symptomatic MD. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Age wise analysis reveals that bleeding is common in children less than 2 years and intestinal obstruction being the most common among adults although some studies have found reverse. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>Out of 36 symptomatic pediatric cases, 44.4% presented with bleeding and only 14.7% with intestinal obstruction in a study by Sai Prasad et al. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>In Mayo clinic study out of 1476 MD patients, only 16% were symptomatic. Among them 76% were adults and 24% were children. Among symptomatic children, 40% had obstruction and 31% had bleeding.- <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>In conclusion, even though, the complications of MD such as diverticulitis and intestinal obstruction are rare in children, they should be kept in mind in the differential diagnosis of small bowel obstruction. <fig id="F1"> <label>Figure 1</label> <caption> <p>Abdominal X-ray revealing multiple fluid levels suggestive of intestinal obstruction and acutely inflamed Meckel′s diverticulum with ileal volvulus with gangrenous changes</p> </caption> <alt-text>Figure 1</alt-text> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="JResMedSci_2013_18_9_826_122712_u1.tif" /> </fig></p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sharma</surname> <given-names>RK</given-names> </name> <name> <surname>Jain</surname> <given-names>VK</given-names> </name> </person-group> <article-title>Emergency surgery for Meckel′s diverticulum</article-title> <source>World J Emerg Surg</source> <year>2008</year> <volume>3</volume> <fpage>27</fpage> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Kuwajerwala</surname> <given-names>NK</given-names> </name> </person-group> <article-title>In: Geibel J, editor.Meckel Diverticulum</article-title> <source>Available from: http://www</source> <year></year> <volume></volume> <fpage></fpage> <comment>In: Geibel J, editor Meckel Diverticulum Available from: http://wwwemedicinemedscapecom/article/194776-overview [Last updated on 2011 Dec 19]</comment> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sharples</surname> <given-names>AJ</given-names> </name> </person-group> <article-title>Meckel diverticulum causing small bowel obstruction</article-title> <source>BMJ Case Rep ;</source> <year>0</year> <volume></volume> <fpage></fpage> <comment>Meckel diverticulum causing small bowel obstruction BMJ Case Rep 2010;2010</comment> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Park</surname> <given-names>JJ</given-names> </name> <name> <surname>Wolff</surname> <given-names>BG</given-names> </name> <name> <surname>Tollefson</surname> <given-names>MK</given-names> </name> <name> <surname>Walsh</surname> <given-names>EE</given-names> </name> <name> <surname>Larson</surname> <given-names>DR</given-names> </name> </person-group> <article-title>Meckel diverticulum: The Mayo Clinic experience with 1476 patients (1950-2002)</article-title> <source>Ann Surg</source> <year>2005</year> <volume>241</volume> <fpage>529</fpage> <lpage>33</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sai Prasad</surname> <given-names>TR</given-names> </name> <name> <surname>Chiu</surname> <given-names>CH</given-names> </name> <name> <surname>Singaporewalla</surname> <given-names>FR</given-names> </name> <name> <surname>Ong</surname> <given-names>CP</given-names> </name> <name> <surname>Low</surname> <given-names>Y</given-names> </name> <name> <surname>Yap</surname> <given-names>TL</given-names> </name> <etal /> </person-group> <article-title>Meckel′s diverticular complications in children: Is laparoscopy the order of the day?</article-title> <source>Pediatr Surg Int</source> <year>2007</year> <volume>23</volume> <fpage>141</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>

JRMS

J Res Med Sci

Journal of Research in Medical Sciences

1735-1995 1735-7136

Medknow Publications Pvt Ltd

India

JRMS-18-826

24381631

Letter to Editor

Meckel′s diverticulitis causing intestinal obstruction in a 3 month old infant

Kumar

Kalenahalli J

Kumar

Mathod G

Shyamala

Pocha

Kumar

M P

Department of Pediatrics, JSS Medical College, JSS University, Mysore, Karnataka, India Department of Pediatric Surgery, JSS Medical College, JSS University, Mysore, Karnataka, India Department of Pediatrics, JSS Medical College, JSS University, Mysore, Karnataka, India Department of Pediatric Surgery, JSS Medical College, JSS University, Mysore, Karnataka, India

Address for correspondence:Kalenahalli Kumar, 85/B, 9th Cross, Navilu Road, Kuvempu Nagar, Mysore, Karnataka, India jagdishmandya@gmail.com

September 2013

18 9 826 826

2013

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<p>Sir,</p> <p>A 3-month-old male presented with bilious vomiting and abdominal distention since 15 days. On examination, vitals were stable and abdomen was distended with visible coils of intestines and his blood counts, urea, creatinine, sodium, and potassium were normal. Abdominal X-ray revealed multiple fluid levels suggestive of intestinal obstruction <xref ref-type="fig" rid="F1">Figure 1</xref>. Emergency laparotomy showed acutely inflamed Meckel′s diverticulum (MD) and the tip was adherent to mesentery acting as a band around which a loop of ileum had undergone volvulus with gangrenous changes <xref ref-type="fig" rid="F1">Figure 1</xref>. The gangrenous ileal loop with MD was resected and end- to -end anastomosis was done. Histopathology showed features of acute inflammation of MD. MD is the most common encountered congenital anomaly of the small intestine, occurs in 2%. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>MD is frequently diagnosed as an incidental finding during a surgical procedure performed for other reasons and most patients are asymptomatic. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Symptomatic is virtually synonymous with complications. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>The life time risk of complications is was 4-6% and may present at any age with most of complications occurring in adults. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>Bleeding is the most common complication occurring in children and most adults present with obstruction, diverticulitis or both. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>MD occurs in 10-20% of symptomatic patients and is more common in older patients. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Meckles diverticulitis can lead to adhesions, which can cause intestinal obstruction. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>In our case, inflamed MD tip was adherent to mesentery acting as a band around which a loop of ileum had undergone volvulus with gangrenous changes. In children, intestinal obstruction is observed in 20-25% of all symptomatic MD. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Age wise analysis reveals that bleeding is common in children less than 2 years and intestinal obstruction being the most common among adults although some studies have found reverse. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>Out of 36 symptomatic pediatric cases, 44.4% presented with bleeding and only 14.7% with intestinal obstruction in a study by Sai Prasad et al. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>In Mayo clinic study out of 1476 MD patients, only 16% were symptomatic. Among them 76% were adults and 24% were children. Among symptomatic children, 40% had obstruction and 31% had bleeding.- <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>In conclusion, even though, the complications of MD such as diverticulitis and intestinal obstruction are rare in children, they should be kept in mind in the differential diagnosis of small bowel obstruction. <fig id="F1"> <label>Figure 1</label> <caption> <p>Abdominal X-ray revealing multiple fluid levels suggestive of intestinal obstruction and acutely inflamed Meckel′s diverticulum with ileal volvulus with gangrenous changes</p> </caption> <alt-text>Figure 1</alt-text> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="JResMedSci_2013_18_9_826_122712_u1.tif" /> </fig></p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sharma</surname> <given-names>RK</given-names> </name> <name> <surname>Jain</surname> <given-names>VK</given-names> </name> </person-group> <article-title>Emergency surgery for Meckel′s diverticulum</article-title> <source>World J Emerg Surg</source> <year>2008</year> <volume>3</volume> <fpage>27</fpage> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Kuwajerwala</surname> <given-names>NK</given-names> </name> </person-group> <article-title>In: Geibel J, editor.Meckel Diverticulum</article-title> <source>Available from: http://www</source> <year></year> <volume></volume> <fpage></fpage> <comment>In: Geibel J, editor Meckel Diverticulum Available from: http://wwwemedicinemedscapecom/article/194776-overview [Last updated on 2011 Dec 19]</comment> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sharples</surname> <given-names>AJ</given-names> </name> </person-group> <article-title>Meckel diverticulum causing small bowel obstruction</article-title> <source>BMJ Case Rep ;</source> <year>0</year> <volume></volume> <fpage></fpage> <comment>Meckel diverticulum causing small bowel obstruction BMJ Case Rep 2010;2010</comment> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Park</surname> <given-names>JJ</given-names> </name> <name> <surname>Wolff</surname> <given-names>BG</given-names> </name> <name> <surname>Tollefson</surname> <given-names>MK</given-names> </name> <name> <surname>Walsh</surname> <given-names>EE</given-names> </name> <name> <surname>Larson</surname> <given-names>DR</given-names> </name> </person-group> <article-title>Meckel diverticulum: The Mayo Clinic experience with 1476 patients (1950-2002)</article-title> <source>Ann Surg</source> <year>2005</year> <volume>241</volume> <fpage>529</fpage> <lpage>33</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sai Prasad</surname> <given-names>TR</given-names> </name> <name> <surname>Chiu</surname> <given-names>CH</given-names> </name> <name> <surname>Singaporewalla</surname> <given-names>FR</given-names> </name> <name> <surname>Ong</surname> <given-names>CP</given-names> </name> <name> <surname>Low</surname> <given-names>Y</given-names> </name> <name> <surname>Yap</surname> <given-names>TL</given-names> </name> <etal /> </person-group> <article-title>Meckel′s diverticular complications in children: Is laparoscopy the order of the day?</article-title> <source>Pediatr Surg Int</source> <year>2007</year> <volume>23</volume> <fpage>141</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>