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Unlike other carcinomas, hepatocellular carcinoma (HCC) metastasizes to distant organs relatively rarely. In contrast, it routinely metastasizes to liver vasculature/liver, affecting portal veins 3-10 times more often than hepatic veins. This portal metastatic predominance is traditionally rationalized within the model of a reverse portal flow, due to accompanying liver cirrhosis. However, this intuitive model is not coherent with facts: 1) reverse portal flow occurs in fewer than 10% of cirrhotic patients, while portal metastasis occurs in 30-100% of HCC cases, and 2) portal vein prevalence of HCC metastasis is also characteristic of HCC in non-cirrhotic livers. Therefore, we must assume that the route for HCC metastatic dissemination is the same as for other carcinomas: systemic dissemination via the draining vessel, i.e., via the hepatic vein. In this light, portal prevalence versus hepatic vein of HCC metastasis appears as a puzzling pattern, particularly in cases when portal HCC metastases have appeared as the sole manifestation of HCC. Considering that other GI carcinomas (colorectal, pancreatic, gastric and small bowel) invariably disseminate via portal vein, but very rarely form portal metastasis, portal prevalence of HCC metastasis appears as a paradox. However, nature does not contradict itself; it is rather our wrong assumptions that create paradoxes. The 'portal paradox' becomes a logical event within the hypothesis that the formation of the unique portal venous system preceded the appearance of liver in evolution of chordates. The analysis suggests that the appearance of the portal venous system, supplying hormones and growth factors of pancreatic family, which includes insulin, glucagon, somatostatin, and pancreatic polypeptide (HGFPF) to midgut diverticulum in the early evolution of chordates (in an Amphioxus-like ancestral animal), promoted differentiation of enterocytes into hepatocytes and their further evolution to the liver of vertebrates. These promotional-dependent interactions are conserved in the vertebrate lineage. I hypothesize that selective homing and proliferation of malignant hepatocytes (i.e., HCC cells) in the portal vein environment are due to a uniquely high concentration of HGFPF in portal blood. HGFPF are also necessary for liver function and renewal and are significantly extracted by hepatocytes from passing blood, creating a concentration gradient of HGFPF between the portal blood and hepatic vein outflow, making post-liver vasculature and remote organs less favorable spaces for HCC growth. It also suggested that the portal vein environment (i.e., HGFPF) promotes the differentiation of more aggressive HCC clones from already-seeded portal metastases, explaining the worse outcome of HCC with the portal metastatic pattern. The analysis also offers new hypothesis on the phylogenetic origin of the hepatic diverticulum of cephalochordates, with certain implications for the modeling of the chordate phylogeny.

Background Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract, and it represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, its infrequent occurrence is mirrored by the paucity of large series of data on it in the literature. Hemorrhage, obstruction and inflammation are most common complications of Meckel’s diverticulum. Perforation of Meckel’s diverticulum is considered very rare. Case presentation We present the case of a 17-year -old male, who presented to the emergency department with 1-day history of lower abdominal pain. CT of the abdomen suggested a perforated Meckel’s diverticulum, which was confirmed later at the exploratory laparotomy. Perforation was due to progressive inflammation and presence of gastric and pancreatic tissue found on histopathology. Conclusion Perforation of Meckel’s diverticulum is rarely suspected. Complications of Meckel’s diverticulum can be difficult to diagnose, and early recognition with timely operative intervention must occur in order to provide the best outcome for these patients. This is an interesting and unusual case of Meckel’s diverticulum perforation that highlights the importance of considering Meckel’s diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

A 3-month-old female patient is presented, with ileo-ileal intussusception secondary to Meckel's diverticulum. The patient underwent emergency surgery due to a diagnosis of intestinal obstruction secondary to intussusception. Resumen: Se reporta caso de paciente femenino de 3 meses de edad, con una intususcepción intestinal íleo-ileal secundario a divertículo de Meckel, intervenida quirúrgicamente de urgencia por diagnóstico de obstrucción intestinal secundario a una invaginación intestinal. Keywords: Intussusception, Meckel's diverticulum, Palabras clave: Intususcepción intestinal, Divertículo Meckel

Introduction Meckel’s diverticulum (MD) commonly presents as gastrointestinal bleeding in the pediatric population and intestinal obstruction in adults. There is no consensus for surgical excision of an incidentally diagnosed MD. We present a hitherto unreported vascular cause of intestinal gangrene due to MD. Case presentation A 16 year old boy was referred as an acute abdomen for tertiary hospital management. Clinical examination and CT suggested small bowel obstruction and emergency laparotomy was performed. A giant MD compressing the root of mesentery, causing critical occlusion of the ileal vessels and extensive ileal gangrene was found. The gangrenous bowel was resected and a jejuno-ascending colon anastamosis was done. Postoperative recovery was uneventful. Discussion This case report highlights an unrecognized complication of a giant Meckel’s diverticulum. There are no clear guidelines on the management of an incidentally discovered MD though certain studies recommend resection of an incidental MD in males and individuals less than 50 years of age or when the MD is larger than 2 cm or contains histologically abnormal tissue. Other meta-analyses do not recommend routine resection. MD has been identified as a high risk region for ileal malignancy and its resection usually has minimal morbidity. A valid consent for opportunistic resection of a Meckel’s diverticulum in any laparotomy would be discerning. Conclusion Appropriate opportunistic resection of an incidental Meckel’s diverticulum may prevent extensive surgical morbidity later. This case highlights the need to revisit guidelines for management of incidentally identified MD.

Highlights • Complicated Meckel’s diverticulum can have different clinical presentations and can cause bowel obstruction especially if a phytobezoar gets impacted in it. • Surgical management is needed and laparoscopic approach could be an option with a better outcome for treatment of this condition., Introduction Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract, occurring in 1–3% of the general population. The most common complication of Meckel’s diverticulum is intestinal obstruction. In this report, we describe a rare cause of intestinal obstruction due to Meckel’s; the phytobezoar. After thorough literature review, the authors found about ten individual reports of the same topic. In all these cases, diagnosis was established intra-operatively. Case presentation A forty-seven-year old male presented to the emergency department with a one-day history of abdominal pain associated with vomiting and constipation. Physical examination diagnostic tests revealed features of intestinal obstruction. Discussion The lifetime risk of complications in patients with a Meckel’sdiverticulum is usually small and occurs only in up to 4%. In adults’ intestinal obstruction is the most common complication (40%). Conclusion Complicated Meckel’s diverticulum can have different clinical presentations and can cause bowel obstruction. An association with bezoars impaction is possible and it should be suspected in adult patients presenting with bowel obstruction of unknown causes especially those with high vegetarian diet.

Highlights • Meckel' diverticulum is the most common congenital anomaly of the small intestine. • It is a relatively not rare disease in the clinical field. • But the presentation as a retroperitoneal abscess as complications of Meckel's diverticulum is a very rare clinical entity. In this report,. • We present a 31-year-old man with perforated Meckel's divertculum with retroperitoneal abscess. • I also reviewed other disease of retroperitoneal abscess. (As I known as, This case report is the first report including review of retroperitoneal abscess)., Introduction The frequent complications of Meckel’s diverticulum are hemorrhage, intestinal obstruction, and inflammation, and perforation. The presentation as a retroperitoneal abscess as complications of Meckel’s diverticulum is a very rare clinical entity. Presentation of case We report a rare case of perforated Meckel's diverticulum with retroperitoneal abscess. A 31-year-old presented with a half-hour history of severe epigastric pain and diffuse periumbilical pain. Abdominal computed tomography (CT) revealed pneumoperitoneum and retroperitoneal abscesses which air, with diffuse infiltration of the small bowel mesentery and a tubular structure that originated in the ileum at the umbilicus level. Preoperative diagnosis was perforation of Meckel's diverticulum or small bowel perforation. We performed an approximate 10-cm segmental resection of the ileum that contained the Meckel’s diverticulum. Discussion Retroperitoneal abscesses are rare complications of Meckel’s diverticulum and are associated with its perforation. Conclusion The complications of Meckel’s diverticulum should be kept in mind in the differential diagnosis of retroperitoneal abscesses.

Perforation of Meckel's diverticulum is a rare complication in neonatal period. A 3-dayold term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel's diverticulum was detected. Pathological report of the tissue showed inflamed diverticulum with heterotopic gastric mucosa. This is the first report of Meckel's diverticulum perforation in a neonate in our country.

Background: Meckel's diverticulum is the most common congenital anomaly of the small bowel and is caused by the incomplete obliteration of the omphalomesenteric duct during the eighth week of gestation. Methods: We report the case of a 51-year-old male who presented to the emergency department with epigastric pain, vomiting, and abdominal distension. Clinically, he had a high intestinal obstruction without any mechanical cause on computed tomography scan. A median laparotomy was proposed. Results: An internal ileum hernia was identified twisted around a giant Meckel's diverticulum with a mesodiverticular artery, coursing from the base of the mesentery to the diverticulum. A small bowel segmental resection was performed, containing the diverticulum. Histology revealed a 15-cm long Meckel's diverticulum with no heterotopic mucosa. Conclusion: Small bowel obstruction due to an internal ileum hernia twisted around a giant Meckel's diverticulum with a mesodiverticular artery is very rare, and its diagnosis is challenging, requires a high level of suspicion, and it is only performed by exploratory surgery.

Meckel's diverticulum is the most frequent congenital malformation of the gastrointestinal tract, occurring in 2% of the general population. Meckel's diverticulum is usually asymptomatic and found incidentally. However, the lifetime risk of complications is 4-40%. In this essay, we describe the clinical and imaging findings in 12 cases of Meckel's diverticula with complications over a 5-year period, which were confirmed pathologically. The major complications of Meckel's diverticulum include gastrointestinal bleeding, bowel obstruction, perforation and inflammation. Small bowel follow-through (SBFT), computed tomography (CT) including CT enterography and RI scintigraphy can be used to show typical imaging features of Meckel's diverticulum and its complications. Knowledge of the clinical and radiologic findings of Meckel's diverticulum can aid in the early and accurate diagnosis of this anomaly and its complications.

We report a review of 208 cases of Meckel's diverticulum among pediatric patients from one single institution. One of the aims of this report is to highlight the different diagnostic modalities of Meckel's diverticulum since a majority of cases is undiagnosed prior to surgery. Our review shows 58 cases containing gastric and/or pancreatic heterotopic tissue, including two unique cases. The first case reported is a desmoid tumor arising at the tip of diverticulum, a case that, to our knowledge, has not been previously reported. The second case involves a female patient appearing with an acute abdomen thought to be appendicitis, instead surgery revealed a diverticulum arising from the ileum. The cause of acute abdomen was due to gonococcal infection. In conclusion, we hope that this large series of Meckel's cases will enrich our readers on the differential diagnosis and preoperative diagnostic techniques of Meckels' diverticulum.

Introduction: Meckel's diverticulum or ileal diverticulum is one of the common congenital anomalies of the digestive system. It may not cause any problems in many, but may form serious life threatening complications in a few. Materials and Methods: We conducted a histo-morphological study of a giant Meckel's diverticulum found during cadaveric dissections of a South Indian adult male cadaver. The diverticulum was 7.5 cm long and had a circumference of 1.5 cm. Results: Gross anatomical and histological observations revealed healthy nature of the diverticulum without any inflammation. However, the mucosa had gastric type of glands with plenty of parietal cells. This incidence of Meckel's diverticulum was noted in only one cadaver among more than 100 cadavers dissected in the past twenty years. Conclusion: Knowledge of its morphological features may be very useful to surgeons, radiologists and gastroenterologists. We discuss the clinical importance of the diverticulum and review the relevant literature in this manuscript.

Highlights • Rare complication of meckel disease. • The urinary symptoms are the main revealing table. • Despite the various investigations done, the diagnosis was carried out, in all the reported cases, in per-operatory. • The treatment of the vescoentericfistula is surgical in all cases. A diverticulectomy and a suture of the bladder fistula were carried out in all the reported cases., Introduction Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can exceptionally result in an vesico-diverticulum fistula, as noted in only seven previously reported cases. Case report A 35-year old Arabic male, quadriplegic,who presented epigastralgia evolving for a week, associated with abdominal distension and cloudy urine. On examination he was feverish (38.5 °C), dehydrated with tenderness in the entire distended abdomen; rectal examination revealed a hypotonic sphincter with no other abnormality. After investigations, acute peritonitis diagnosis was retained. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a performed Meckel’s diverticulum. Diverticulectomy, ileostomy and bladder sutures were performed after peritoneal cleansing. The postoperative course was uneventful. The anatomo-pathological examination confirmed the diagnosis of a perforated Meckel’s diverticulum that did not contain ectopic gastric or pancreatic tissue. Conclusion Vesico-diverticular fistula resulting from a perforated Meckel's diverticulum is a rare complication. To our knowledge, this is only the fourth reported case which is not associated to inflammatory bowel disease.

Background Meckel's diverticulum (MD), the most common congenital anomaly of the gastrointestinal tract, is a true diverticulum. MD is mostly seen in pediatric age groups but may be seen in adults as well. Is twice common in men than women. Surgical treatment is required in symptomatic MD patients. We present a 21-year-old female patient who was admitted with acute abdomen and underwent diverticulectomy with diagnosis of Meckel's diverticulum. Presentation of case The 21-year-old female patient was admitted to emergency service with abdominal pain, nausea and vomiting. Physical examination revealed abdominal distention, rebound tenderness and defense. Abdominal radiography revealed air-fluid levels. White blood cell count was high. In the exploration, torsion of MD was observed and diverticulectomy was performed. Histopathologic analysis indicated the presence of MD. The patient recovered without complication, and was uneventfully discharged. Discussion MD is found in 2% of the general population. Common complications of MD include gastrointestinal bleeding, intestinal obstruction, perforation and diverticulitis. However, axial torsion of MD is a rare complication. Simple diverticulectomy is sufficient in the treatment of most MD cases; however, ileal resection may be required in some cases. Diagnosis of MD is established by histopathologic analysis. Conclusion Although MD is known as a pediatric disease, it is likely to occur in adults as well. Axial torsion of Meckel's diverticulum should be kept in mind the adults presenting with symptoms of acute abdomen., Highlights • Axial torsion of MD is very a rare and serious complication. • Although MD is known as a pediatric disease, it is likely to occur in adults as well. • Axial torsion of Meckel's diverticulum should be kept in mind the adults presenting with symptoms of acute abdomen.

Meckel’s Diverticulum (MD) is the most common congenital anomaly of the small bowel found in 2% of population. The majority of patients with this anomaly will remain asymptomatic; however, several complications can occur, including obstruction, intussusceptions, hemorrhage and diverticulitis. Perforation of Meckel’s diverticulum is rare complication occurring in less than 7% of patients complicated by Meckel’s diverticulum that can often mimic appendicitis. Preoperative diagnosis of perforated Meckel’s diverticulum remains a challenging issue. This case demonstrates that a healthy degree of suspicion for complicated Meckel’s diverticulum should be present when dealing with a questionable diagnosis of appendicitis. We report case of 19 years old boy who presented to emergency department with abdominal pain in right lower quadrant mimicking perforated appendicitis. Exploratory laparotomy disclosed normal appendix and perforation of Meckel’s diverticulum.

Acute gastrointestinal obstruction can have a varied spectrum of clinical presentation and etiologies. It has been studied in detail and the management criteria have been well defined for the most part in our era. The etiologies are usually well defined. However, acute small bowel obstruction (SBO) due to intussusception caused by an inverted Meckel's diverticulum is a rare phenomenon that is often times missed on initial presentation and/or consequently until resected and visualized on pathological examination. We present a case of a 34-year-old presenting with symptoms and signs of acute intestinal obstruction and radiographic exam showing ileo-ileal intussusception. The patient failed to improve initially following conservative management and was taken to the operating room for small bowel resection which then revealed an inverted Meckel's diverticulum.

Meckel diverticulum may become symptomatic if it is complicated by hemorrhage, intestinal obstruction, diverticulitis, or tumor. Although classically described in children, it is often missed in adults because of lack of suspicion and difficulty in detection. The purpose of this article is to review the imaging findings and management of Meckel diverticulum and its complications.Although it is infrequently encountered incidentally, Meckel diverticulum should be considered especially when interpreting examinations for abdominal pain, small-bowel obstruction, and gastrointestinal bleeding.

A Meckel’s diverticulum was diagnosed by mesenteric angiography in a 34 year-old patient who presented with hematochezia and dropping hemoglobin. The case demonstrates the challenges often encountered in workup of occult gastrointestinal (GI) bleeding, and shows that angiographic diagnosis of Meckel’s diverticulum is possible, even in the absence of angiographic evidence of active extravasation. Our patient had a previous non-diagnostic workup including upper and lower endoscopy, videocapsulography, and Technetium-99m pertechnetate (Tc-99m) scintigraphy. Visceral angiogram demonstrated the presence of a persistent vitelline artery, diagnostic of Meckel’s diverticulum. While no active extravasation was seen at the time of the angiogram, operative specimen demonstrated a Meckel’s diverticulum with ectopic gastric mucosa and intraluminal hemorrhage.

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Introduction. Meckel?s diverticulum is the most common congenital anomaly of the gastro intestinal tract, present in about 2% of population. Case Outline. The article presents the case of a 44-year-old otherwise healthy man with anemia, who was diagnosed lower gastrointestinal bleeding. An abdominal CT scan revealed a clearly demarcated solid tumor in hypogastric region, measuring 65 ? 45 mm. A laparotomy through lower midline incision was performed. A surgical resection of a lesion of a Meckel?s diverticulum was carried out and a final diagnosis of gastrointestinal stromal tumor was made. The patient made an uneventful recovery. Conclusion. The preoperative diagnosis of a complicated Meckel?s diverticulum may be challenging. CT is usually an adequate method to diagnose tumors arising from Meckel?s diverticulum.

Meckel's diverticulum is the most common of the omphalomesenteric duct anomalies encountered in clinical practice. It may present with a wide variety of symptoms. Presentation in the neonatal period is very rare. We present a case of ileal obstruction from Meckel's diverticulum in a neonate with resultant stenosis of the proximal and distal bowel adjoining the Meckel's diverticulum and a short review of literature. Intrinsic intestinal stenosis should be borne in mind as one of the mechanisms by which Meckel's diverticulum causes bowel obstruction.

Complications from a Meckel’s diverticulum include diverticulitis, bleeding, intussusception, bowel obstruction, a volvulus, a vesicodiverticular fistula, perforation or very rarely as a tumour. We report a case where a Meckel’s diverticulum presented with a terminal ileal volvulus in a 32-year-old man without the presence of a typical vitelline band or axial torsion of the diverticulum causing the volvulus. It was successfully managed laparoscopically.

Littre's Hernia is an abnormal protrusion of Meckel's Diverticulum through an abdominal opening. Alexis Littre first described the condition in relation to a femoral hernia in 1770 (1). It is a very rare condition and very few cases are reported till date. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is a true diverticulum found in the anti-mesentric border. It is the remnant of the persistent intestinal part of the vitello-intestinal or omphalo-enteric duct and comprises of all intestinal layers (2, 3, 4). It is found in 2% of total population, 2 feet from ileo-caecal junction and 2 inches in length, 2 types of common ectopic tissue (gastric and pancreatic). Meckel's diverticulum may be accompanied in the sac by the ileal loop to which it is attached; rarely, it may undergo incarceration or strangulation, necrosis, and perforation. In children, it is mostly found in umbilical hernias in which case it is more prone to adhere to the sac. Intestinal obstruction may occur due to volvulus, intussusception or very rarely as a complication of Littre's hernia (2, 3, 5). Its diagnosis is usually difficult despite the availability of modern investigative tools. A high index of suspicion is mandatory. In most cases it is an incidental finding. Hernial obstruction and strangulation of Meckel's diverticulum (Littre's Hernia) is a rare phenomenon and representing 10% of all complications of Meckel's diverticulum (6, 7). Surgery is the mainstay of treatment. We herein present an extremely rare case of strangulated Meckel's diverticulum in a Ventral Hernia (Littre's Hernia) which only became evident during surgery. The ventral hernia developed following emergency appendicectomy operation done for acute appendicitis 5 months back.

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is the common differential diagnosis thought of in cases of lower abdomen pain especially in Appendicitis. When present, Meckel's diverticulum is around 2-5cm and its lifetime risk of complications is approximately 4-6%. Though an entity called 'Giant Meckel's diverticulum' is described in some studies, there are controversies about length or the width of the diverticulum to be considered for calling it a 'giant'. Usually Meckel's diverticulum is directed towards umbilicus or anterior abdominal wall due to its embryological origin. There are various ways of presentation of Meckel's diverticulum and pre-operative diagnosis is difficult except when suspected in cases of bleeding, or when ectopic mucosa is present. Intra-operatively diagnosed Meckel's diverticulum is treated mainly by resection, though the controversies arise for the treatment of co-incidentally found diverticula. We present a case of unusually long Meckel's diverticulum with its tip attached to root of mesentery and causing strangulation of ileal loops underneath it.

Background Meckel’s diverticulum is the most common developmental anomaly of the gastrointestinal tract, affecting 1–3% of the general population. This anomaly is caused by incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation and is located in the last meter of the ileum in 90% of patients. Meckel’s diverticulum is often an incidental finding during a laparotomy for other causes, such as acute appendicitis, and occasional complications are bleeding, obstruction, diverticulitis, and perforation. Objective Primary aim of this study was to present and share an extremely rare case of double Meckel's diverticulum. Methods A 20-year-old woman who was admitted due to symptoms of right lower quadrant pain, nausea, and vomiting. A laparotomy with a McBurney’s incision was performed because of a presumed diagnosis of acute appendicitis. The surgical exploration revealed a double Meckel’s diverticulum localized 50 cm proximal to the ileocecal valve, but no acute appendicitis. The operation was finished after a diverticulectomy and appendectomy. No complications occurred during the postoperative follow-up. Conclusions We conducted a literature review of studies published in the English language on double Meckel’s diverticulum, accessed via PubMed, Medline, and the Google Scholar databases. We found only five case reports of such a Meckel’s diverticulum variant.

Meckel’s diverticulum is usually asymptomatic but occasionally presents with complications. Formation of an enterolith inside a Meckel’s diverticulum is very uncommon and dislodgement of such a stone causing obstruction is extremely rare. We herein present a case of a 48-year-old man who presented with small bowel obstruction. Preoperative radiologic studies revealed a stone-like lesion in the right lower quadrant. Upon laparotomy, an inflamed Meckel’s diverticulum was found as well as a 2.5 cm stone obstructing the terminal ileum. The stone was removed and the diverticulum was excised. The differential diagnosis of acute intestinal obstruction should include this extremely rare clinical entity especially when the combination of small bowel obstruction with radiopaque stone-like finding on preoperative x-rays is present.

Resection of Meckel’s diverticulum is performed for complications resultant of the diverticulum or incidental finding during laparotomy. This chapter lists the indications, essential steps, common technical variations, and complications of the procedure. A detailed template operative dictation note is included.

Aim-Background This article presents the case of a young man with gangrenous Meckel’s diverticulum, and reviews the literature in depth for relative references. Meckel’s diverticulum is the most frequently encountered congenital anomaly of the gastrointestinal tract that results from persistence of the omphalomesenteric duct due to developmental failure or arrest of the yolk sac. This case report summarizes data on the incidence, symptoms and possible complications of Meckel’s diverticulum. Furthermore, it touches on contemporary issues raised in the international scientific community involving both differential diagnosis and surgical or non-surgical treatment of diverticulum of Meckel, when this is an accidental intraoperative finding.

Surgical treatment of the complications associated with Meckel’s diverticulum is widely accepted, but surgical management of an asymptomatic diverticulum found incidentally during laparotomy for other reasons is controversial. Appendectomy is the most common reason for laparotomy in many pediatric surgery clinics. The most common causes of an intestinal obstruction in the early period after appendectomy are an intra-abdominal abscess, adhesive small bowel obstruction and invagination. Obstruction due to Meckel’s diverticulum is reported rarely. In this study, we present 2 cases, five and eleven years old, with an asymptomatic Meckel’s diverticulum where appendectomy was performed due to acute and perforated appendicitis and obstruction developed due to Meckel’s diverticulitis in the postoperative early stage. Meckel’s diverticulitis must be considered in intestinal obstruction cases developing in the early stages after appendectomy although quite rare.

Ciliated hepatic foregut cyst (CHFC) is a rare lesion which originates from detached hepatic diverticulum or from detachment and migration of buds from the esophageal and bronchial regions of the foregut which subsequently get entrapped by the liver during the early embryonic development of the foregut. CHFCs are mostly seen in adults and are rarely reported in children, with only about 10 cases reported in this age group. Hereby, we present two cases of CHFC in two 3.5-year-old boys; one of them had cystic lesion at medial segment of left lobe of liver (common site), and in the other one it was located at right lobe of liver (less common site). Histologically, both cysts had four layers composed of inner ciliated, pseudostratified, columnar epithelium; subepithelial connective tissue; smooth muscle layer; and an outer fibrous layer.

Highlights • Giant colonic diverticulum is a rare complication of colonic diverticulosis that occurs when a single diverticulum enlarges to over 4 cm in diameter. • The author presents a rare case of a giant colonic diverticulum that presented as a sigmoid volvulus. The management and pathology are discussed., Introduction Giant colonic diverticulum is a rare complication of colonic diverticulosis that occurs when a single diverticulum enlarges to over 4 cm in diameter. There have been fewer than 200 cases reported worldwide since it was first described in 1946. Presentation of case The author presents a rare case of a giant colonic diverticulum that presented as a sigmoid volvulus. The patient underwent emergency surgery with resection of the diverticulum and reduction of the volvulus. Discussion Due to their propensity to cause complications and mechanical blockage from their large size, all authors recommend surgical resection of giant colonic diverticula. This has been documented to be safely done by diverticulectomy as was performed in this patient, but also by segmental colectomy, laparoscopic diverticulectomy, or laparoscopic colectomy. Conclusion Giant colonic diverticulum is a rare entity that tends to cause many intra-abdominal complications, including volvulus. Surgical resection is recommended once identified.

The Meckel’s diverticulum (MD) is the commonest congenital abnormality of the gastrointestinal tract. It has an ileal mucosa, but heterotopic mucosa can be found, and then 80–85 % of the ectopic tissue is gastric mucosa, sometimes associated with pancreatic tissue. Heterotopic mucosa is often responsible for complications as bleeding or diverticulitis, but small bowel obstruction is the most frequent clinical manifestation of MD. Technetium 99m pertechnetate scintigraphy and CT scan are the principal imaging means. The treatment of a symptomatic MD is resection. Laparoscopicassisted diverticulectomy and segmental ileal resection are now the usual procedures to treat MD. When incidental MD is identified, no prophylactic resection is recommended because leaving an incidental MD in situ reduces the risk of postoperative complications without increasing late complications.

Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract. It affects approximately 2 % of the population, but is often encountered as an incidental finding in an asymptomatic patient during an unrelated abdominal operation. When symptomatic, it can be a challenging mimicker of other intra-abdominal pathologies. The most common symptomatic presentation is gastrointestinal hemorrhage, due to the propensity for heterotopic gastric tissue within the diverticulum causing a distal peptic ulcer. The technetium-99m pertechnetate nuclear medicine study (“Meckel’s scan”) can help localize heterotopic gastric tissue and confirm the diagnosis. The diverticulum can also cause intestinal obstruction, an acute inflammatory process, umbilical pathology, or an unusual form of inguinal hernia (Littre hernia). When symptomatic, the Meckel’s diverticulum and surrounding ulcerated or inflamed bowel should be resected. Complications following resection are similar to those encountered after any abdominal operation, with adhesive bowel obstruction being the most common.

Background Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract. It is usually asymptomatic, but approximately 4 % present with complications such as bleeding, intestinal obstruction, and inflammation, while perforation is rare. Carcinoid or gastrointestinal stromal tumors are occasionally found in the resected specimens of Meckel’s diverticulum, particularly in the context of perforation. Case presentation A 62-year-old male with a recent history of admission and evaluation for hematochezia presented with abdominal pain. His physical examination was consistent with peritonitis. Results of laboratory testing were significant for white blood cell count of 32,000/μL. CT scan of the abdomen revealed pneumoperitoneum. During the exploratory laparotomy, perforated Meckel’s diverticulum was encountered and segmental bowel resection was performed. Histological examination findings were compatible with gastrointestinal stromal tumor within Meckel’s diverticulum. Conclusions While gastrointestinal stromal tumor is a rare finding in Meckel’s diverticula, the potential for the coexistence of this and other tumors suggests that segmental resection of the small bowel should be considered in the treatment of perforated Meckel’s diverticulum.

A 17-year-old boy, with a background of haemophilia A, presented to hospital with an episode of brisk and painless per rectal (PR) bleeding. Initial investigation with gastroscopy and colonoscopy revealed no source of bleeding. Examination of the small bowel including MRI, CT angiogram and capsule endoscopy revealed no abnormalities. Double balloon enteroscopy (DBE) from an antegrade position was attempted, with no abnormalities noted. The symptoms persisted and DBE was attempted again from a retrograde approach and a diverticulum was subsequently noted. Laparoscopic surgery was performed identifying a diverticulum as the source of bleeding, 110 cm from the ileocaecal valve, which is more proximal than is normally seen. Histological examination revealed a Meckel9s diverticulum. The case described here, although more unusual in adults, demonstrates that complete visualisation of the small bowel remains challenging and that newer modalities of enteroscopy including DBE can help aid in the diagnosis of obscure gastrointestinal bleeding.

The gallbladder is a piriform structure on the undersurface of liver. It collects bile from the liver to concentrate it and to store it. The gallbladder has a cystic duct which joins the common bile duct and through these ducts bile passes into the duodenum. There is usually a single gallbladder (arising from the cystic bud of hepatic diverticulum) with one cystic duct supplied by a cystic artery taking origin from the right hepatic artery. But in few persons there are double gallbladder or double cystic ducts or different variations in the origin and course of cystic arteries. A study was undertaken in 2006 to detect the anomalies of these structures among the people Kolkata (a metropolis of eastern part of India), by dissection of cadavers. This study was conducted from the year 2006 to 2009 in the Department of Anatomy of Calcutta National Medical College and in other medical colleges of Kolkata. Three cases of double gallbladder and few other variations like double cystic duct were found in this study. These findings will help the clinicians (specially the surgeons, radiologists of the eastern part of India) to undertake any investigative or surgical procedure in the region of extra hepatic biliary apparatus. This study will enhance our knowledge not only surgical Anatomy, but also in embryology and in gross anatomy.

We report the investigation and treatment of a 14-year-old girl in whom a detailed assessment of recurrent episodes of pancreatitis revealed a large intraluminal 'windsock'-like duodenal diverticulum. As the diverticulum was closely attached to the papilla of Vater, it was resected by a transduodenal approach. This report focuses on the significance of rare congenital anomalies of the duodenum (e.g., duplication cyst, intraluminal diverticulum) during the diagnostic workup of recurrent pancreatitis in children.

Meckel's diverticulum is congenital abnormality of gastrointestinal tract. It is generally accepted that the radiological demonstration of a Meckel's diverticulum is not practicable. But when there is associated complications with Meckel's diverticulum it becomes relatively easy. Abdominal radiograph does not provide any information but USG and CT features are helpful in diagnosing however the single most accurate diagnostic test for a Meckel's diverticulum is scintigraphy.

A Meckel’s diverticulum is a remnant of the vitelline duct, which leads to the formation of a true diverticulum containing all layers of the small intestine. The diverticulum can contain ectopic gastric, duodenal or pancreatic tissue and is the most common congenital anomaly of the gastrointestinal tract with estimates of prevalence ranging from 0.3% to 3%. The condition is usually clinically silent. In children the most common complication is gastrointestinal bleeding caused by ulceration due to the acid secretion by ectopic gastric mucosa.

Meckel diverticulum is the most common congenital abnormality of the gastrointestinal (GI) tract, occurring in approximately 2% of the general population. The lifetime complication rate from a Meckel diverticulum is 0.5%-2%. The most common complications include bleeding, obstruction, inflammation and perforation. However, the clinical manifestations of a Meckel diverticulum are frequently nonspecific. As a result, complications secondary to Meckel diverticulitis can mimic a variety of more common intra-abdominal processes, such as appendicitis, inflammatory bowel disease and any other cause of small bowel inflammation or obstruction. The radiologist should be aware of potential manifestations of the disease on different imaging modalities. In this pictorial essay, we illustrate several complications related to the Meckel diverticulum, in multiple modalities.

Colonic diverticula and colonic polyps are two of the most common causes of lower gastrointestinal (GI) hemorrhage [1, 2]. Colonic polyps or carcinoma can arise from the normal mucosa near or within a diverticulum [3]. Case reports describe colonic tumors found within a diverticulum, e.g., colon polyps [4], carcinoids [5], lymphoma [6], and adenocarcinoma [3, 7–13]. Rarely adenocarcinoma in a diverticular colonic abscess has been reported [14, 15]. None of the cases has presented as hematochezia or been associated with diverticular bleeding. We report a case of malignant colon polyp within a diverticulum presenting as diverticular hemorrhage.