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Meckel憩室は多くの場合無症状で経過する.時に腸閉塞,憩室炎,出血などをおこし外科治療を有するが,異物による穿孔は極めて稀である.今回,われわれは魚骨によるMeckel憩室穿孔の1例を経験したので,文献的考察を加え報告する.症例は68歳,男性.右下腹部を中心とした腹痛を主訴に受診された.虫垂切除の既往歴があり憩室もしくは潰瘍穿孔による汎発性腹膜炎を疑い臨時手術を施行した. Meckel憩室に2.5cmの魚骨が突出しており,魚骨によるMeckel憩室穿孔と診断し,憩室切除を施行した.術前CTをretrospectiveに検討すると魚骨と一致して拡張した小腸壁に向かったhigh densityの線状陰影が認められた.魚骨によるMeckel憩室穿孔は本邦では文献的に11例しか報告がなく稀な症例である.小さな魚骨でも腹膜炎型をとり急性虫垂炎と診断され手術されることが多く,術前に魚骨を同定しえた症例はない.

WOS: 000386290900001, PubMed ID: 27429672, Background: During embryonal period, complete obliteration of the urachus at the umbilicus and incomplete closure at the bladder level are the cause of vesicourachal diverticulum. This abnormality is a rare finding that is usually discovered incidentally during radiological evaluation. Occasionally, stones have been detected within the diverticulum. Case Report: We present a case of a vesicourachal diverticulum with calculus diagnosed by multidetector computed tomography and confirmed surgically and histopathologically in a 24-year-old man. Conclusions: During the radiological differential diagnosis of abnormalities of abdominal wall and urinary system, consideration of urachal abnormalities is important especially in symptomatic patients.

Background/Purpose: The process of tracheoesophageal separation during early development of the foregut has been disputed and has led to difficulties explaining how congenital abnormalities of the trachea and esophagus might occur. This study clarifies the embryogenesis of tracheoesophageal separation by using sequential 3-dimensional imaging at crucial stages of foregut development. Methods: Timed pregnant Sprague Dawley rats were killed at days 11, 11.5, 12, 12.5, and 13. The embryos were harvested, histologically sectioned, and stained with H&E. Digitized photographs were taken of sequential serial transverse sections and their tracings layered in a 3-dimensional rendering program before being "skinned" to produce a 3-dimensional object. Results: The first respiratory structures to develop are the bronchi on day 11.5. They are evident first as bulges on the ventrolateral wall of the foregut approximately two thirds of the way between the lowest pharyngeal pouch and the level of the hepatic diverticulum and pancreatic buds. Lateral grooves dorsal to the respiratory bud on the lateral walls extend cranially. On day 12 the lateral bulges have developed into the 2 main bronchi, although the trachea is yet to separate from the foregut. On days 12.5 to 13 the trachea progressively elongates, and by day 13 tracheoesophageal separation is complete. Conclusions: After the main bronchi have developed, the trachea forms when the ventral component of the foregut is "cut" away from the dorsal component. There is an area of apoptosis at the point of tracheoesophageal separation, and, as the embryo grows, this causes the separation point to stay at a constant distance from the pharynx. Meanwhile, the trachea and esophagus distal to it increase dramatically in length. The area immediately caudal to the initial point of tracheoesophageal separation ultimately forms the stomach. J Pediatr Surg 38:173-177. Copyright 2003, Elsevier Science (USA). All rights reserved.

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Most cases are asymptomatic; however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis, and perforation. Tumors within a Meckel's diverticulum are rare. Herein, we present a gastrointestinal stromal tumor arising from the Meckel's diverticulum that led to intestinal obstruction by volvulus.

Intestinal obstruction due to Meckel’s diverticulum is the most common presentation in adults. There are various mechanisms by which it can cause intestinal obstruction such as volvulus of small intestine around a fibrous band extending from Meckel’s diverticulum to umbilicus, intussusception, and Littre’s hernia. We report the case of a young adult operated on emergency for acute intestinal obstruction. The CT scan suggested a nonspecific internal herniation. Surgical exploration confirmed a rare type of obstruction due to Meckel’s diverticulum.

INTRODUCTION Primer small intestine bezoar is seen rarely. It frequently arises from underlying small intestine pathologies (diverticle, tumor, stricture etc.). We report a very rare case of disopyrobezoar in the duodenal diverticulum, a kind of phytobezoar caused by persimmons, which was treated laparoscopically. PRESENTATION OF CASE The 47-year-old patient applied to polyclinic with complaints of epigastric tenderness, occasional distension, and acid regurgitation. In endoscopical examination, impacted bezoar was determined in the diverticulum in the duodenum. Because it is too hard, it was unable to remove endoscopically. On the abdominal tomography, a smooth-bounded non-homogeneous mass including gas and soft tissue areas in the 2nd portion of the duodenum was detected. A barium meal confirmed the presence of a 5 cm diameter diverticulum on the lateral wall of the second portion of the duodenum. It also showed an intraluminalfilling defect as well as the mottled appearance of the bezoar. Learned from history of the patient, that the patient consumed over persimmon in childhood. DISCUSSION Generally, duodenal diverticles are asymptomatic. Surgical treatment is rarely necessary because of complications such as bleeding, perforation, abdominal pain, bezoar formation. As well as using methods such as gastric lavage, enzymatic dissolution, endoscopical fragmentation in the treatment of phytobezoar, their chances of success are low because its structure is rigid. Usually, surgical intervention is required. CONCLUSION For the treatments of bezoar cases located in the small intestine, laparoscopic surgical method is a safe and feasible method in selected cases.

Diverticulum of the caecum is a rare lesion. From a clinical point of view, the inflammation it causes can mimic symptoms of acute appendicitis, causing difficulties in diagnosis and thus prescription of appropriate treatment. It is almost impossible to differentiate this disease from acute appendicitis through physical examination alone, and radiological imaging may also prove insufficient. For this reason, it is common to perioperatively diagnose diverticula of the caecum. Two cases of patients who underwent surgery for perforated caecal diverticula are presently described.

症例は31歳,男性.腹痛のため当院受診し諸検査を受けるも原因不明で経過観察となった.腹痛が繰り返しみられ,腹部単純X線撮影にて小腸ガス像を認めたため入院となった. 腹部CT検査にて,下腹部の腸管内に腫瘤様陰影をみとめた.小腸造影検査で,下部回腸内に長軸方向に長い陰茎様腫瘤陰影を認めその口側に小腸重積像を認めた.後日の小腸造影検査では, 6×2cmの腫瘤陰影は認められたが,造影剤の通過障害は改善され腸重積は保存的に軽快していた.小腸腫瘍による腸重積を疑い開腹術施行した.回盲部より80cm口側の回腸内に5×2cmの腫瘤を触れ,腸間膜側やや側壁に漿膜面の陥入と腸間膜の索状肥厚を認め,小腸切除術を施行した.病理組織学的に腫瘤は腸管壁全層が内翻したものであった.以上から内翻したMeckel憩室による腸重積症と診断した.

症例は75歳の男性. 食後のつかえ感を主訴に来院. 上部消化管造影X線検査にて胃噴門部に辺縁明瞭, 立ち上がりなだらかな腫瘤陰影があり, 腹部食道前壁に憩室を認めた. 上部消化管内視鏡検査にて食道下部に立ち上がりやや急峻な, 食道粘膜におおわれた隆起性病変を認めた. 腹部食道の憩室および胃平滑筋腫瘍を疑い, 開腹術を施行した. 腫瘍は腹部食道に存在し, 憩室は腫瘍直上に隣接していた. 腫瘍を核出し食道憩室は内反させ, 筋層を縫合閉鎖した. 切除した腫瘍は, 病理組織学的に食道平滑筋腫と診断した. 本邦報告例において食道平滑筋腫に合併した食道憩室の成因は牽引性であるとするものが多い. 筋腫に合併した憩室の成因は, 腫瘍が壁外性発育をした場合には牽引性の要素が, 腫瘍が壁内性発育をした場合には内圧性の要素が関与していると考えられた. 本症例の憩室の成因は, 文献的考察から牽引性要素と内圧性要素の2つが関与していると考えられた.

Meckel's diverticulum is the common congenital anamoly of the gastrointentestinal tract, caused due to failure of involution of vitelline duct after seventh or eighth week of intra-uterine life. It is usually present within the last 90cm of terminal ileum. Histologically, Meckel's diverticulum consists of all layers of small intestine. Rarely, heterotopic tissue is present derived from gastric or pancreatic tissue. In the case presented here, Meckel's diverticulum was found on the ante mesenteric border of the ileum with no peritoneal attachment during routine Anatomy cadaveric dissection. It was present 26cm proximal to the ileocecal junction, with no attachment to umbilicus. It’s blood supply was derived from the vitelline artery. Histological examination revealed the presence of 3 layers: mucosa, submucosa and muscularis propria with no heterotopic tissue.

Incidental carcinoid tumor of the Meckel's diverticulum is an uncommon event. Herein, a case of a carcinoid tumor in Meckel's diverticulum that was incidentally found in a patient with acute appendicitis is presented. A 42-year-old Caucasian man presented with acute abdomen and clinical signs of acute appendicitis. A typical appendectomy was performed during which further abdominal exploration revealed a Meckel's diverticulum 60 cm proximal to the ileocecal valve, with an irregular and somewhat indurated serosal region on one side. A stapled diverticulectomy was performed. Pathology revealed an incidental carcinoid tumor measuring 1 cm within the Meckel's diverticulum. CT scan of the abdomen and 24-h urine 5-hydroxyindoleacetic acid results were normal. The patient had an uneventful recovery and was discharged at the 5th postoperative day. He is alive and without evidence of disease 23 months after the operation. Coexistence of acute appendicitis along with an incidental Meckel's diverticulum raises controversies in their surgical management. We discuss the issues in managing patients with two or more of these coexistent pathologies.

Perforation is a rare but serious complication of a duodenal diverticulum and often presents itself with nonspecific symptoms and signs. Ectopic pan-creatic tissue within a duodenal diverticulum is another rare situation. In this article, we report a case of an 87 year-old woman who presented with spontaneous perforation of the duodenal diverticulum. Operative resection and simple closure of the duodenum was performed. Ectopic pancreatic tissue was observed within the diverticulum at histological evaluation.

Meckel’s diverticulum is the most frequent congenital malformation of the gastrointestinal tract. The most common ectopic tissue within a Meckel’s is heterotopic gastric mucosa, with bleeding being the most common presentation. However, perforation of a Meckel’s diverticulum is a rare presentation. NSAID-associated Meckel’s perforation has been suggested, however has not been documented in the literature. We present a case of a 17-year-old female with acute abdominal pain and tenderness following a 24-hour history of excessive ingestion of NSAIDS for pain related to tooth extraction. Chest radiograph demonstrated free intra-abdominal air and she was subsequently taken for exploratory laparotomy. A perforated Meckel’s diverticulum was isolated and resected. Though NSAID-associated bleeding of heterotopic gastric mucosa has been described, and perforation of the Meckel’s diverticulum has been suggested, no clear association between heterotopic gastric mucosa and perforation exists. On the other hand, the relationship between NSAIDS and gastric ulcer perforation is well documented. A similar mechanism may also play a role in NSAID-associated Meckel’s perforation. With how common NSAID use is, we believe it is important to document NSAID-associated perforation of a Meckel’s diverticulum. Keywords Meckel’s diverticulum; NSAIDS; Perforation; Heterotopic gastric mucosa

Giant colonic diverticulum is an extremely rare condition in colonic diverticular disease. More than 90% of giant colonic diverticula are found in the sigmoid colon. Inflammatory and pseudodiverticula are the most frequent. Only one case of a true diverticulum of the transverse colon has been reported in the literature. Case Report We report a case of a 22-year-old woman presenting with constipation and meteorism from childhood. A plain abdominal X-ray showed a round radiolucent air-filled cyst. Barium enema revealed a single, large diverticulum of the transverse colon. An extended right hemicolectomy with primary end-to-end anastomosis was performed. The postoperative course was uneventful, and she was discharged in 1 week without any complications. Histopathology showed a true diverticulum containing all layers of the colon.

BACKGROUND: Intussusception with the Meckel?s diverticulum is rare cause of small bowel obstruction in the adults. The Meckel diverticulum is the most common cause of intestinal obstruction in children. METHODS (CASE REPORT): We present a case of 18-year-old boy with developing signs of small bowel obstruction The onset of disease was the day before the first examination. There was no history of prior surgery. According to the clinical symptoms, physical examinations as well as radiographic and ultrasound examination, surgical treatment was indicated. Surgical approach was inferior medial laparotomy. Intussusceptions of the Meckel?s diverticulum and into the coecum with incarceration were found. De-sincarceration and simple diverticulectomy was done. CONCLUSION: The Meckels?s diverticulum should be consider as a possible cause of the small bowel obstruction in previously healthy patient.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, and in the majority of cases it remains asymptomatic. The total lifetime rate of complications is 4%. It is an uncommon cause of intestinal obstruction in adults. Loop formation of Meckel's diverticulum leading to small bowel obstruction is an extremely rare event. We report two such cases in which the bowel became obstructed and strangulated in a loop formed by adhesion of the distal end of the Meckel's diverticulum to the proximal ileum and mesentery.

Highlights • It is important to differentiate this rare pathological feature of MD from other entities as the treatment is surgical rather than medical. • No pathognomonic clinical symptoms indicating MD has been reported. • Diagnosis usually is by a technetium Tc 99m-pertechnetate scanning. • The treatment of symptomatic MD is surgical resection (wedge resection of the MD or resection of ileum). • The heterotopic tissue is: gastric, pancreatic, jejuna, duodenal, colonic or hepatobiliary tissue., Introduction Intussusception with the Meckel’s diverticulum (MD) is a rare cause of chonic abdominal pain in the adults. We wish to present this first case of intussusception of MD within its own lumen without small bowel obstruction. Presentation of case We report the case of a 27-year-old man who was admitted to the emergency room due to a diffuse abdominal pain. Abdominal CT scan showed invagination of MD. The exploratory laparoscopy revealed the presence of intussusception of MD within its own lumen. Segmental resection of the small intestine was performed. The patient was discharged on the third post-operative day. Discussion The prevalence of MD is 1 to 4%. Diagnosis is often difficult and delayed because clinical symptoms are not specific and the diagnosis is performed mainly by imaging studies. Factors pre-disposing these patients to intussusception of MD within its own lumen include a narrow diverticulum, large diverticululm, and associated inflammation of the diverticulum. Intestinal obstruction is a more common complication in adults, whereas in children, bleeding is the more common complication. In our case, the patient had a diffuse abdominal pain without small bowel obstruction because the intussusception of MD was within its own lumen. Laparoscopy may be useful for confirming the presence of intussusception, and demonstrating the underlying organic lesion serving as the lead point. Conclusion It is important to differentiate this rare pathological feature of MD from other entities as the treatment is surgical rather than medical. Abdominal surgeons should bear in mind this rare entity.

Heterotopic gastric mucosa (HGM) is a rare, but acknowledged source of gastrointestinal pathology in pediatric patients. Sometimes clinically confused with a Meckel's diverticulum, HGM diagnosis is often made postoperatively by pathology. We present a case of jejunal HGM with a positive technetium pertechnetate scan in the right lower quadrant that resembled a Meckel's diverticulum.

Intestinal obstruction is a common complication associated with Meckel’s diverticulum in adults. The diverticulum itself or its fibrous band can lead to an intestinal volvulus, intussusceptions, or closed-loop obstructions, which require surgery. The incarceration of Meckel’s diverticulum in either inguinal or femoral hernia sacs (Littre’s hernia) is another, less common, etiology underlying intestinal obstruction. This case report describes a 45-year-old man who had an obstruction associated with a Meckel’s diverticulum that passed through a congenital defect in the mesocolon into the right subphrenic space. The patient, who had not undergone abdominal surgery previously, came to the emergency room with acute onset of intermittent epigastric pain and abdominal distention. Computed tomography images showed the presence of a segment of the small bowel and a diverticulum in the right subphrenic space and paracolic gutter. The twisted mesentery and the dilated loops of the proximal small bowel were indicative of an intestinal volvulus and obstruction. Meckel’s diverticulum complicated by a transmesocolic internal hernia was diagnosed, and this condition was confirmed during emergency surgery. The patient’s postoperative recovery was uneventful. This case report highlights another presentation of Meckel’s diverticulum, that is, in combination with a transmesocolic internal hernia. This etiology may lead to an intestinal volvulus and necessitate early surgery.

Highlights • Meckel’s diverticulum (MD), a remanant of omphalomesenteric duct, is the most common congenital malformation of GIT. • Most patients are asymptomatic. Patients develops symptoms due to its complications like bowel obstruction, hemorrhage, diverticulitis, Littre’s hernia or perforation. • Case presented with persistent features of subacute intestinal obstruction due to herniation of bowel loops through unusual mesentery of Meckel’s diverticulum extending from base of diverticulum to the band which was running from it’s tip to adjacent mesentry encircling the herniated loops of intestine forming a complete hernial sac; a rarest way of presentation. • Limitation of imaging modalities in diagnosis of complications of diverticulum. • Surgical intervention indicated for patients with intestinal obstruction or high risk of incarceration. The treatment option is surgical resection with diverticulectomy and reduction of internal herniation., Introduction Meckel’s diverticulum is the most common congenital gastrointestinal anomaly. However, only 2% of cases are symptomatic. It can cause intestinal obstruction by various mechanisms as volvulus, adhesions, Littre’s hernia, intussusception. Case presentation An unusual case of internal herniation of small bowel loops into complete hernia sac formed by unusual mesentery of Meckel’s diverticulum which was present upto the adhesive band, extending from tip of the Meckel’s diverticulum to the adjacent mesentery of small intestine leading to small bowel obstruction (SBO). Diverticulectomy with resection of adjacent ileum with ileo-ileal anastomosis was done. Discussion Internal herniation by MD leading to SBO is an extremely rare complication. In literature, cases of internal hernia through mesentry of Meckel’s diverticulum, through mesodiverticular band, adhesion of inflamed end of MD to corresponding base of mesentry, fibrous cord extending upto umblical wall have been reported but in our case, patient had both adhesion band along with internal herniation into sac formed by unusual mesentry of the meckel’s diverticulum and the adhesion band. Preoperative diagnosis is often difficult with only 6–12% of cases diagnosed correctly. Surgical intervention is indicated for patients with intestinal obstruction or high risk of incarceration. Conclusion Meckel’s diverticulum causing internal hernia is rare event. It’s presentation due to herniation of bowel loops into sac formed by mesentery attached to diverticulum and the adhesion is rarest, with non specific signs and symptoms. Early diagnosis and prompt treatment prevent further complications.

Meckel’s diverticulum is the most common congenital abnormality of the gastrointestinal tract and it is found to affect nearly 2 percent of the population. Interestingly, the surgical management of an asymptomatic Meckel’s diverticulum remains widely controversial in the adult population. Review of the literature finds the overall risk of Meckel’s diverticulum becoming symptomatic to be low; however, the risk accompanying its resection also proves to be minimal thus perpetuating the question of its proper management. We report our experience with an elderly patient who required an emergent operative intervention and was incidentally found to have Meckel’s diverticulum. Review of final pathology found Meckel’s diverticulum to contain a carcinoid tumor. In our review, the presence of a carcinoid tumor within Meckel’s diverticulum is a rare finding, but its incidence may further support the resection of incidentally found asymptomatic Meckel’s diverticulum in patients of all ages.

Jejunal diverticula are quite rare. Furthermore, small bowel diverticular disease resulting in volvulus can lead to complications necessitating surgical intervention. In this manuscript, we report a case of large sacculated jejunal diverticulum causing small bowel volvulus in a 40-year male. The jejunal mesentery at the base of the diverticulum was adhered to the terminal ileal mesentery forming a narrow base and complete small bowel going into volvulus by rotating around the narrow base. This case highlights a large jejunal diverticulum causing small bowel volvulus as an uncommon mechanism of complete small bowel volvulus. Although a rare entity, familiarity with jejunal diverticular disease, its complications and its management should be part of every surgeon’s base of knowledge when considering abdominal pathology.

Giant sigmoid diverticuli are uncommon and usually seen in association with multiple colonic diverticuli. A solitary diverticulum in an otherwise normal colon is very rare. Mostly asymptomatic, excision of giant sigmoid diverticuli is advised to prevent complications.

The human biliary system is formed from the hepatic diverticulum, a structure which develops from the embryonic foregut in the fourth week of gestation. The cephalic portion of the hepatic diverticulum lies within the septum transversum, and gives rise to entodermal cells which become the primitive hepatocytes. The caudal part of the hepatic diverticulum is molded by mesenchyme to form the gallbladder, cystic duct, and extrahepatic bile duct. The gallbladder is initially tubular in shape, and undergoes morphological changes to become saccular during the 11th week of gestation. The extrahepatic bile duct elongates and widens as gestation progresses, and intramural mucus glands develop. There is no solid stage during the development of the extrahepatic bile duct. The extrahepatic bile duct is a well-defined tubular structure by the 6th week of gestation, whereas the intrahepatic biliary system during this period of gestation is represented by the primitive ductal plate. The ductal plate undergoes structural changes from the 11th week of gestation, beginning at the porta hepatis and progressing through gestation to the periphery of the liver. This remodeling process shapes the ductal plate from a flat sheath of biliary epithelium surrounding the portal vein branches into a network of interconnecting tubular structures. Mesenchyme plays an important role in ductal plate remodeling. The intrahepatic biliary system is in luminal continuity with the extrahepatic bile duct throughout gestation at the porta hepatis. The major bile ducts at the porta hepatis are fully formed by the 16th week of gestation.

Classical transplantation studies using chick and quail embryos demonstrated that the vertebrate liver parenchyma is derived from an outgrowth of the ventral foregut endoderm, referred to as the liver bud (LeDouarin 1964, 1968, 1975). This process, illustrated in Figure 1, initiates at around gestation day 8.25 (7–8 somites) in the mouse (Gualdi et al. 1996). Invagination of the foregut positions a ventral portion of foregut endoderm next to the developing cardiac mesoderm. Early on, it was proposed that specification of the hepatic diverticulum relied upon the close proximity of cardiac mesoderm. Several studies, the most recent by Gualdi et al. (1996), provided strong evidence to support this proposal. In general, it was found that ventral endoderm from either mouse or chick was unable to adopt a hepatic fate, or express characteristic hepatic mRNAs, if it were grown in the absence of developing cardiac tissue (LeDouarin 1975; Houssaint 1980; Fukuda-Taira 1981; Gualdi et al. 1996). Moreover, this inductive capacity seemed to be restricted to cardiac mesoderm, because other noncardiac mesoderms failed to induce hepatic development (Fukuda 1979; Fukuda-Taira 1981).

Alpha-fetoprotein (AFP) is the major serum protein during development. AFP is one of the earliest proteins to be synthesised by the embryonic liver. The synthesis of AFP decreases dramatically after birth and only trace amounts are expressed in the adult liver. The tissue distribution of AFP in early human embryogenesis has not been defined. We have studied the expression pattern of AFP mRNA in human and mouse embryos by in situ hybridisation. In humans, AFP is expressed in the hepatic diverticulum at 26 d postovulation as it differentiates from the foregut endoderm (i.e. in the most primitive hepatocytes). It is also expressed in the endoderm of the gastrointestinal tract and in the yolk sac at this age. AFP is subsequently expressed in the mesonephros and transiently in the developing pancreas. In the mouse, no expression of AFP was observed in the mesonephros but other sites of expression were similar. Thus AFP has a distinct temporospatial expression pattern during the embryonic period and this differs between human and mouse species. It is interesting that AFP is expressed by tumours such as primitive gastrointestinal, renal cell and pancreatic tumours as well as those of hepatocyte origin. This distribution reflects the sites of AFP expression during development.

Historical background The first description of a diverticulum of the small intestine is attributed to Fabricius Hildanus in 1598. In 1742, a small bowel diverticulum strangulated in an inguinal hernia was reported by Littre. In 1809, the German comparative anatomist Johann Friedrich Meckel the Younger first published his observations on anatomy and embryology of the diverticulum that bears his name. In 1898, Kuttner reported small bowel intussusception secondary to an invaginated Meckel’s diverticulum (MD). Ectopic gastric mucosa and inflammation in an MD were first described by Salzer in 1907 and Gramen in 1915, respectively.

今回,われわれは下血を主訴としたMeckel憩室腫瘍の1例を経験した.症例は69歳男性.下部消化管内視鏡検査を施行するも出血源は同定されなかった.骨盤部CT検査にて膀胱直腸窩に径約7cm大の腫瘍が認められたため,膀胱後腫瘍の小腸穿破による消化管出血と診断したが,再度下血が出現したため,緊急開腹術が施行された.回盲部より100cmの部位に回腸漿膜より壁外に発生する径8×7×7cmの腫瘍が認められたため,これを含めた回腸部分切除術が施行された.切除標本では回腸粘膜面に憩室による開口部が認められ,腫瘍はこの憩室に連続して存在する充実性の腫瘍であった.病理組織学的には,平滑筋層より発生した間葉系腫瘍であった.本症例においては, Meckel憩室腫瘍が根治可能で,かつ消化管出血に対しても完全止血できたという意味で回腸部分切除術が有効であった.

Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.

A polyclonal antibody against a glutathione S:-transferase fusion protein containing the 76 COOH-terminal amino acids of Hex, a divergent homeobox gene, was raised in rabbits. Western blot and immunofluorescence reveal that Hex is a 35-37-kD soluble protein present both in the nucleus and cytoplasm of transfected and nontransfected cultured cells as well as in whole mouse embryo. Confocal microscopy of whole mount immunostained mouse embryos at E7. 5 and E8.5 demonstrates that Hex is differentially localized in the cytoplasm and nucleus of definitive endoderm, developing blood islands, and hepatic diverticulum. In particular, in the region of the foregut that gives rise to the liver, Hex expression is nuclear in the endodermal cells of the hepatic diverticulum, whereas expression is primarily cytoplasmic in cells lateral to the liver-forming region. This suggests that nuclear localization of Hex is involved in early hepatic specification and that compartmentalization of Hex protein plays an important role in its function during mouse development.

We report a case of adenomyoma of the small intestine arising in a Meckel diverticulum. The patient was a 22-month-old boy who presented with signs and symptoms of intussusception. At surgery, a Meckel diverticulum was found and removed. On histologic examination, a tumor consisting of dilated cystic glands and smooth muscle bundles was identified. A diagnosis of adenomyoma arising in a Meckel diverticulum was made. A review of the literature showed that only six other pediatric cases of adenomyoma of the small intestine have been reported. The presence of an adenomyoma in a young patient within a Meckel diverticulum favors the view that adenomyomas are a variant of pancreatic heterotopia.

We report a case of peritonitis due to Meckel's diverticulosis with ectopic gastric mucosa and pancreatic tussue. A 29-year-old man was admitted because of right lower abdominal pain. An emergency laparotomy was performed on suspicion of peritonitis due to perforated appendicitis. Although the appendix was normal, Meckel's diverticulum was found about 60cm proximal to Bauhin's valve, and diverticula had formed. Resection of Meckel's diverticulum and peritoneal lavage were performed. Microscopic examination of the resected specimen revealed gastric mucosa and inflamed pancreatic tissue, but perforation of the diverticulum was not found. The cause of peritonitis was not perforation but pancreatitis.

Giant Meckel's diverticulum is rare and usually presents in childhood with haemorrhage or bowel obstruction. Bleeding results from the presence of ectopic gastric mucosa causing peptic ulceration of adjacent mucosa. We discuss the case of a 21-year-old man with a giant Meckel's diverticulum who presented with rectal bleeding. A Meckel's scan was negative and histology following surgical excision ruled out the presence of ectopic gastric mucosa. There was however evidence of chronic inflammation and small bowel mucosal ulceration. We hypothesize that this arose from ischaemia and pressure necrosis because of the large size of the diverticulum and chronic distension by food debris. This case highlights the difficulties in investigating anaemia in young adults despite modern imaging techniques.

Meckel's diverticulum is the most common congenital anomaly of the gastro-intestinal tract. It is generally asymptomatic. Occasionally, it may cause some complications such as bleeding, obstruction, diverticulitis and intussusception. We present a case of a 21-year-old female with intussusception due to inverted Meckel's diverticulum. Diagnosis and therapy of inverted Meckel's diverticulum is a subject of debate because of its rarity and the limited number of reports in the literature.

Meckel's diverticulum is a true diverticulum involving the three layers of intestine. It occurs as a result of incomplete atrophy of the omphalomesenteric duct. Usually asymptomatic, presentation is most often due to complications. Sonographic features are diverse and can represent the diverticulum per se or be due to its complications. Haemoperitoneum is one such finding caused by perforation of the diverticulum.

Meckel’s diverticulum occurs in about 1–3% of general population. The majority of them are asymptomatic and incidentally found at laparotomy. The most common complication due to Meckel’s diverticulum in adults is intestinal obstruction. The frequency of symptoms decreases with age. Enteroliths are rarely formed in a Meckel’s diverticu-lum and are known to cause intestinal obstruction. These should be considered in the differential diagnosis of radio-opaque shadows in the plain abdominal films. We describe a rare presentation of Meckel’s diverticulum in an elderly woman.

We report a very rare case of ileo-abdominal fistula caused by penetration of the ileal diverticulum. Small bowel diverticulosis is generally considered to be an innocuous condition. In this report, we describe a case of ileal diverticulitis associated with an abdominal wall abscess.

Meckel's diverticulum is silent in the clinical course in most cases, and is often detected incidentally at laparotomy. It sometimes causes some complications which include perforation due to a foreign body in a lowest frequency. This paper reports a rare case of perforation of Meckel's diverticulum due to a fish bone. A 60-year-old man was referred to the hospital with a diagnosis of acute appendicitis from another hospital. With a diagnosis of perforative peritonitis due to acute appendicitis, an emergency operation was conducted. It revealed that a foreign body was stipping a 3×5 cm Meckel's diverticulum at 70 cm oral side from the ileocecal region. We made a diagnosis of perforation of the Meckel's diverticulum due to the foreign body, and performed a resection of the diverticulum. The foreign body was a sharp fish bone, 3.5 cm in length and 1.5 mm in diameter. It was comfirmed as a salmon's bone that was inferred from the menu he ate. Pathological study indicated true diverticulum with infiltration of inflammatory cells extending the full thickness. No aberrant tissue, however, was demonstrated. There have been only ten cases of perforation of Meckel's diverticulum due to a fish bone in the Japanese literature so far. This case is thought very rare.

Perforation of a diverticulum of the colon is extremely rare in juvenile people, and it commonly appears in the sigmoid colon and in patients who have multiple diverticula if it occurs. This time we have experienced a case of perforation of solitary diverticulum in the ascending colon in a juvenile patient. In this patient a barium enema study and abdominal computed tomography scan presented difficulty in differential diagnosis from acute appendicitis. This case which is thought to be rare as well as to be suggestive in terms of the differential diagnosis is reported here, together with a review of the literature.

A 31-year-old man was emergently admitted to the department of gastroenterological medicine in our hospital because of abrupt massive anal bleeding. Upper and lower gastrointestinal endoscopy and angiography faild to identify the bleeding site. A total of about 7500ml of anal bleeding was noted during these three days, but hemostasis was achieved conservatively. Intestinal fluoroscopy revealed a true diverticulum with peristalsis in the contralateral mesentery at 40cm from the terminal ileum. It was diagnosed as Meckel's diverticulum, but Tc scintigraphy did not visualize the diverticulum. Angiography confirmed abnormal vessels distributed in the diverticulum. It was determined that massive anal bleeding was originated from the Meckel's diverticulum. On November 15, 1996, a partial resection of the ileum including the diverticulum was performed under laparoscopy. Histological examination of the resected material revealed regeneration of epithelia at the top of the diverticulum which appeared to be a repairing process of acute mucosal lesion. Differing from usual bleeding from Meckel's diverticulum, massive bleeding in this case was thought to occur from the acute mucosal lesion of the diverticulum.