Meckel 게실의 임상양상

이진범,이용순,유은선,김혜순,손세정,박은애,이승주,성순희,서정완,Lee, Jin Beom,Lee, Yong Soon,Yoo, Eun Sun,Kim, Hae Soon,Son, Se Jeong,Park, Eun Ae,Lee, Seung Joo,Sung, Sun Hee,Seo, Jeong Wan 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.4

Purpose : The diagnosis of Meckel's diverticulum is difficult and delayed because it presents with various clinical symptoms. We evaluated clinical, imaging and pathologic findings of Meckel's diverticulum to facilitate detection of Meckel's diverticulum in children. Methods : Review of clinical, imaging, surgical and pathological findings in 10 children aged 7 days to 14 years with Meckel's diverticulum during an 8-year period, 1993-2001, at Ewha Womans University Hospital was undertaken. Results : The male to female ratio was 2.3 : 1. The chief complaint was painless lower gastrointestinal( GI) bleeding; others were abdominal pain, abdominal distention and vomiting, in order of frequency. The diagonsis before surgery were Meckel's diverticulum in 5 patients, non-reducible intussusception in 3 patients and intestinal obstruction in 2 patients. The diverticulum was located between 35 cm to 70 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 4 cm to 12 cm and 80% of it was within 5 cm. A Meckel scan($^{99m}Tc-pertechnetate$ scintigraphy) after cimetidine administration was done in 6 cases. All 5 cases that presented with lower GI bleeding had ectopic gastric mucosa confirmed on pathology. Out of 5 cases of ectopic gastric mucosa, only 4 cases were positive on the Meckel's scan. Conclusion : In cases of unexplained GI bleeding, obstruction, or inflammation diagnostic workup should be carried out to rule out Meckel's diverticulum. Laparoscopy, high resolution ultrasonography and computed tomography of the abdomen may be indicated in the assessment of pediatric patient with lower GI bleeding, especially in patients with suspected bleeding from Meckel's diverticulum showing negative Meckel's scan.

소아 멕켈씨 게실의 합병증

전흥만,남소현,김대연,김성철,김인구,Jun, Heung-Man,Nam, So-Hyun,Kim, Dae-Yeon,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2007 소아외과 Vol.13 No.2

Meckel's diverticulum is the most common congenital anomaly of gastrointestinal tract in children. The incidence of complicated Meckel's diverticulum is about 4 %. The major complications of Meckel's diverticulum are bleeding, intussusception, obstruction and perforation. The aim of this study was to investigate the clinical manifestations and the role of laparoscopic surgery in complicated Meckel's diverticulum in children. We retrospectively reviewed the medical records of 19 patients with complicated Meckel's diverticulum who underwent operation at Asan Medical Center between Jan. 1990 and Apr. 2007. Male to female ratio was 11:8, and median age was 1 year (1 day-13 years). The most frequent symptom was hematochezia (68%), followed by irritability or abdominal pain (16%), vomiting (11%), and abdominal distension (5%). Two operative procedures were performed; small bowel resection with anastomosis (68%) and diverticulectomy (32%). The operation proven complications of the Meckel's diverticulum were bleeding (68%), intussusception (16%), perforation (11%) and obstruction (5%). Ectopic tissues found by postoperative pathologic examination were gastric (84%) and pancreatic (11%). Hospital stay after laparoscopic operation for bleeding Meckel's was 5 days (median) and average first postoperative feeding was 1.5 days. On the contrary, hospital stay for open surgery was 7 days and first feed was 3 days. In summary, the most common compliation of Meckel's diverticulum in children was bleeding and ectopic gastric tissues were present in 84%. Laparoscopic procedure seemed to be useful for diagnosis as well as for definitive treatment.

크론병에 동반된 Meckel 게실 출혈 1예

오희주 ( Hee Ju Oh ),장병익 ( Byung Ik Jang ),김동희 ( Dong Hee Kim ),김용길 ( Yong Gil Kim ),김경옥 ( Kyeong Ok Kim ),이시형 ( Si Hyung Lee ) 대한장연구학회 2010 Intestinal Research Vol.8 No.1

Meckel’s diverticulum is the most common congenital anomaly of the intestine. The association between Meckel’s diverticulum and Crohn’s disease is unclear. Meckel’s diverticulum has previously been reported to be present in patients with Crohn’s disease. However, the finding is typically incidental, and a bleeding Meckel’s diverticulum in a patient with Crohn’s disease is uncommon. Recently, we managed a 27-year-old man with known Crohn’s disease who presented with hematochezia thought to be due to an ileal ulcer of Crohn’s disease. At the time of intra-operative small bowel endoscopy, the hematochezia was shown to be due to bleeding from Meckel’s diverticulum. Although the patient had already been diagnosed with Crohn’s disease, we need to consider the possibility of other causes of bleeding. (Intest Res 2010;8:80-83)

신생아에서 급성 복증으로 발현된 Meckel 게실 1예

임재영,장선화,조재민,고경혁,박은실,서지현,박찬후,우향옥,윤희상,Lim, Jae Young,Jang, Sun Hwa,Cho, Jae Min,Ko, Gyung Hyuck,Park, Eun Sil,Seo, Ji Hyun,Park, Chan Hoo,Woo, Hyang Ok,Youn, Hee Shang 대한소아소화기영양학회 2005 Pediatric gastroenterology, hepatology & nutrition Vol.8 No.2

Meckel's diverticulum is generally acknowledged to be the most prevalent congenital anomaly of the gastrointestinal tract. The preoperative diagnosis of Meckel's diverticulum is difficult, especially in neonates, because of the lesions ability to masquerade as one of a variety of much more common abdominal pathologies. Recently we experienced a case of perforated Meckel's diverticulum with mild inflammatory reaction, intestinal adhesion, and small bowel obstruction in a previous healthy 9-day-old neonate. The spontaneous perforation of Meckel's diverticulum in neonate is very rare but serious entity. The course was rapid and progressed to sepsis. So despite its varied presentation, Meckel's diverticulum should be kept in mind as a cause of acute abdomen in neonates.

반복적인 장폐쇄를 야기한 Meckel 게실

김은영 ( Eun Yeong Kim ),차재명 ( Jae Myung Cha ),이정일 ( Joung Il Lee ),최재원 ( Jae Won Choe ),주광로 ( Kwang Ro Joo ),정성원 ( Sung Won Jung ),신현필 ( Hyun Phil Shin ),이석환 ( Suk Hwan Lee ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.6

Meckel`s diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. Gastrointestinal bleeding is the most common presenting symptoms of Meckel`s diverticulum in children, however, intestinal obstruction is the most common complications in adult patients. Reported mechanism of intestinal obstruction in Meckel`s diverticulum include intussusception, adhesion, and volvulus. Recently, we experienced a case with Meckel`s diverticulum associated with ileal stricture causing recurrent partial intestinal obstruction in a 48-year-old man. In contrast to other published cases of small bowel obstruction in Meckel`s diverticulum, this case was caused by ileal stricture associated with Meckel`s diverticulum. (Korean J Gastroenterol 2008;51:372-376)

성안에서 유발펀 맥켈씨 게살 반전에 의한 장중첩증

전태용 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.23

A Meckel's diverticulum, a true congenital diverticulum, is a small bulge in the small intestine present at birth. It is a vestigial remnant of the omphalomesenteric duct, and is the most frequent malformation of the gastrointestinal tract, occurring in 1-3% of the population according to autopsy studies. The most common presenting symptom is painless rectal bleeding, followed by intestinal obstruction, volvulus and intussusception. Although Meckel's diverticulum is a relatively common anomaly, inverted Meckel's diverticulum has been reported rarely. Herein the author describe a case of inverted Meckel's diverticulum located at the distal ileum simulating a benign tumor. Computed tomography showed a small mass with a central area of low fat density. Surgical resection revealed a Meckel’s diverticulum containing an ectopic gastric tissue with ulceration. The unique clinical symptoms and the methods of diagnosis are discussed. Special features regarding the pathophysiology and treatment of an inverted Meckel's diverticulum acting as an intussusception are also reviewed.

이소성 췌장과 위점막을 가진 멕켈 게실에 의한 장중첩증 1예

김미진,김재영,설지영,강대영,Kim, Mi Jin,Kim, Jae Young,Sul, Ji Young,Kang, Dae Young 대한소아소화기영양학회 2006 Pediatric gastroenterology, hepatology & nutrition Vol.9 No.1

Intussusception is a frequent cause of intestinal obstruction in early childhood and most are idiopathic in origin. In a minority of cases a definite pathological lead point is identified by imaging studying or during surgery. As the pathologic lead point of intussusception, Meckel's diverticulum is the most common lesion. In symptomatic patients, 40~60% of Meckel's diverticulum contain ectopic tissue, with gastric mucosa being far the most common type. A few Meckel's diverticulum contain pancreatic tissue. Combined heterotopic pancreatic and gastric tissues in the Meckel's diverticulum especially causing intussusception is extremely rare. We report the case of 5-year-old girl with an intussusception caused by Meckel's diverticulum containing both heterotopic gastric and pancreatic tissues.

성인에서 반복적인 복부통증을 유발한 Meckel 게실염에 의한 복막유착 1예

김명식,방제소,권계숙,조현근,문희용,김범수,신용운,김영수,김준미 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.6

멕켈 게실 천공에 의한 신생아 복막염 1례

김동원,김성신,박재옥,이도상,Kim, Dong Won,Kim, Seung Sin,Park, Jae Ock,Lee, Do Sang 대한소아소화기영양학회 2004 Pediatric gastroenterology, hepatology & nutrition Vol.7 No.1

Meckel's diverticulum is the most common malformation of gastrointestinal tract. Symptoms of Meckel's diverticulum usually arise within 2 years of life. The most common presentations include hemorrhage, perforation, diverticulitis and intestinal obstruction. Perforation of the Meckel's diverticulum in a neonate is uncommon but life threatening condition. We describe the first case of perforation of Meckel's diverticulum in a 1-day-old neonate who presented with abdominal distension without hemorrhage.

고령에서 반복하는 혈변으로 진단된 멕켈 게실 1예

김동균,김진오,김현건,이태희,정윤호,조주영,이준성,진소영 대한소화기내시경학회 2010 Clinical Endoscopy Vol.40 No.5

The small bowel is the most common site of an unknown origin of gastrointestinal bleeding. Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract in children. The complications from Meckel’s diverticulum such as bleeding decrease with age, and so Meckel’s diverticular bleeding is very rare in old age patients. The diagnosis of Meckel’s diverticulum may be very difficult and especially in old age patients. Capsule endoscopy and double balloon enteroscopy have recently become useful diagnostic tools for assessing diverticular bleeding and small bowel lesions as these techniques can examine the entire small intestine. We report here on a case of Meckel’s diverticulum that was detected by capsule endoscopy and double balloon enteroscopy and this was confirmed by surgery in a 76-year-old man with recurrent hematochezia. 불분명한 위장관 출혈의 가장 흔한 원인은 소장에 있다. 멕켈 게실은 위장관에서 발생하는 가장 흔한 선천성 기형이지만 소아에서 흔하고 출혈 등의 합병증도 연령이 증가하면서 감소하기 때문에 고령에서 멕켈 게실에 의한 출혈은 매우 드물다. 멕켈 게실의 진단은 쉽지 않으며 특히 고령일 경우 매우 어렵다. 최근에는 캡슐내시경과 이중풍선 소장내시경으로 전 소장을 관찰할 수 있어 게실 출혈이나 소장의 병변을 진단하는데 많은 도움이 되고 있다. 저자들은 반복하는 혈변을 주소로 내원한 76세 남자에서 캡슐내시경 및 이중풍선 소장내시경을 이용하여 멕켈 게실을 진단하고 수술로 확진하여 이를 보고한다.