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Special Feature |

Image of the Month—Diagnosis FREE

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Section Editor: Grace S. Rozycki, MD

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Arch Surg. 2006;141(2):215-216. doi:10.1001/archsurg.141.2.216.
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Published online

Helical computed tomography of the abdomen and pelvis after contrast shows the “target”-shaped area within 1 of the small-bowel loops, consistent with ileoileal intussusception (Figure 1). The patient underwent resection of the mass with an 8-cm margin from each side. The small bowel was then reconnected with a primary anastomosis. The patient was discharged home on postoperative day 4.

Place holder to copy figure label and caption
Figure 1.

Helical computed tomographic scan after oral contrast shows the characteristic “target”-shaped lesion within 1 of the distal small-bowel loops, indicating an ileoileal intussusception.

Graphic Jump Location

Pathologic examination of the specimen confirmed the diagnosis of inverted Meckel diverticulum with heterotopic pancreatic tissue and acute ischemic enteritis with serositis. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2% to 3% of the population1and often asymptomatic. Clinical symptoms arise from complications, which occur in 4.2% to 6.4% of those harboring the diverticulum.2,3The lifetime risk of complications is likely independent of age, although they are more common in men than women.4

Intestinal obstruction is the most common complication in adults with Meckel diverticula.5This may be caused by intussusception, volvulus, luminal obstruction from an inverted diverticulum, diverticulitis or a foreign body inside the diverticulum, inclusion of a diverticulum into a hernia, or neoplastic obstruction.

Heterotopic pancreatic tissue is found in 5% to 16% of resected Meckel diverticula.6,7The heterotopic pancreatic tissue may be located in the distal tip of the diverticulum and serve as a lead point for intussusception.

Only a few cases of inverted Meckel diverticulum have been reported.6,8Clinically, these patients present with bleeding, melena, and acute abdominal pain. Our case is unique because the patient presented with chronic diarrhea and intermittent abdominal pain.

Although a preoperative diagnosis of intussuscepted Meckel diverticulum has traditionally been based on an enteric contrast study or ultrasonography, computed tomography has been shown to be equally accurate if not more so.9A classic feature of this ileoileal intussusception is the target lesion, which helped the diagnosis in this case.

Correspondence:David Jacobsen, MD, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.

Accepted for Publication:May 25, 2005.

Moore  TC Omphalomesenteric duct malformation. Semin Pediatr Surg 1996;5116- 123
PubMed
Soltero  MJBill  AH The natural history of Meckel's Diverticulum and its relation to incidental removal: a study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period. Am J Surg 1976;132168- 173
PubMed Link to Article
Cullen  JJKelly  KAMoir  CRHodge  DOZinsmeister  ARMelton  LJ  III Surgical management of Meckel's diverticulum: an epidemiologic, population-based study. Ann Surg 1994;220564- 569
PubMed Link to Article
Cullen  JJKelly  KA Current management of Meckel's diverticulum. Adv Surg 1996;29207- 214
PubMed
Fa-si-Oen  PRRoumen  RMCroiset van Uchelen  FA Complications and management of Meckel's diverticulum—a review. Eur J Surg 1999;165674- 678
PubMed Link to Article
Pantongrag-Brown  LLevine  MSElsayed  AMBuetow  PCAgrons  GABuck  JL Inverted Meckel diverticulum: clinical, radiologic, and pathologic findings. Radiology 1996;199693- 696
PubMed
Groebli  YBertin  DMorel  P Meckel's diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg 2001;167518- 524
PubMed Link to Article
Dujardin  MOp de beeck  BOsteaux  M Inverted Meckel's diverticulum as a leading point for ileoileal intussusception in an adult: case report. Abdom Imaging 2002;27563- 565
PubMed Link to Article
Goldmann  AHaberle  HJWallner  BSchnarkowski  PFriedrich  JM Computed tomographic aspects of intestinal intussusception [in German]. Aktuelle Radiol 1992;2100- 103
PubMed

Figures

Place holder to copy figure label and caption
Figure 1.

Helical computed tomographic scan after oral contrast shows the characteristic “target”-shaped lesion within 1 of the distal small-bowel loops, indicating an ileoileal intussusception.

Graphic Jump Location

Tables

References

Moore  TC Omphalomesenteric duct malformation. Semin Pediatr Surg 1996;5116- 123
PubMed
Soltero  MJBill  AH The natural history of Meckel's Diverticulum and its relation to incidental removal: a study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period. Am J Surg 1976;132168- 173
PubMed Link to Article
Cullen  JJKelly  KAMoir  CRHodge  DOZinsmeister  ARMelton  LJ  III Surgical management of Meckel's diverticulum: an epidemiologic, population-based study. Ann Surg 1994;220564- 569
PubMed Link to Article
Cullen  JJKelly  KA Current management of Meckel's diverticulum. Adv Surg 1996;29207- 214
PubMed
Fa-si-Oen  PRRoumen  RMCroiset van Uchelen  FA Complications and management of Meckel's diverticulum—a review. Eur J Surg 1999;165674- 678
PubMed Link to Article
Pantongrag-Brown  LLevine  MSElsayed  AMBuetow  PCAgrons  GABuck  JL Inverted Meckel diverticulum: clinical, radiologic, and pathologic findings. Radiology 1996;199693- 696
PubMed
Groebli  YBertin  DMorel  P Meckel's diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg 2001;167518- 524
PubMed Link to Article
Dujardin  MOp de beeck  BOsteaux  M Inverted Meckel's diverticulum as a leading point for ileoileal intussusception in an adult: case report. Abdom Imaging 2002;27563- 565
PubMed Link to Article
Goldmann  AHaberle  HJWallner  BSchnarkowski  PFriedrich  JM Computed tomographic aspects of intestinal intussusception [in German]. Aktuelle Radiol 1992;2100- 103
PubMed

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