Diverticulul Meckel la adult

Abstract

Introducere: Deoarece diverticulul Meckel (DM) este rar diagnosticat la adulți, nu există un consens despre tipul de procedură necesar de efectuat pentru un DM simptomatic, și cînd e nevoie de excizie la un DM depistat accidental. Material şi metode: A fost efectuat un studiu retrospectiv în baza a 21 pacienți cu DM tratați în cadrul Clinicii de chirurgie ”Nicolae Anestiadi”, în perioada anilor 2012-2018. Rezultate: Vârsta medie – 50.2±3.9 ani (95% CI:41.91-58.56). Bărbaţi – 11 (52,3%) cu vârsta medie de 45.1±3.5 ani(95% CI:37.17- 52.83), femei – 10(47,6%), vârsta medie fiind de 56.1±7.2 ani (95% CI:39.66-72.34). Raportul B:F-1.1:1. Conform manifestărilor clinice, pacienții au fost divizați în 2 loturi: asimptomatici – 7 pacienți (33.3%), simptomatici – 14 (66.7%), (p=0.0629), dintre care bărbați – 5 (45.5%) și femei – 9 (90%), (p<0.05). Complicațiile depistate intraoperator: diverticulită – 42.8% (n=9), torsiune – 9.5% (n=2), hemoragie – 4.7% (n=1), hernie Littre – 4.7% (n=1) și ocluzie – 4.7% (n=1). În 17 cazuri (80.9%) – diverticulectomie, în 3 (14.2%) – rezecție de intestin. Într-un singur caz de DM (<2cm) depistat accidental nu s-a recurs la rezolvare chirurgicală. Distanța medie de la unghiul ileocecal la DM: 55.8±5.4 cm. Morfologia piesei postoperatorii: lungimea – 5.1±0.6 cm (de la 1.5 la 12), grosimea – 2.1±0.2 cm (de la 1 la 4), raportul L/G – 2.6±0.3 (de la 1 la 5). Histologic în 95% cazuri (n=19) DM tapetat cu mucoasă intestinală nemodificată, într-un singur caz – 5%, s-a evidențiat țesut pancreatic ectopic. Concluzii: Rata DM simptomatic a constituit 66.7%, cea mai frecventă complicație fiind diverticulita, înregistrată mai des la femei. Tratamentul DM asimptomatic la adult, conform datelor literaturii, este argumentat, dar necesită aplicarea criteriilor bine definite.

Background: Since Meckel’s diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Methods and materials: A retrospective study was performed on 21 patients with DM treated in the Department of Surgery Nr.1 “Nicolae Anestiadi” from 2012 to 2018. Results: Average age – 50.2±3.9 years (95% CI:41.91-58.56). Men – 11 (52,3%) with average age of 45.1±3.5 years (95% CI:37.17- 52.83), women – 10 (47,6%) with average age of 56.1±7.2 years (95% CI:39.66-72.34). M:W ratio – 1.1:1. According to the clinical manifestations, the pacients were divided into 2 groups: asymptomatic – 7 pacients (33.3%), symptomatic– 14 (66.7%), (p=0.0629), of which: men – 5 (45.5%) and women – 9 (90%), (p<0.05). Intraoperatively detected complications: diverticulitis – 42.8% (n=9), torsion– 9.5% (n=2), bleeding – 4.7% (n=1), Littre hernia – 4.7% (n=1) and obstruction – 4.7% (n=1). Diverticulectomy was performed 17 cases (80.9%), in 3 cases (14.2%) – intestinal resection. Only in one case of incidental discovery MD (<2cm) no surgical resolution was applied. MD was situated at the average distance of 55.8±5.4 cm from ilececal junction. Morphology of the postoperative piece: lenght – 5.1±0.6 cm (from 1.5 to 12), width – 2.1±0.2 cm (from1 to 4), ratio L/W – 2.6±0.3 (from 1 to 5). Histologically, in 95% of cases (n=19), the lining of MD was consist entirely of intestinal mucosa, in one case - 5%, ectopic pancreatic tissue was revealed. Conclusions: Ratio of symptomatic MD was 66.7%, and diverticulitis was the most frequent complication, reported more frequently in women. According to literature data, treatment of asymptomatic MD in adults is argued, but requires the application of well-defined criteria.