Category: Small intestine

Complications of Meckel’s diverticulum

Complications of Meckel’s diverticulum

Q. Least common complication of Meckel's diverticulum (NEET 2018) 

a) Bleeding

b) Obstruction

c) Neoplasm

d) Obstruction

Answer is free 
7) c Neoplasm

The most common clinical presentation of Meckel’s diverticulum is gastrointestinal bleeding, which occurs in 25% to 50% of patients who present with complications

intestinal obstruction occur as a result of a volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia (Littre hernia)

Diverticulitis accounts for 10% to 20% of symptomatic presentations.

Neoplasms can also occur in a Meckel’s diverticulum, with NET as the most common malignant neoplasm (77%). Other histologic types include adenocarcinoma (11%), which generally originates from the gastric mucosa, and GIST (10%) and lymphoma (1%).

Sabiston -1285

Spontaneous fistula closure

Spontaneous fistula closure

Q) Adverse factor for spontaneous fistula closure:

a) Tract <1cm

b)Transferrin > 200

c) Location in esophagus

d) First surgery done in the same institution

Answer free

a) Tract less than 1 cm

Spontaneous fistula closure

Short-turnover  protein (prealbumin,  retinol-binding  protein,  transferrin)  levels should  be  measured  at  least  weekly  to  assess  the  adequacy of  protein  delivery. An  ongoing  catabolic  state  will adversely  affect  short-turnover  protein  levels,  even  with maximal  protein  delivery.

Failure  of  an  enterocutaneous  fistula  to  close  spontaneously  is associated with acronym FRIENDS): 

the  presence  of  a foreign  body  within  the  tract  or  adjacent  to  it,  previous radiation  exposure  of  the  site,  ongoing  inflammation (most  commonly  from  Crohn  disease)  or  infection  that contributes  to  a  catabolic  state,  epithelialization  of  the fistula  tract  (particularly  if  the  fistula  tract  is  less  than 2  cm  long),  neoplasm,  distal  intestinal  obstruction,  and  pharmacologic  doses  of  steroids. 

Fistulas  associated  with  a concurrent  pancreatic  fistula  also  have  a  low  rate  of  spontaneous  closure,  as  do  those  occurring  in  the  presence  of  malnutrition  or  adjacent  infection.

In general,  anatomic  locations  that  are  favorable  for  closure  are  the  oropharynx,  esophagus,  duodenal  stump,  pancreas,  biliary  tree,  and  jejunum.

Duodenal atresia

Duodenal atresia

Question on Duodenal atresia was asked in AIIMS 2017 in April

Q) An infant presents with duodenal atresia. Which of the following is true about this condition?

a) It is the most common GI atresia

b) It presents soon after birth with non bilious vomiting

c) Pre natal detection of duodenal atresia is common

d) Gastro jejunostomy is the procedure of choice to bypass the obstruction

Answer (free) 

C-

Commonly detected in the pre natal ultrasound

Duodenal atresia is seen in 1:5000 live births and most common atresia is jejunoileal (1in 2000). It is associated with lot of other congenital malformations like Down's,  prematurity, biliary atresia etc.

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