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

목 적 : Meckel 게실은 장출혈, 장폐색, 감염, 천공등의 합병증에 의한 증상이 나타날 수 있으며 급성 복증을 일으키는 다른 질환과 감별진단이 어렵고 진단이 지연되기 쉽다. 저자들은 Meckel 게실 환자에서 임상증상과 조직학적 소견을 비교하여 신속히 진단하고 치료하는데 도움이 되고자 하였다. 방 법 : 1993년 10월부터 2001년 8월까지 이화의료원에서 진단한 Meckel 게실 10례의 의무기록을 후향적으로 조사하여 임상증상과 조직학적 소견 등을 분석하였다. 결 과 : 1) 환자의 연령은 7일-14세의 분포를 보였고, 6세 이전(60%)이 많았다. 남녀비는 2.3 : 1로 남아에서 많았다. 2) 주요증상은 무통성 하부 장출혈, 복통, 복부 팽만, 구토 순이었고 나이가 많을수록 증상이 심하였다. 3) 수술 전에 Meckel 게실로 진단되거나 의심되어 수술 한 경우 5례, 초음파 유도하 수압으로 정복되지 않은 장중첩증(3례)과 장폐색(2례)으로 수술하여 발견된 경우 5례이었다. 4) Meckel 스캔($^{99m}Tc-pertechnetate$)은 cimetidine을 투여한 후 6례에서 시행되었으며, 이소성 위점막이 있었던 5례 중 4례에서 양성, 1례 위음성, 이소성 위점막이 없었던 1례에서 음성이었다. 5) Meckel 게실은 회맹판으로부터 35-70 cm 상부에 있었고, 길이는 4-12 cm이었으며 이중 80%가 5cm 미만이었다. 6) 하부 장출혈이 있었던 5례 모두에서 이소성 위점막이 발견되었고, 그 외의 조직학적 소견은 염증 3례, 궤양 3례, 천공 1례, 출혈 3례, 경색 1례이었다. 결 론 : Meckel 게실은 출혈량이 적거나 증상이 경미한 환자에서 신속히 진단하게 되면 출혈이나 수혈의 빈도를 줄일 수 있으며 회복도 빠르므로, Meckel 게실을 염두에 두고 조영술이나 내시경에 우선하여 Meckel 스캔을 시행하는 것이 좋다. 이소성 위점막이 없는 Meckel 게실에서는 Meckel 스캔이 음성이므로 임상적으로 의심될 때에는 복강경, 컴퓨터 단층촬영, 고해상도 초음파촬영 등의 다양한 진단법이 시도되어야 할 것이다. 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.

경부접근법을 통한 Killian-Jamieson게실의 수술적 치료 1예

최윤석,배창훈,김용대,송시연 대한이비인후과학회 부산,울산,경남 지부회 2016 임상이비인후과 Vol.27 No.1

Pharyngoesophageal diverticula have two major catergories : Zenker’s diverticulum and Killian-Jamieson diverticulum. Zenker’s diverticulum is common than Killian-Jamieson diverticulum and is originated in the posterior wall above the cricopharyngeus muscle called Killian’s dehiscence. Whereas, Killian-Jamieson diverticulum is rare pharyngoesophageal diverticulum which protrudes through a muscular gap of anatomical weak area in the cervical esophagus below the cricopharyngeus muscle. They are usually asymptomatic and hard to diagnose without radiologic evaluation, but symptomatic pharyngoesophageal diverticula should be treated with complete excision. Recently, we experienced a rare case of Killian-Jamieson diverticulum which was treated by open surgical excision and suggest the proper approach to excision of Killian-Jamieson diverticulum for preserving the recurrent laryngeal nerve near lateral side of cervical esophagus.

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)

갑상선절제술 중 우연히 발견된 식도 게실 1예

김민식,김동조,이진춘,성의숙 대한이비인후과학회 부산,울산,경남 지부회 2018 임상이비인후과 Vol.29 No.2

Esophageal diverticulum is very rare disease. Since it usually has no symptoms, it is hard to find and diagnose. Moreover, if the diverticulum is located nearly to thyroid gland, surgeons sometimes misdiagnose as a thyroid nodule. Here, we represent our case which has papillary thyroid cancer and esophageal diverticulum together. In this case, we experienced the surgical procedure and postoperative complications of the esophageal diverticulum. Even though esophageal diverticulum was in preoperative computed tomography and ultrasound, it was neglected before the surgery so that found during the operation. The purpose of this study was to know the preoperative radiological findings of the esophageal diverticulum and to find out what to be aware of during surgery and how to manage the complications after surgery.

Usefulness of EndoFLIP in Diverticular Peroral Endoscopic Myotomy for Symptomatic Epiphrenic Diverticulum

Jin Hee Noh,Do Hoon Kim,Kee Wook Jung,Hee Kyong Na,Ji Yong Ahn,Jeong Hoon Lee,Kee Don Choi,Ho June Song,Gin Hyug Lee,Hwoon-Yong Jung 대한소화기 기능성질환∙운동학회 2023 Journal of Neurogastroenterology and Motility (JNM Vol.29 No.2

Background/AimsDiverticular peroral endoscopic myotomy (D-POEM) is known to be a safe and feasible technique for managing diverticular diseases of the esophagus. In this study, we aim to report our experience with D-POEM and to investigate the usefulness of endoscopic functional luminal imaging probe (EndoFLIP) in determining the need for cardiomyotomy with septotomy for symptomatic epiphrenic diverticulum. MethodsConsecutive patients who underwent D-POEM for symptomatic epiphrenic diverticulum between September 2019 and September 2021 were eligible for this study. EndoFLIP and high-resolution manometry results and endoscopic treatment outcomes were retrospectively investigated. ResultsA total of 9 patients with symptomatic epiphrenic diverticulum were included. The median size of the diverticulum and septum was 50 (interquartile range [IQR], 48-80) mm and 20 (IQR, 20-30) mm, respectively. The overall technical success rate was 100%, with a median procedure time of 60 (IQR, 46-100) minutes. The 5 patients (high-resolution manometry results; 3 normal, 1 ineffective esophageal motility, and 1 Jackhammer esophagus) who had decreased esophagogastric junction distensibility index on pre-procedure EndoFLIP underwent cardiomyotomy with septotomy regardless of the presence of esophageal motility disorders, and the distensibility index increased and normalized after procedure. The mean dysphagia score decreased from 2.0 ± 1.0 pre-procedure to 0.4 ± 0.7 during a median follow-up of 11 (IQR, 4-21) months post-procedure. No serious adverse events that required surgical intervention or delayed discharge were noted. ConclusionsEndoFLIP may help decide whether to perform combined cardiomyotomy and septotomy for the treatment of an epiphrenic diverticulum. Further large-scale studies are needed to confirm these results.

Acquired Pharyngeal Diverticulum after Anterior Cervical Fusion Operation Misdiagnosed as Typical Zenker Diverticulum

박종명,김창완,김도형 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.4

A pharyngeal diverticulum is a rare complication of an anterior cervical discectomy and fusion (ACDF). We present a c ase of a p haryngeal d iverticulum after an A CDF, w hich was m isdiagnosed as a typical Z enker diverticulum. A 54-year-old woman presented with dysphagia and a sense of irritation in the neck following C5 through C7 cervical fusion 3 years prior. The patient underwent open surgery to resect the diverticulum with concurrent cricopharyngeal myotomy. An ACDF-related diverticulum is difficult to distinguish from a typical Zenker diverticulum.

Multilobular Lacrimal Sac Diverticulum Presenting as a Lower Eyelid Mass

( Jung Hoon Kim ),( Hae Ran Chang ),( Kyung In Woo ) 대한안과학회 2012 Korean Journal of Ophthalmology Vol.26 No.4

Lacrimal sac diverticulum is a rare condition, and its various symptoms complicate differential diagnosis. We present cases of a peculiar type of lacrimal diverticulum. A 5-year-old girl and a 50-year-old woman presented with a protruding mass inferior to the medial canthus. Each lacrimal system was patent to irrigation. The masses compressed and distorted the lacrimal passage and had no apparent connection with the lacrimal sac in dacryocystography or computed tomography. Surgical exploration and complete excision of the masses were completed. Each patient had an inverted Y- and an inverted V-shaped multilobular cystic mass that was pathologically confirmed as a lacrimal sac diverticulum. Lacrimal sac diverticula may rarely take the form of a multilobular cyst and can present as a lower lid mass. We speculate that an abnormality in lacrimal embryogenesis resulted in multiple blind pouches, a peculiar type of lacrimal sac diverticulum.

Percutaneous Nephroscopic Surgery

황태곤 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.5

With the development of techniques for percutaneous access and equipment to disintegrate calculi, percutaneous nephroscopic surgery is currently used by many urologists and is the procedure of choice for the removal of large renal calculi and the management of diverticula, intrarenal strictures, and urothelial cancer. Although it is more invasive than shock wave lithotripsy and retrograde ureteroscopic surgery, percutaneous nephroscopic surgery has been successfully performed with high efficiency and low morbidity in difficult renal anatomies and patient conditions. These advantages of minimal invasiveness were rapidly perceived and applied to the management of ureteropelvic junction obstruction, calyceal diverticulum, infundibular stenosis, and urothelial cancer. The basic principle of endopyelotomy is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter. The preferred technique for a calyceal diverticulum continues to be debated. Excellent long-term success has been reported with percutaneous, ureteroscopic, and laparoscopic techniques. Each approach is based on the location and size of the diverticulum. So far, percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique. Infundibular stenosis is an acquired condition usually associated with inflammation or stones. Reported series of percutaneously treated infundibular stenosis are few. In contrast with a calyceal diverticulum, infundibular stenosis is a more difficult entity to treat with only a 50-76% success rate by percutaneous techniques. Currently, percutaneous nephroscopic resection of transitional cell carcinoma in the renal calyx can be applied in indicated cases.

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)

Enterovesical Fistula From Meckel Diverticulum

한승림,김형진,유니나,신석현,김건,조현민,이승주,이향임 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.S

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.