Symptomatic mesodiverticular bands in children

Abstract

Objective: The aim of this study was to review the English literature about a rare condition such as symptomatic mesodiverticular bands (MDBs) in children.

Background: The MDB is an embryologic remnant of the vitelline circulation, which carries the arterial supply to Meckel’s diverticulum. In the event of an error of involution, an arterial band persists and extends from the mesentery to the apex of the antimesenteric diverticulum. This can create a snare-like opening through which bowel loops may herniate and become obstructed. This type of internal hernia is a very rare and often overlooked cause of small bowel obstruction.

Materials and methods: A computer-assisted (PubMed) search of the literature to identify all cases of symptomatic MDB reported in English with patients’ age ranging from 0 to 14 years was performed.

Results: Eight cases of symptomatic MBD in pediatric age (0–14 years) were found in the literature in the last 50 years. Male : female ratio was 3 : 1. The age of onset ranged from 10 days to 12 years. All cases reported an intestinal occlusion as clinical picture. Internal hernia was the cause of the obstruction in six cases, whereas in two patients the occlusion was due to a direct compression. All patients were approached with emergent laparotomy except one case of laparoscopic approach.

Conclusion: MDB causing internal hernia is a very rare event but it should be kept in mind concerning patients with the presentation of small bowel obstruction when early surgery is important to prevent strangulation, gangrene of the bowel, and to avoid dramatic events.

Keywords: internal hernia, laparoscopy, Meckel’s diverticulum, mesodiverticular band, small bowel obstruction