12th Ljudevit Jurak International Symposium on
Comparative Pathology
June 1-2, 2001

R. Bussani, P. Cusati, D. Camilot, A. Messineo*, M. Gasparella*, F. Silvestri
Department of Pathological Anatomy,University of Trieste, Trieste, Italy
*IRCCS ĒBurlo GarofaloĒ, Trieste, Italy
Meckelís diverticulum represents the persistence of the embryologic omphalomesenteric duct. It is the most common intestinal congenital anomaly (found in 1-2% of the general population) and is usually an incidental finding. The rare symptomatic patient may be presented with intestinal obstruction, ulcer with hemorrhage, perforation or diverticulitis. Ectopic gastric or pancreatic tissues are found in about 30-40% of cases and are usually encountered in the distal portion of the diverticulum.
A 15-year-old girl was hospitalised in the pediatric surgery department for an intestinal obstruction. Three days before the girl presented high fever and vomit. The clinic presentation was characterized by lower painless, gastrointestinal bleeding (diarrhea and hematochezia), progressive dehydration and lethargy. There was a palpable swelling in the right lower quadrant of the abdomen. A typical intestinal obstruction with numerous intestinal levels appeared in a direct abdominal X-ray, while an ultrasonography of the abdomen suggested the diagnosis of intussusception. Rehydration with intravenous fluids, nasogastric suction and antibiotics were the first treatments. A transverse right lower quadrant incision was used and an intussusception included ileum, cecum and ascending colon were recognized associated with a Meckelís diverticulum. The intestinal segment appeared dark due to polychronic endoluminal bleeding.
The surgical treatment consisted of manual reduction of the intussusception and resection of the Meckelís diverticulum. Macroscopically, the resected diverticulum measured 3.5 cm and included a large lobulated polyp measuring 2x3x2 cm. Microscopically it presented the histopathologic characteristics of a hyperplastic polyp of the gastric type. Surprisingly, within the polyp there were dysplastic epithelia of all grades, with large areas of severe dysplasia mostly in the superficial and medium parts of it.
At the 3 months follow-up the patient is well and has no clinical symptoms.
To our knowledge this is one of the few reported cases of hyperplastic-severely dysplastic polyp of the gastric type found in the Meckelís diverticulum of a young patient.
Poster Presentation