12th Ljudevit Jurak
International Symposium on
June 1-2, 2001
|HYPERPLASTIC AND SEVERELY DYSPLASTIC POLYP OF
GASTRIC TYPE ARISING IN A MECKELíS DIVERTICULUM
|R. Bussani, P. Cusati, D. Camilot, A. Messineo*,
M. Gasparella*, F. Silvestri
Department of Pathological Anatomy,University of Trieste, Trieste,
*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.