John J. S. Martis

Asymptomatic Meckel’s Diverticulum in Adults: Is Diverticulectomy Indicated?

Background/Aim: The objective of this study was to estimate the incidence of the Meckel’s diverticulum (MD) and to study its clinical profile and surgical outcome, as well as to check whether diverticulectomy is indicated for asymptomatic MD in adults. Materials and Methods: This is a prospective study of 1332 patients who were operated upon for acute abdomen during the period August 1999 to July 2009 in a single surgical unit. Preoperative abdominal ultrasonography and plain x-ray abdomen (erect) were done depending on the necessity. These patients were subjected to laparotomy/ appendicectomy depending on the case. A search for MD was done, and if found, surgical resection and analysis by histopathological confirmation of the resected MD were performed. Results: During the operation, this study detected 15 (1.13%) patients with MD. In none of these cases, preoperative diagnosis of Meckel’s diverticulitis was made. The age of the patients ranged from 18 to 68 years (mean age, 32.9 years). Out of 15 patients, 9 (60%) were males; 6 (40%) were females. Seven (46.7%) cases were symptomatic due to MD and 8 (53.3%) were asymptomatic. One patient presented with hematochezia; 2, with intestinal obstruction due to gangrene of the MD; and 4, with Meckel’s diverticulitis. One patient had duplication of (double) Meckel’s diverticulum without any inflammation in both the diverticulae. Histopathological examination of these specimens confirmed 4 cases with inflammation; 2, with gangrene; and 1, with ulcerated gastric mucosa in the MD. Among these, in 2 (13.3%) cases there was heterotopic epithelium (ulcerated gastric mucosa- 1, colonic mucosa- 1). Conclusion: We recommend that a search for MD in every case of appendicectomy/ laparotomy done for acute abdomen should be conducted, and if found, Meckel’s diverticulectomy or resection should be performed to avoid secondary complications arising from it.

Cornu cutaneum at an unusual site

Cutaneous horn (cornu cutaneum) is a clinical diagnosis referring to a conical projection above the surface of the skin that resembles a miniature horn. The base of the horn may be flat, nodular or crateriform. The horn is composed of compacted keratin. Various histologic lesions have been documented at the base of the keratin mound and histological confirmation is often necessary to rule out malignant changes. Tenderness at the base of the lesion and lesions of larger size favour malignancy. Malignancy is present in 16-20% of the cases with squamous cell carcinoma being the most common type. We report a young male patient with a keratin horn on the right index finger tip.