Case Report: Laparoscopy-assisted trans-umbilical Meckel's diverticulectomy for Meckel's diverticulum complicated by internal hernia: a three-case series and narrative literature review.

BACKGROUND

Meckel's diverticulum (MD) is the most prevalent congenital anomaly of the small intestine. Internal hernia secondary to MD is extremely rare in children and poses a diagnostic and therapeutic challenge.

CASE PRESENTATION: We report three consecutive paediatric cases successfully managed by laparoscopy-assisted trans-umbilical Meckel's diverticulectomy (LATUM) and provide a comprehensive review of the world literature. Clinical data of three children with MD complicated by internal hernia treated between March 2023 and April 2024 were retrospectively analysed. A systematic search of PubMed, Web of Science and Google (up to June 2025) was performed to identify previously published paediatric cases. Two boys and one girl (median age: 7 years, range: 7-11) presented with acute abdominal pain and vomiting. Pre-operative imaging suggested intestinal obstruction or intussusception. Laparoscopy revealed internal hernia formed by a mesodiverticular band (MDB) in all cases. LATUM was completed without conversion. Median operative time was 65 min (range: 50-90, IQR: 55-75), estimated blood loss was 10 mL (range: 5-15, IQR: 7.5-12.5), and time to first flatus was 24 h (range 18-36, IQR 20-30). Median hospital stay was 7.5 days (7-8). No complications occurred during a median follow-up of 16 months. The literature review yielded 25 additional paediatric cases. Including our series, 28 children have been reported; 9 cases (32.14%) used LATUM, 8 cases (28.57%) used open resection, and 11 cases (39.29%) did not describe the surgical approach.

CONCLUSION

LATUM offers a safe, minimally invasive and cosmetically superior option for children with MD complicated by internal hernia. A high index of suspicion and early laparoscopy are crucial to avoid bowel necrosis.