LAUSR

We appreciate the authors’ contributions in the article by Teng et al. The authors described a giant Meckel’s diverticulum (MD) that presented with the classic clinical picture of appendicitis. We wish to highlight certain aspects of this report that merit further discussion. The 20-cm-long MD described by the authors is indeed a giant MD, defined as an MD with a length >5 cm. However, this is not the largest reported MD in existing literature as the authors suggest. Meckel’s diverticula up to 100 cm length have been described and in recent literature; Akbulut and Yagmur reported an MD of 27 cm long and 6 cm wide. Furthermore, the authors performed an incidental appendectomy to eliminate future diagnostic confusion. However, there would not be much confusion in the diagnosis of subsequent episodes of right lower quadrant pain in a young male who has undergone resection of the anatomical anomaly (MD). Considering the potential versatility of a normal appendix for use in procedures such as a Malone antegrade continence enema, urologic and biliary reconstruction, together with the possibility of stump leak and wound complications on resecting the appendix, Healy et al. in their systematic review suggested that surgeries in the right lower quadrant which previously mandated an appendectomy, no longer necessitate one. Future studies could explore the grey area concerning the need for an appendectomy when resecting an MD and the need for a Meckel’s diverticulectomy when performing surgery for appendicitis in a prospective fashion. We appreciate the authors’ efforts to shed light on this classic yet important differential diagnosis of appendicitis.