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Meckel's diverticulum
Last reviewed: 23.04.2024
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Meckel's diverticulum is a congenital sack-shaped diverticulum of the distal ileum, which is observed in 2-3% of people. It is usually located within 100 cm of the ileocecal valve and often contains heterotopic tissue of the stomach and / or pancreas. Symptoms of Meckel's diverticulum are uncharacteristic, but include bleeding, intestinal obstruction and signs of inflammation (diverticulitis). The diagnosis is troublesome and often requires radionuclide examination and studies with barium. Treatment of Meckel's diverticulum consists in surgical removal of it.
[What causes the diverticulum of Meckel?
In the early embryonic stage, the yolk duct, which extends from the terminal part of the ileum to the navel and the yolk sac, is usually obliterated at the 7th week. If its part connecting with the ileum does not atrophy, the Meckel diverticulum is formed. This congenital diverticulum is located on the opposite side of the mesentery to the edge of the gut and contains all layers of the normal gut. Approximately 50% of the diverticula also contain heterotopic gastric tissue (and thus contain parietal cells that secrete HCI), the pancreas, or both.
Only about 2% of people with Meckel's diverticulum develop complications. Although diverticula are equally common in men and women, in men 2-3 times more often develop complications. Complications include bleeding, obturation, diverticulitis and tumors. Bleeding is more common in young children (younger than 5 years) and develops if the acid secreted by the ectopic gastric mucosa in the diverticulum causes ulceration of the ileum. Intestinal obstruction can develop at any age, but is more common in older children and adults. In children, intussusception of the diverticulum is the most likely cause. Obstruction can also be a consequence of the adhesive process, curvature, foreign bodies, tumors or infringement in the hernia (hernia Littra). Acute diverticulitis of Meckel can develop at any age, but its peak incidence falls on older children. Tumors, including carcinoid, are rare and develop mainly in adults.
Symptoms of Meckel's diverticulum
In all ages, intestinal obstruction is manifested by cramping pains in the abdomen, nausea and vomiting. The acute diverticulitis of Meckel is characterized by abdominal pain and painful palpation, usually located below or to the left of the navel; pain is often accompanied by vomiting and proceeds like appendicitis, except for the localization of pain.
Children may experience repetitive episodes of painless, rectal bleeding with scarlet blood, which is usually not severe enough to cause shock. Bleeding can be observed in adults, usually manifested by melanoma, and not by pure blood.
Diagnosis of Meckel's diverticulum
The diagnosis of Meckel's diverticulum is complex and the choice of methods of investigation is based on the presentation of symptoms. If rectal bleeding from Meckel's diverticulum is suspected, a scan with 99m Tc pertechnetate allows the identification of the ectopic mucosa of the stomach and, hence, the diverticulum. Patients with abdominal pain and local soreness should perform a CT scan of the abdominal cavity with oral contrast. When vomiting and symptoms of obstruction are carried out mainly radiographs of the abdominal cavity in a vertical and horizontal position. Sometimes the diagnosis is established only with surgical treatment with suspicion of appendicitis; whenever a unmodified appendix is detected, Meckel's diverticulum should be suspected.
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Treatment of Meckel's diverticulum
Patients with intestinal obstruction due to Meckel's diverticulum require urgent surgical care.
Diverticulum complicated by hemorrhage, with the induction of a nearby ileal zone, requires resection of this part of the intestine and diverticulum. Diverticulum complicated by bleeding without inducing ileum, requires only resection of the diverticulum.
Meckel's diverticulitis also requires resection. Small, asymptomatically flowing diverticulum of Meckel, which are encountered accidentally with laparotomy, do not require removal.