What is Surgery – Meckel Diverticulum
On the antimesenteric boundary of the ileum, there is a true congenital small-bowel diverticulum. The rule of twos is followed: 'It occurs in 2% of the population, is 2 feet from the ileocaecal valve, and is 2 inches long.'
The omphalomesenteric/vitelline duct joins the developing midgut to the yolk sac in an embryo. A persistent diverticulum or, more rarely, an omphalomesenteric fistula, sinus, fibrous band, or vitelline duct cyst might arise if the duct does not entirely retract during the 5th–7th week.
EPIDEMIOLOGY The most frequent congenital defect of the small intestine, affecting 2% of the population, males are 2–4 times more symptomatic than females, and 60% of them become so before the age of ten.
The majority of the time, this is an asymptomatic or coincidental discovery. PR bleeding (often seen in youngsters) is characterised by painless dark or red blood (brick red) combined with excrement that can be severe and cause shock.
Diverticulitis/ulceration causes abdominal pain. Symptoms of volvulus or intussusception, which cause intestinal obstruction. Mucoid or purulent discharge from the umbilicus on rare occasions.
Signs may be minimal. There may be indicators of shock if there is bleeding. Inflammation-induced guarding/rebound tenderness might be mistaken for indications of acute appendicitis. A real diverticulum (0.5 to 50cm) has all layers of the bowel wall and is lined with small intestinal mucosa, however it frequently contains heterotopic tissue (5 percent of asymptomatic cases and 60% of symptomatic patients), often stomach or pancreatic mucosa (but rarely duodenal, jejunal or colonic). Acid is secreted by ectopic gastric mucosa, which can induce erosion or bleeding.
FBC, U&E, clotting, and crossmatch if bleeding. Isotope scan: If ectopic gastric mucosa is present, 99mTc-pertechnetate is taken up by a Meckel's diverticulum (but a negative scan does not rule it out). It's tough to make a pre-operative diagnosis. During barium contrast investigations, it's possible to notice it. If there are symptoms of blockage or perforation, get an AXR and an upright CXR. Mesenteric angiography: May be effective in cases of aggressive bleeding; but, if bleeding is sluggish, it may not be sensitive.
In case of an emergency (bleeding or obstruction), dial 911. Fluid and electrolyte imbalances are corrected during resuscitation.
Surgical: Resection of the diverticulum (diverticulectomy) with or without small-bowel resection and band division. Resection of an accidental Meckel's diverticulum is not recommended, but it can be done laparoscopically with endostaplers.
COMPLICATIONS Bleeding, blockage due to an internal hernia around an omphalomesenteric band, inflammation (diverticulitis), intussusception, or enterolith have a lifetime risk of 6%. A Littre's hernia is characterised by the confinement of a Meckel's diverticulum. There have been reports of carcinoid tumours in Meckel's diverticulum.
With proper care, the prognosis is usually good.
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