Meckel's diverticulum is an insidious disease with unpleasant consequences. Meckel's diverticulum

German anatomist, 1781 - 1833) is a congenital anomaly caused by incomplete reverse development of the vitelline duct and manifested by protrusion of the ileum. Described by J. Meckel the Younger in 1809.

Human embryo at 1st month. development receives nutrition from the yolk sac, connected to the midgut by the vitelline, or umbilical-intestinal, duct (ductus omphaloentericus). Then the vitelline nutrition is gradually replaced by nutrition from the mother’s blood, and the vitelline duct undergoes reverse development and by the end of the 3rd month. completely resolves. In 2-3% of people, the vitelline duct does not undergo reverse development, resulting in such anomalies as umbilical granuloma, incomplete umbilical fistula, complete umbilical fistula, umbilical enteroteratoma, enterocystoma, umbilical ligament and ileal diverticulum (Meckel's diverticulum) .

M. d. comes from the ileum at an average distance of 60 cm from the ileocecal angle (this distance ranges from 20 cm in newborns to 1.5 m in adults). The length of the diverticulum is 4-6 cm. The longest diverticulum described by McMurich was 104 cm.

The diameter of the diverticulum can reach the width of the ileum.

M. d. is located on the antimesenteric edge of the ileum, in some cases - on its side wall. In most cases, the diverticulum hangs freely into the abdominal cavity, sometimes its apex is attached to the umbilical ring, intestinal mesentery, bladder or other organs, which is a predisposing factor to the development of intestinal obstruction.

This anomaly does not manifest itself clinically, however, 20-25% of people with this anomaly experience acute surgical diseases of the abdominal organs. Patol, processes in MD most often develop in childhood, although they can also occur in old age. Some patol processes associated with the presence of MD are shown in Figure 1.

Inflammation is one of the common diseases of the abdominal cavity. The mechanism of its occurrence is similar to the pathogenesis of acute appendicitis (see). There are catarrhal, phlegmonous, gangrenous and perforative forms of diverticulitis. Inflammation of the abdominal cavity usually simulates the picture of acute appendicitis. Therefore, in case of pronounced wedge, manifestations or detection of effusion in the abdominal cavity against the background of minor changes in the appendix, it is necessary to inspect the ileum for at least 1 m to exclude diverticulitis. Failure to comply with this provision may lead to complications and the need for relaparotomy. It should be noted that the detection of an altered appendix during surgery does not always exclude patol, a process in MD.

Diverticulitis can also occur chronically, resembling the picture of hron, appendicitis.

Acute intestinal obstruction (see) in 3-5% of cases is caused by intestinal obstruction, which can be invaginated, strangulated, or create conditions for the development of strangulation or obstructive obstruction. Wedge, the picture of this form of ileus develops more slowly than the manifestations of its other forms, and patients are admitted at a later stage of the disease.

Hron, intestinal obstruction can develop as a result of adhesions formed as a result of hron, diverticulitis.

In most cases, the structure of the wall of the intestine is similar to the structure of the wall of the ileum (see Intestine, anatomy). In 10-20% of cases, its mucous membrane contains inclusions of heterotopic mucous membrane of other parts of the gastrointestinal tract. tract or exocrine part (acini) of the pancreas. In these cases, the heterotopic gastric mucosa secretes hydrochloric acid and pepsin, and exocrine pancreatocytes secrete proteolytic enzymes that have a corrosive effect on the epithelium and lead to the formation of a peptic ulcer of the diverticulum. The ulcer occurs most often between the ages of 2 and 5 years. Its main symptom is the sudden appearance of bloody stool in a child who was previously completely healthy. The first stools are usually dark in color, followed by dark blood without clots or mucus. In contrast to gastrointestinal bleeding (see) of another origin, there is no bloody vomiting with MD. As a rule, bleeding is profuse and is accompanied by a rapid decrease in the amount of hemoglobin and the number of red blood cells (up to 2 million and below). At the same time, pale skin, tachycardia, and sometimes collapse with loss of consciousness develop. In more rare cases, bleeding is light and sometimes hidden. However, when repeated periodically (every 3-4 months), it causes significant anemia. When making a differential diagnosis of bleeding M.D., diseases accompanied by intestinal bleeding (intussusception and intestinal neoplasms, blood diseases, hemorrhagic capillary toxicosis) are excluded.

Among the more rare diseases of M. d., it should be noted that it is strangulated in an abdominal hernia, the presence of M. d. in the hernial sac with an inguinal hernia - the so-called. Littre's hernia. Foreign bodies, getting into the m. d., sometimes perforate it. Most often, the cause of perforation is fish bones, in isolated cases - metal needles and objects of plant and animal origin (needles, bristles). Neoplasms (carcinoid tumor, or adenocarcinoma) can also arise from M. d.

Diagnosis of diseases associated with MD is difficult, since none of them has specific symptoms. They are diagnosed by exclusion. It should be borne in mind that MD is often combined with other malformations, such as embryonic hernia, delayed obliteration of the urinary duct (see), defects of the heart, limbs and other organs. The development of a picture of an acute abdomen against the background of these defects or their presence in the anamnesis indirectly indicates the possibility of patol, a process in MD. The final diagnosis is established only during laparotomy (see). Late falling off of the umbilical cord, weeping of the navel and vague pain in the abdomen, mainly in the peri-umbilical region, indirectly indicate the presence of umbilical cord. With rentgenol, research it is impossible to identify patol, the process in the umbilical region and it cannot be rejected, because diverticulum is rare filled with a contrast suspension of barium. When filled with a contrast agent, the diaphragm appears on radiographs as a caecum extending from the ileum. In the diagnosis of MD, a radioisotope method for studying the abdominal cavity is used. The child is intravenously injected with the isotope technetium pertechnetate (which accumulates in the gastrointestinal tract) at a rate of 0.1 µCurie/kg. After 15, 30, 60, 120, 150 minutes. perform scintigraphy (see). Foci of accumulation of the isotope are found in the stomach, bladder, and, if M. d. is present, in it.

Treatment of diseases caused by MD is surgical. If a bleeding diverticulum is suspected, as well as repeated unclear intestinal bleeding after excluding general somatic diseases, a diagnostic laparotomy is indicated. In case of diverticulitis, access in the right iliac region is sufficient; in case of intestinal obstruction and an unclear diagnosis, a median laparotomy is indicated. The type of operation depends on the degree of change in the MD and the patient’s condition. In all cases, if there is a patol, a process in the MD, it must be removed. If M. d. is accidentally discovered during laparotomy for another disease and the patient’s condition is satisfactory, the unchanged diverticulum should also be removed to prevent possible complications. However, in severe condition of the patient (perforated appendicitis, surgery for neoplasms) or extensive surgical intervention, removal of an intact diverticulum is not advisable.

The surgical technique for a narrow base of the MD (less than 1 cm) is similar to appendectomy (see). With a wider base, a diverticulectomy is performed according to the type of wedge resection of the intestine (Fig. 2). If the base of the diverticulum is larger than 1/2-3/4 of the intestinal diameter, it is preferable to perform a circular resection of the intestine with the formation of an end-to-end anastomosis (see Enteroenteroanastomosis). Mortality after surgery for MD varies between 5-10%. It is caused by errors in diagnosis and associated late surgical intervention against the background of the patient’s serious condition.

Bibliography: Akzhigitov G.N. and Khoroshkevich G.V. Errors and dangers in acute diseases of Meckel’s diverticulum, Surgery, No. 8, p. 101, 1975; Bairov G. A. Emergency surgery of children, p. 246, L., 1973; Doletsky S. Ya. and Isakov Yu.F. Pediatric surgery, part 2, p. 577, M., 1970; Zemlyanoy A.G. Diverticula of the gastrointestinal tract, p. 154, L., 1970; D e Bartolo H. M. a. van Heerden J. A. Meckel's diverticulum, Ann. Surg., v. 183, p. 30, 1976; Meckel J. F. tiber die Divertikel am Darmkanal, Arch. Physiol. (Halle), Bd 9, S. 421, 1809; P o c h o n J.P. Das Meckelsche Diverticel und seine Komp-lication (184 Falle, mit einem Hinweis auf die Genese der Invagination), Z. Kin-derchir., Bd 12, S. 223, 1973.

G. N. Akzhigitov.

Meckel's diverticulum is otherwise called an ileal diverticulum. As a result of this pathology, a pathological violation of the reverse development of the proximal small intestine occurs. This area is responsible for the movement of bile.

What is Meckel's diverticulum?

According to the medical definition, already at the first stage of fetal development, the functioning of the vitelline and urinary ducts occurs. They make up the umbilical cord and are necessary for receiving nutrition to the fetus and excreting urine into the amniotic fluid.

After five months, the process of reverse development of the ducts and their fixation on the inner surface of the peritoneum should take place.

Changes in vitelline duct atrophy have varying degrees of localization:

1. Complete or incomplete umbilical fistulas.
2. Meckel's diverticulum.
3. Enterocystoma.

Doctors consider this pathology to be quite common, because almost 3% of the world's inhabitants have been diagnosed with this disease. The risk of deviations due to such disorders occurs in early childhood in about 50% of all cases.


Often, visible signs of the disease begin to appear only at age 30. A sac-like formation in the distal ileum is important and must be treated.

Heterotopic tissue components of the stomach and pancreas can cause serious disruptions in the body, requiring urgent surgical intervention.

Meckel's diverticulum is located between the intestine and the navel.

Main causes, clinical symptoms

Doctors call deviations during embryonic development the leading cause of pathology. Non-fusion of the bile duct provokes the formation of a protrusion.

The diverticulum reaches a size of about 3-4 cm. It resembles the shape of a cone or cylinder.

Symptomatic manifestations of this disease

It is possible to detect an asymptomatic course of a diverticulum when examining a patient for other diseases:

• atresia of the esophagus or rectum;
• Crohn's disease.

These pathologies very often accompany a congenital anomaly leading to the formation of a diverticulum.

The process of exacerbation can be caused by the accumulation of food in Meckel's diverticulum.

The patient begins to experience the following symptoms:

• painful sensations;
• bloating;
• fever;
• nausea;
• vomiting attacks;
• bowel disorders;
• general weakness;
• irritability.

The listed signs are not always present. For a long time, the diverticulum develops without any manifestations. However, at the same time, a dangerous damage process can develop, provoking dangerous conditions - peritonitis and internal bleeding.

Development of an attack in an adult

Doctors emphasize that various factors can cause attacks:

• poor nutrition;
• excess weight;
• insufficient fluid intake;
• sedentary lifestyle;
• impaired motility of the digestive system and other organs.

The progression of the disease can be stopped with a rational lifestyle and nutrition. The importance of antimicrobial or surgical treatment cannot be ruled out.

Signs indicating inflammation

Inflammation of Meckel's diverticulum is observed in 10-20% of cases. This happens due to stagnation of fluid in the saccular process.

The process of secondary infection occurs when pathogenic microflora multiply.

The risk group consists of adults over 40 years of age. The main symptom is frequent spasmodic pain in the navel area.

If the inflammation is prolonged, there is a high probability of the formation of intestinal adhesions. The danger of this condition is that the diverticulum may rupture as a result of inflammation, causing peritonitis.

The clinical picture of the development of inflammation of the diverticulum is similar to an attack of appendicitis.

The whole process is intense and quickly spreads to other internal organs.

The patient suffers from severe pain, complains of difficulty breathing and headache. I start vomiting and constantly feel nauseous. Body temperature rises.

Often, no painkillers help block the pain syndrome. An acute attack can cause loss of consciousness. You need to call an ambulance immediately.

It is very difficult to diagnose a protrusion - Meckel's diverticulum without pronounced complications.


Therefore, diagnostic specialists use several methods simultaneously:

1. A blood test helps determine your red blood cell levels. A low level confirms the diagnosis and indicates problems in the diverticulum in the presence of blood in the stool. An important condition is a stool smear. The level of hemoglobin is important, as is the hematocrit.
2. A technetium scan (radioisotope scan) is indicated for patients with suspected bulging pouches in the intestine. This method is aimed at diagnosing diverticulitis and is based on the injection of a special dye, technetium, into a vein. Its active components are collected precisely around the formation.
3. Irrigoscopy is an X-ray examination of the colon with the introduction of barium into the colon. The patient is given 700-1000 ml of the product through an enema, which gradually covers the intestinal walls. With this study, all affected or impassable areas become visible.
4. Colonoscopy is prescribed for patients who have severe bleeding and it is absolutely impossible to scan the intestines. The intestines are examined by a doctor using a medical probe inserted through the anus.
5. Endoscopy allows you to identify pathological processes in the upper parts of the gastrointestinal tract. These two examinations are often carried out as a complement to the other.
6. Laparoscopy is one of the most radical, but also the most definitive methods in diagnosing Meckel's diverticulum. It is indicated when none of the above methods have brought results.

Diagnostic studies are effective only with a strict individual approach and careful consideration of the patient’s medical history.

Video

How is differential diagnosis performed?

The main condition for effective differential diagnosis is the exclusion of other diseases with a similar clinical picture.

For example, intestinal bleeding can develop for reasons:

• hemorrhagic capillary toxicosis;
• intussusception;
• neoplasms in the intestines;
• blood diseases.

Thus, using the exclusion method as the most predominant method when diagnosing Meckel's diverticulum, the disease can be identified in the shortest possible time.

It is important to note that diverticulum is often combined with other developmental anomalies:

• heart disease;
• malformations of the limbs;
• delayed obliteration of the urinary duct;
• embryonic hernia;
• malformations of internal organs.

Differential diagnosis is important for bleeding from the gastrointestinal tract and intestinal obstruction.

A council of doctors makes a diagnosis based on studying the patient’s medical history, all tests and complaints. A thorough external examination of the patient and exclusion of cancer pathologies is necessary.

Features of conservative treatment

Drug therapy is used only to relieve some of the symptoms of Meckel's diverticulum during acute inflammation.

More often, medications are prescribed to children, provided that the disease has appeared for the first time and is not complicated by life-threatening pathological processes.

Specialists, guided by the immediate provision of assistance to the patient, prescribe:

1. Antibacterial drugs to stop an infection that can cause an exacerbation of the disease.
2. Anti-inflammatory medications help relieve pain and reduce inflammation symptoms.
3. Infusion and detoxification agents are indicated for the development of peritonitis.

The recurrent nature of the disease and the absence of a positive trend with drug therapy is an indication for surgical treatment.

In a situation where the diverticulum is not complicated by concomitant pathologies, doctors recommend focusing on improving nutrition. This will help to stop the development of the disease to a greater extent.

It is important to maintain a balanced diet, consume vitamins and microelements for the normal functioning of the intestine.

It is recommended to follow the therapeutic dietary features:

1. Products containing dietary fiber should form the main diet. Fiber is found in sprouted grains and bran. You can add it to food and with plant elements, you just need to take into account the difficult digestion of bran.
2. Adjusting your water intake will help improve the absorption of coarse fibers and normalize the overall water-salt balance.
3. It is recommended to exclude products that enhance the process of gas formation, namely: legumes, cabbage, milk, fruits of fruit trees. Nuts and seeds are also prohibited for most patients. When prescribing a diet for diverticulum, doctors take into account the individual characteristics of the body and the eating habits of each patient.
4. To normalize stool and for constipation, it is recommended to consume dried fruits and fermented milk products. It is imperative to drink at least 2 liters of water during the day.

Any changes in diet should be gradual. Side effects of such a diet may occur, namely bloating and some soreness.

You should eat food much more often, up to 8 times a day, but in small portions. Solids should make up a minimal portion.

Vegetables need to be stewed or boiled. Overeating and consumption of spicy, fatty or smoked foods are contraindicated.

A healthy diet for Meckel's diverticulum should include only healthy foods:

• milk porridges and dietary puree soups;
• pasta, bran and bran bread;
• dairy products;
• dishes from vegetables and fruits, purees, mousses, jellies, jelly, etc.

Alcohol, carbonated drinks and coffee must be excluded from the menu. It is important to limit baked goods and white bread, hard raw vegetables and seaweed. Heavy foods include semolina porridge and mushrooms.

Separate nutrition with a gentle regimen can quickly restore the activity of the gastrointestinal tract. This will help stop the pathological process of diverticulum.

Possible complications in the area where the growth is localized

According to medical studies, diverticulum provokes life-threatening complications in 6.4% of cases. Each of them requires surgical manipulation.


Complications discovered spontaneously, but requiring drastic medical action, are of a different nature:

1. Bleeding develops in 30% of patients. The risk group includes children under 2 years of age and the male half of humanity. The symptomatic picture is manifested by blood particles in the stool of varying intensity. When diagnosed with Meckel's diverticulum, bleeding is accompanied by pain, anemia and general weakness.
2. Intestinal obstruction worries 20% of patients. This complication is absolutely impossible to diagnose in any way other than surgery. Tumors often form in such pathologies. Signs of obstruction include constipation, vomiting, and painful attacks.
3. Perforation of a diverticulum due to inflammation in it. Spastic localized pain in the navel area develops gradually but steadily. The condition in most cases leads to peritonitis, which in turn requires emergency surgery.
4. Umbilical pathology is diagnosed in 10% of patients. When performing laparotomy, this complication is detected as concomitant with other diseases. The danger of this condition is the high risk of developing a hernia or volvulus.
5. The neoplastic process, in other words, the development of neoplasms is observed in only 5% of patients. The nature of the tumor is determined after a biopsy. The tactics of the entire treatment depend on these tests.

According to experts, based on studies of patient medical histories, men get sick three times more often than women. This is due to multiple factors, the leading of which are physiological characteristics and norms of behavior, lifestyle.

Resection of diverticulum in adults and features of the postoperative period

Cardinal surgical intervention is indicated in situations of complex clinical manifestations. Quite often, a diverticulum is discovered during surgery for another reason.

Gastrointestinal bleeding stops spontaneously, but if it needs to be stopped, certain methods are used. The diverticulum is removed, and the affected intestine is sutured in the transverse direction.

Some surgeons use a special stapler. First, the doctor makes sure that the bleeding has formed directly in the diverticulum. Sometimes this may occur at its base or in the ileum.

Segmental resection of a section of the intestine along with a diverticulum is indicated for bleeding from the intestine itself. Such manipulations give excellent results, and the discovery of secondary bleeding occurs in exceptional cases.

Intestinal obstruction caused by intussusception requires resection of Meckel's diverticulum with preliminary disintussusception. The formation of torsions or internal hernias requires their elimination.

Surgical interventions complicated by concomitant pathologies can cause adhesions.

Often intestinal obstruction develops and another operation is required. There is a risk of death in 10% of all such cases.

The biggest difficulty when choosing surgical tactics for treating diverticulum is that the disease is very often asymptomatic. Clinical manifestations decrease with patient age.

Therefore, the best period for disinvagination is at the first signs of diverticulum. Timely treatment will help ease the postoperative period.

Meckel's diverticulum is a relatively common pathology that is associated with disruption of normal intrauterine development. As a result of the influence of certain factors, a pouch-like protrusion forms in the lower third of the ileum. By the way, this disease is considered one of the most common congenital pathologies of the gastrointestinal tract. So what is a diverticulum? Is it possible to detect it yourself? How dangerous is this pathology? The answers to these questions will be of interest to many readers.

Meckel's diverticulum: what is it?

According to statistics, approximately 2-3% of people on the planet suffer from a similar pathology. Meckel's diverticulum is a congenital defect that is a small pouch-like formation located in the distal ileum. Quite often, heterotopic tissue of the pancreas and stomach is found within this structure. In some cases, the formation is connected to the navel by a fibrous cord.

In approximately 50% of cases, complications occur in early childhood. In other patients, the diverticulum can be detected much later, often after 30 years. It is worth noting that the pathology often does not cause any visible symptoms for decades, which significantly complicates the diagnostic process.

Brief historical background

The first mention of this pathology appeared in 1598. Fabricus Hildanus, in his research, described the strange appendage of the small intestine he discovered. However, active research began only at the beginning of the nineteenth century. Johann Friedrich Meckel published a scientific work that contained a fairly accurate anatomical description of the diverticular process. Moreover, it was he who proved the embryonic origin of such a formation, as a result of which the name appeared - Meckel's diverticulum.

How does this pathology appear?

As mentioned, such a pathological structure is formed during the process of intrauterine development. In the first months of growth and development in the fetus, the so-called embryonic vitelline duct functions, which connects the yolk sac with the terminal part of the ileum and is part of the umbilical cord. By about 3-5 months of pregnancy, this duct atrophies.

If the fetus retains the bile duct, by the time of birth it may well turn into a Meckel's diverticulum. In addition, complications include enterocyst, complete and incomplete umbilical fistulas.

The wall of the diverticulum has the same morphological structure as the intestine. However, quite often in the tissues of this structure elements of the gastric mucosa or cells characteristic of the pancreas are found. Under certain conditions, these elements can release hydrochloric acid or certain enzymes, which negatively affect the condition of the diverticulum wall and often lead to its ulceration.

Meckel's diverticulum: photos and symptoms

In fact, such a pathology can occur without any external signs. Most often, during laparoscopy, doctors accidentally discover Meckel's diverticulum.

Symptoms appear only in the presence of certain complications. By the way, such a pathology can cause some quite dangerous conditions. In particular, inflammation - diverticulitis - is a common consequence. In addition, the presence of such a formation in the intestine can lead to the development of intestinal obstruction. Another complication is ulceration of the diverticulum wall with subsequent intestinal bleeding. Some umbilical pathologies are also possible.

By the way, according to statistics, complications develop in boys and men approximately 3 times more often than in representatives of the fair sex with the same diagnosis.

Modern diagnostic methods

It is immediately worth noting that Meckel’s diverticulum in children, in the absence of certain complications, is diagnosed only in 10% of cases, and completely by accident. As a rule, this occurs during laparoscopy of the abdominal cavity in the presence of other diseases.

If complications do appear, then various diagnostic methods are used. In particular, a biochemical blood test is performed, as well as a laboratory test of stool for occult blood. In the presence of an inflammatory process, children are prescribed an ultrasound of the abdominal organs. In addition, diagnosis may include x-ray of the small intestine using contrast, as well as scinography, colonoscopy, and CT scan of the abdominal cavity.

In any case, you should understand that Meckel’s diverticulum is a rather serious pathology, so you should never neglect your doctor’s advice.

Bleeding is one of the complications of the disease

One of the most common complications is intestinal bleeding. By the way, statistical data confirm that such conditions are most often diagnosed in men and children under two years of age.

As mentioned earlier, the appearance of bleeding is associated with the specific structure of the diverticulum, which may contain cells of the gastric mucosa that secrete hydrochloric acid. In turn, this aggressive component corrodes the intestinal walls, which leads to the formation of ulcers.

It is worth noting that bleeding may vary. For example, increased sensitivity of the abdominal wall and the presence of scarlet blood in the stool indicate the presence of active massive bleeding. In some cases, blood loss may be minimal but constant. Such patients develop anemia and some other disorders over time. In the most severe cases, sudden massive loss of blood leads to shock.

Another complication is perforation of the diverticulum, resulting in its contents entering the abdominal cavity. The symptoms in this case resemble the clinical picture of an acute abdomen. Such patients require urgent hospitalization and surgical intervention.

Inflammation of the diverticulum

Approximately 10-20% of patients experience inflammation of Meckel's diverticulum. The cause of this disease is stagnation of fluid in the sac-like formation, which, in turn, creates excellent conditions for the proliferation of pathogenic microflora and secondary infection.

As a rule, this complication occurs in adulthood. Patients complain of periodic pain and spasms in the navel area. A long-term inflammatory process leads to the formation of adhesions between the intestines. Moreover, rupture of the inflamed diverticulum is also possible, which can lead to peritonitis.

Intestinal obstruction in this disease

Approximately 20-25% of complications occur due to intestinal obstruction. How can a diverticulum lead to this disorder? First, it can cause intussusception of the small intestine. Secondly, with such a pathology, the umbilical-mesenteric canal can be attached to the abdominal wall: in such cases, a loop of intestine can simply wrap around it. Occasionally, a tumor also forms in the wall of the diverticulum, which constantly grows and causes intussusception.

The main symptoms of intestinal obstruction are acute abdominal pain, frequent vomiting and constipation. In some cases, patients also experience jelly-like stools. A person with such complaints is referred for an X-ray of the intestines. After completing the diagnosis, the doctor decides on surgical intervention.

Unfortunately, the presence of Meckel's diverticulum is usually determined during surgery, since such a formation can not always be seen on X-ray films.

Umbilical pathologies

Meckel's diverticulum in children may be associated with certain umbilical pathologies. In particular, sometimes this formation and the navel are connected by fibrous cords. Such an umbilical sinus can become constantly inflamed, which leads to a host of complications. In the most severe cases, an abscess of the abdominal wall forms. In addition, some children experience the formation of fistulas and cysts, which is also extremely unpleasant.

Modern methods of treatment

It is worth noting that today surgeons do not have a consensus on whether it is necessary to remove the diverticulum if the child does not have any complications. After all, such a pathology may not cause any consequences.

If a similar formation in the small intestine was detected during another abdominal operation (for example, during removal of the appendix), then it is excised. In other cases, no specific treatment is required. There are only a few precautions that patients diagnosed with Meckel's diverticulum should take. The diet should include foods rich in plant fibers and exclude foods that cause gas. In addition, people are advised to undergo regular examinations in order to detect the presence of complications in the early stages.

During the inflammatory process, the use of anti-inflammatory and painkillers (for example, Ibuprofen), as well as intravenous infusions of antibiotics, is indicated.

Surgical removal of diverticulum

In some cases, doctors decide that it is necessary to remove Meckel's diverticulum. Surgery is necessary for complications such as intestinal obstruction, bleeding, and acute inflammatory process. In addition, surgery is recommended if umbilical cords are present. Potentially dangerous are diverticula with a narrow neck, as well as those structures that contain tissue from the mucous membrane of the stomach or pancreas: in such cases, the risk of sudden complications is extremely high.

Today, there are many surgical techniques; the choice here depends on the anatomical and physiological characteristics of the patient’s body. For example, the doctor may remove only the diverticulum. But in case of acute intestinal obstruction, resection of part of the intestine is also necessary. If there is a connection with the navel, the cord is also removed.

The prognosis for patients who have undergone surgery is quite favorable. Complications are usually associated with tissue infection. In approximately 4-6% of cases, intestinal obstruction develops after surgery, which requires additional therapy.

– a congenital anomaly of the ileum, resulting from a violation of obliteration of the proximal part of the vitelline duct. Meckel's diverticulum in children is dangerous due to its complications: bleeding, intestinal obstruction, inflammation, perforation, strangulation, and tumor processes. To diagnose Meckel's diverticulum in children, radiography of the small intestine with a barium suspension, scintigraphy, ultrasound and CT of the abdominal organs, and laparoscopy are performed. Complicated cases of Meckel's diverticulum in children require surgical tactics - resection of the diverticulum or section of the intestine.

General information

Meckel's diverticulum in children is a malformation of the small intestine, which is a pathological pouch-like protrusion in the lower third of the ileum. Meckel's diverticulum is one of the most common congenital anomalies of the gastrointestinal tract, detected in 2-3% of children, more often in boys. In half of the cases, the manifestation of clinical manifestations develops in children under 10 years of age, in the rest - under the age of 30 years. Meckel's diverticulum in children is a rather insidious pathology: it is difficult to diagnose, can have an asymptomatic course throughout life, or manifest itself as an acute abdomen in early childhood. Improving diagnostic and treatment algorithms for Meckel's diverticulum in children is an urgent task in pediatric abdominal surgery and pediatrics in general.

Causes of Meckel's diverticulum in children

Meckel's diverticulum in children is an embryonic defect, that is, it is formed during intrauterine development.

In the first months of fetal development, the embryonic vitelline duct, which is part of the umbilical cord and connects the terminal part of the ileum with the yolk sac, functions. At 3-5 months of embryonic development, obliteration of the vitelline duct and its atrophy normally occur. In the case of incomplete obliteration and preservation of the bile duct at the time of birth of the child in one form or another, the following types of anomalies are distinguished: incomplete and complete umbilical fistulas, enterocystoma, Meckel's diverticulum.

In most cases, Meckel's diverticulum in children is formed in the lower third of the ileum at a distance of 60-80 cm from the ileocecal (ileo-cecal) angle. Typically, a diverticulum is about 3-4 cm long, shaped like a cone or cylinder, and is located on the wall of the ileum opposite the mesentery. Meckel's diverticulum in children is a true diverticulum, since its wall completely repeats the morphological structure of the ileal wall. However, the diverticulum wall often contains ectopic gastric mucosa, capable of producing hydrochloric acid, or pancreatic tissue. The presence of ectopic glandular epithelium of the stomach in Meckel's diverticulum in children causes ulceration of its wall and gastrointestinal bleeding.

Meckel's diverticulum in children is often combined with esophageal atresia, anal and rectal atresia, omphalocele, and Crohn's disease.

Symptoms of Meckel's diverticulum in children

Uncomplicated Meckel's diverticulum in children is asymptomatic and may be an incidental finding during laparotomy for another disease or may not be recognized. The clinical manifestation of Meckel's diverticulum in children is usually associated with the development of complications: intestinal bleeding, inflammation (diverticulitis), intestinal obstruction (intussusception, strangulation), tumors.

Bleeding from a peptic ulcer, as the most common complication of Meckel's diverticulum in children, can be acute, profuse or chronic, hidden. A sign of intestinal bleeding with Meckel's diverticulum in children is tarry, black stool. Bleeding is accompanied by general weakness, dizziness, tachycardia, pallor, and clinical and laboratory signs of posthemorrhagic anemia. Unlike bleeding from esophageal varices or gastric and duodenal ulcers, children with complicated Meckel's diverticulum never experience "coffee-ground" vomiting.

Intestinal obstruction caused by Meckel's diverticulum in children is accompanied by nausea, vomiting, cramping abdominal pain, and increasing intoxication. Obstruction can be caused by intussusception, torsion of ileal loops around a diverticulum, or strangulation of intestinal loops.

Sometimes in children, Meckel's diverticulum becomes strangulated in the hernial sac of an inguinal or femoral hernia (Litre's hernia). If a hernia is strangulated, there is a sharp pain, tension and uncontrollability of the hernial protrusion, and the absence of a symptom of a cough impulse.

Less often than other complications, tumors of Meckel's diverticulum, both benign (hamartomas, fibroids, lipomas) and malignant (adenocarcinomas, carcinoids), occur in children. Clinical manifestations of Meckel's diverticulum tumors in children may be associated with intestinal obstruction, wall perforation, and bleeding.

Diagnosis of Meckel's diverticulum in children

Preoperative diagnosis of Meckel's diverticulum in children is established in less than 10% of cases. A physical examination usually reveals signs of muscle tension, local soreness, and peritoneal irritation. Of the laboratory tests, the most important are clinical and biochemical blood tests, feces for occult blood.

If intestinal obstruction is suspected, a plain radiography of the abdominal cavity, excision of the diverticulum of the small intestine (diverticulectomy) or segmental resection of the small intestine with end-to-end enteroenteroanastomosis is performed. In pediatric surgery, preference is given to endoscopic resection of the small intestine.

The method of choice for treating diverticulitis in children is conservative drug therapy: antibiotic infusions, injections of anti-inflammatory drugs. With the recurrent nature of inflammation of Meckel's diverticulum in children, the issue of resection of the diverticulum is resolved.

With the development of peritonitis, in addition to resection of the small intestine, it is necessary to carry out drainage and sanitation of the abdominal cavity, prescribe massive antibiotic therapy, infusion and detoxification therapy.

Prognosis of Meckel's diverticulum in children

In 95% of cases, Meckel's diverticulum remains asymptomatic throughout life; complications of Meckel's diverticulum develop in only 4-5% of children.

In case of complicated Meckel's diverticulum in children, the outcome of the disease is influenced by the timeliness of hospitalization and surgical treatment. The risk of surgical complications is low, but sometimes postoperative complications may develop.

Meckel's diverticulum is a disease first described by Johann Friedrich Meckel. Its essence lies in disorders of intrauterine development of a person. Due to the influence of certain factors in the ileum, namely in its lower part, a kind of protrusion is formed. This disease is the most common type of gastrointestinal disease. In this article we will try to determine the essence of Meckel's diverticulum, what symptoms it has, and what is the danger of this disease. How can you get rid of it?

What is Diverticulitis?

At the first stage, the bile duct, which is located from the ileum, namely its terminal section to the navel and gall sac, is usually obliterated by the seventh week. If the area connecting it to the ileum does not atrophy, Meckel's diverticulum is formed.

This diverticulum is called congenital and it extends along the edge of the mesentery opposite the attachment and has all the characteristics of the intestine. In five cases out of ten, Meckel's diverticulum has heterotopic gastric tissue or pancreatic tissue or two organs at once.

Complications after the development of Meckel's diverticulum occur in only 2% of patients. As for gender, complications develop 2-3 times more often in men. Complications include bleeding, obstruction, diverticulitis, and tumor formation.

Causes and symptoms of diverticulitis

Diverticulitis occurs due to the retention of food debris in the diverticulum and, as a result, the formation of fecal stones, which is accompanied by infection. The inflammatory process can only be represented by a diverticulum. In addition, neighboring organs and tissues are at risk of inflammation, which consists of the development of an interintestinal abscess or the occurrence of peritonitis.

The most obvious signs of this disease are determined by the type of protrusion. According to this criterion, a separate type of Meckel's diverticulum is determined. Most often, protrusion is represented by the formation of intestinal cells.

This feature allows the diverticulum to have normal bowel functions. As a result, there may be a complete absence of symptoms confirming the presence of this disease. In this case, a list of special tests is necessary, since standard diagnostics cannot detect Meckel’s disease behind the masking signs. Cases of diverticulum formation based on cells of the stomach or pancreas are common.

At the stage when the protrusion is already part of the intestine, the symptoms become more pronounced. Among them are:

• blockage of the intestinal tract;
• bleeding, which leads to the presence of blood in the stool;
• inflammation;
• pain and other discomfort of varying degrees;
• anemia;
• febrile processes caused by inflammation;
• vomit;
• problems with stool.

When determining symptoms, the age of the patient should be taken into account. Thus, in childhood, intestinal blockage predominates among the symptoms. As for bleeding, it appears in a child at an older age. As a rule, the disease is detected before 10 years of age.

In addition, symptoms of an irregular nature are possible. For example, bleeding may occur for several days, after which the stool returns to normal. This feature creates additional problems in determining Meckel's diverticulum.

It is extremely rare to experience blood in the stool all the time. This may be the cause of iron deficiency anemia, which is one of the signs of the disease. However, this symptom indicates a danger to the patient’s life. Surgery is required to remove Meckel's diverticulum.

Diverticulosis and its diagnosis

Intestinal diverticula in the model.

In determining the diagnosis of Meckel's diverticulum, the symptoms shown and the qualifications of the attending physician play a role. Bloody stool in a child is usually a defining indicator of the disease. In 1967, a method for diagnosing the gastric mucosa called “scintigraphy” was created. This method began to operate in 1970. The procedure is based on examining the gastric mucosa for its ability to absorb and excrete isotopes. As soon as the isotope enters the body, a scanogram is performed in several projections.

Under normal conditions, a high accumulation of radionuclides is formed in the stomach and bladder, which accumulate due to the duodenum and small intestine, namely its proximal section. A diagnosis of the kidneys and urinary system is carried out. Scintigraphy is considered positive if pathology of radionuclide accumulation is observed.

The location of Meckel's diverticulum is usually localized in the lower abdomen. However, his mobility gives him the ability to change positions.

The reliability of this method is determined as a percentage from 50 to 92%. The result directly depends on the properties of the isotope and blood circulation in the area where the diverticulum is supposed to be located. You should also take into account its size and characteristics regarding the excretion of the isotope and the rate of its leaching from a given area.

In case of a positive result, a differential diagnosis of another area of ​​the gastric mucosa should be carried out to determine the authenticity of the results. Suitable areas for this procedure include gastrogenic cysts, enteral type duplications, and Barrett's esophagus. The cause of the first diagnosis error may be hyperemia of the mucous membrane or the presence of blood, which defines intestinal disease as ulcers, intussusception, intestinal obstruction and others.

Most often, the pathology of Meckel's diverticulum is confused with intestinal duplications. The accuracy of diagnosis can be increased through the use of pentagastrin, which helps increase the absorption functions of the gastric mucosa, and cimetidine, which slows down the release of nuclides from the area being diagnosed. In addition, the quality of the examination is improved by scanning in the lateral projection after urination. In case of pronounced signs of the disease and a negative result, scintigraphy should be repeated.

If symptoms include intestinal obstruction and abdominal discomfort, Meckel's diverticulum is not diagnosed until after surgery. Given the patient's age and severity of symptoms, intussusception may be suspected. In this case, in the absence of peritonitis, diagnosis is carried out by filling the colon with barium, which, in addition, has a therapeutic effect. X-ray examination for diverticulosis does not make sense.

Symptoms in the form of complete intestinal obstruction or peritonitis warrant exploratory laparotomy. In this case, the disease is diagnosed at the stage of surgery.

Treatment of diverticulosis

The treatment method for Meckel's disease, namely surgery, depends directly on how exactly the small intestinal diverticulum was detected: based on symptoms or during surgery. If symptoms of disease are present, treatment depends on surgical findings. Typically, when gastrointestinal bleeding occurs, it may stop suddenly. It is at these moments that the diverticulum should be removed by transverse suturing of the intestine.

Typically this procedure occurs using a stapler. The first step is to determine where the source of bleeding is located. Thus, if there is heavy bleeding not from the diverticulum, but from the ileum, the correct solution would be to perform a segmental resection of this area of ​​the intestine along with the diverticulum. Typically, resection helps eliminate bleeding.

In the case of intestinal obstruction in the form of intussusception, disintussusception should initially be carried out if possible, and only then proceed with removal of the diverticulum. If the resection is the cause of narrowing of the intestine, segmental intestinal resection should be performed. The consequences of intussusception cannot be corrected in the presence of Meckel's diverticulum or intestinal gangrene. Intestinal resection and anastomosis should be used. In extreme cases, with local changes, it is necessary to apply temporary stomas.

After the operation, complete recovery occurs.

The cause of intestinal obstruction in children is a volvulus or herniation, which is a consequence of the presence of remnants of the bile duct. In this case, the treatment method is the elimination of volvulus or strangulation and resection of the remaining portion of the bile duct. The following procedure is identical to the above instructions. Deterioration of the clinical picture is possible with perforation of Meckel's diverticulum or intestinal gangrene, volvulus or strangulated hernia. Child mortality reaches 10% and is directly related to the presence of complications in the form of infection. Adhesions and intestinal obstruction may occur, which is a common consequence of laparotomy.

Among the pathologies of the navel, the most popular are granulomas. Their treatment is quite simple, namely by cauterization with silver nitrate. In the absence of treatment results, the presence of an open bile duct, communication with the gastrointestinal tract or urachus should be assumed. Diagnosis occurs by performing a fistulogram. If a connection with the gastrointestinal tract is determined, it is necessary to excise the duct by suturing the ileum.

Problems with selecting a surgical intervention method are associated with the presence of symptoms of the disease. The likelihood of sudden diverticulum activity decreases as the person gets older. The best option is to perform resection of the diverticulum in childhood or if a lump is detected. Excision of the diverticulum is the right solution in the absence of other treatment options.