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

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

Human embryo at the 1st month. development receives nutrition from the yolk sac, connected with the middle intestine by the yolk, or umbilical-intestinal, duct (ductus omphaloentericus). Then yolk nutrition is gradually replaced by nutrition from the mother's blood, and the yolk duct undergoes reverse development and by the end of the 3rd month. dissolves completely. In 2-3% of people, the yolk duct does not regress, resulting in abnormalities such as umbilical granuloma, incomplete umbilical fistula, complete umbilical-intestinal fistula, umbilical entero-teratoma, enterocystoma, umbilical-intestinal 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 the top is attached to the umbilical ring, intestinal mesentery, bladder or other organs, which is a predisposing factor for the development of intestinal obstruction.

This anomaly is not clinically evident, however, 20-25% of people with this anomaly have acute surgical diseases of the abdominal cavity. Patol, processes in M. more often develop in childhood, although they can also occur in old age. Some patol, the processes connected with M.'s presence are shown in figure 1.

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

The diverticulitis can proceed also chronically, reminding a picture hron, appendicitis.

Acute bowel obstruction (see) in 3-5% of cases is due to M. d., which can be invaginated, infringed or create conditions for the development of strangulation or obturation obstruction. A wedge, the picture of this form of an ileus develops more slowly, than manifestations of its other forms, and patients arrive in later terms of a disease.

Hron, impassability of intestines can develop as a result of the commissures which were formed owing to hron, a diverticulitis.

In most cases, the structure of the M.'s wall is similar to the structure of the wall of the ileum (see Intestine, anatomy). In 10-20% of cases in its mucous membrane there are inclusions of a heterotopic mucous membrane of other departments went. - kish. tract or exocrine part (acini) of the pancreas. In these cases, the gastric mucosa of the stomach secretes hydrochloric acid and pepsin, and exocrine pancreocytes - proteolytic enzymes that have a corrosive effect on the epithelium and lead to the formation of a peptic ulcer of the diverticulum. Ulcers occur most often between the ages of 2 and 5 years. Its main symptom is the sudden appearance of bloody stools in a child who was previously quite healthy. The first stools are usually dark in color, in subsequent stools dark blood appears without clots and mucus. Unlike gastrointestinal bleeding (see) of another origin, with M. there is no hematemesis. 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 or less). At the same time, pallor of the skin, tachycardia, and sometimes collapse with loss of consciousness develop. In more rare cases, bleeding is mild, and sometimes hidden. However, periodically repeating (after 3-4 months), it causes significant anemia. Carrying out differential diagnostics of bleeding M., exclude diseases accompanied by intestinal bleeding (invagination and neoplasms of the intestine, blood diseases, hemorrhagic capillary toxicosis).

Among the more rare diseases of M. d., it should be noted that it is infringed in the abdominal hernia, the presence of M. d. in the hernial sac with inguinal hernia - the so-called. hernia Littre. Foreign bodies, getting into 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 come from M..

Diagnosis of diseases associated with M. d. is difficult, since none of them has specific symptoms. They are diagnosed by exclusion. It should be borne in mind that M. d. is often combined with other malformations, such as embryonic hernia, delayed obliteration of the urinary duct (see), heart defects, 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 indicate the possibility of patol, a process in M. d. The final diagnosis is made only during laparotomy (see). Late falling away of the umbilical cord, weeping of the navel and vague pain in the abdomen, mainly in the umbilical region, indirectly indicate the presence of M. d. With rentgenol, the study cannot reveal patol, the process in M. d. and cannot be rejected, because diverticulum is rare filled with a contrast suspension of barium. When filling with a contrast agent, M. d. on radiographs looks like a blind process extending from the ileum. In M.'s diagnosis use a radioisotope method of a research of an abdominal cavity. Technetium isotope pertechnetate (which accumulates in the gastrointestinal tract) is administered intravenously to a child at a rate of 0.1 microcurie/kg. After 15, 30, 60, 120, 150 min. produce scintigraphy (see). The centers of accumulation of the isotope are found in the stomach, bladder, and in the presence of M. d. - and in it.

Treatment of diseases caused by M. d., surgical. If a bleeding diverticulum is suspected, as well as with repeated unclear intestinal bleeding after exclusion of general somatic diseases, a diagnostic laparotomy is indicated. With diverticulitis, access in the right iliac region is sufficient, with intestinal obstruction and an unclear diagnosis, a median laparotomy is indicated. The type of operation depends on the degree of change in M. d. and the patient's condition. In all cases at the presence patol, process in M. of it is subject to removal. If M. is accidentally detected during laparotomy for another disease and the patient is in a satisfactory condition, the unchanged diverticulum should also be removed to prevent possible complications. However, in a serious condition of the patient (perforated appendicitis, surgery for neoplasms) or extensive surgical intervention, the removal of an intact diverticulum is impractical.

The technique of operation at the narrow basis of M. of d. (less than 1 cm) is similar to appendectomy (see). With a wider base, diverticulectomy is performed according to the type of wedge resection of the intestine (Fig. 2). If the base of the diverticulum is greater than 1/2-3/4 of the diameter of the intestine, 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 M. varies within 5-10%. It is caused by errors in diagnosis and the late surgical intervention associated with them against the background of a serious condition of the patient.

Bibliography: Akzhigitov G. N. and Khoroshkevich G. V. Mistakes and dangers in acute diseases of Meckel's diverticulum, Surgery, No. 8, p. 101, 1975; Bairov G. A. Emergency surgery for 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 Komplication (184 Falle, mit einem Hinweis auf die Genese der Invagination), Z. Kinderchir., Bd 12, S. 223, 1973.

G. H. Akzhigitov.

Meckel's diverticulum is also 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 vitelline and urinary ducts function. They make up the umbilical cord and are necessary for nourishing the fetus and excreting urine into the amniotic fluid.

After five months, the process of reverse development of the ducts should form and fix them on the inner surface of the peritoneum.

Changes in atrophy of the vitelline ducts have a different degree of localization:

Complete or incomplete fistulas of the umbilicus.
Meckel's diverticulum.
Enterocystoma.

Doctors consider this pathology quite common, because almost 3% of the inhabitants of the planet have this diagnosis. 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 by the age of 30. Saccular formation in the ileum in its distal segment is important and must be treated.

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

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

Main causes, clinical symptoms

The leading cause of pathology, doctors call deviations in the period of embryonic development. Non-union 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.

Symptoms 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 accumulation of food in Meckel's diverticulum can cause an exacerbation process.

The patient begins to worry about the following symptoms:

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

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

The development of an attack in an adult

Doctors focus on the fact that various factors can cause seizures:

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

It is possible to stop the progression of the disease with a rational principle of 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 under the condition of reproduction of pathogenic microflora.

The risk group is adults over 40 years of age. The main symptom is frequent spastic pains in the navel.

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 can 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 proceeds intensively and quickly spreads to other internal organs.

The patient suffers from severe pain, complains of difficulty in breathing and headache. Vomiting opens, constantly sick. The body temperature rises.

Often, no pain medications can 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, specialists in diagnostics use several methods simultaneously:

A blood test helps determine the level of red blood cells. A low level confirms the diagnosis and indicates problems in the diverticulum if there is blood in the stool. An important condition is a fecal smear. The level of hemoglobin is important, as well as hematocrit.
Technetium-based scanning (radioisotope examination) is indicated in patients with suspected protrusion of sacs in the intestine. This method is aimed at diagnosing diverticulitis, based on the introduction of a special dye, technetium, into a vein. Its active components are collected precisely around the formation.
Irrigoscopy is an x-ray study of the colon with the introduction of barium into the intestine. The patient is injected through an enema with 700-1000 ml of the agent, which gradually covers the walls of the intestine. In this study, all affected or impassable areas become visible.
Colonoscopy is indicated for patients who have heavy bleeding and it is absolutely impossible to scan the intestines. The intestines are viewed by a doctor using a medical probe inserted through the anus.
Endoscopy reveals pathological processes in the upper gastrointestinal tract. These two examinations are often carried out as an addition to the other.
Laparoscopy is one of the most cardinal, but also the most definitive methods in diagnosing Meckel's diverticulum. It is shown when none of the above methods has brought results.

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

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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 capillarotoxicosis;
intestinal intussusception;
neoplasms in the intestine;
blood diseases.

Thus, using the method of exclusion, as the most predominant in the diagnosis of Meckel's diverticulum, the disease can be detected as soon as possible.

It is important to note that the 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 for intestinal obstruction.

A council of doctors makes a diagnosis based on the study of the patient's medical history, all tests and complaints. A thorough external examination of the patient and the exclusion of cancerous pathologies are necessary.

Features of conservative treatment

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

More often, drugs are prescribed to children, provided that the disease manifests itself 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:

Antibacterial drugs to stop the infection, which can provoke an exacerbation of the disease.
Anti-inflammatory drugs help relieve pain and reduce symptoms of inflammation.
Infusion and detoxification agents are indicated for the development of peritonitis.

The recurrent nature of the disease and the absence of a positive trend in 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, the use of vitamins and trace elements and for the normal functioning of the intestine.

It is shown to observe the therapeutic features of nutrition:

Foods that include 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 only need to take into account the difficult digestion of bran.
Correcting the mode of water intake will help improve the absorption of coarse fibers and normalize the overall water-salt balance.
It is shown 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. Doctors in prescribing a diet for diverticulum take into account the individual characteristics of the body and the eating habits of each patient.
To normalize the stool, with constipation, it is recommended to use dried fruits and sour-milk products. It is mandatory to drink at least 2 liters of water during the day.

Any changes in the diet should be gradual. There may be adverse reactions to such a diet, namely bloating and some soreness.

You should eat much more often, up to 8 times a day, but in small portions. Solid foods should be the minimum part.

Vegetables need to be stewed or boiled. Overeating and eating spicy, fatty or smoked foods is contraindicated.

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

milk porridge and diet puree soups;
pasta, bran and bran bread;
dairy products;
dishes from vegetables and fruits, purees, mousses, jelly, jelly and more.

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

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

Possible complications in the area where the outgrowth is localized

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

Discovered spontaneously, but requiring the adoption of cardinal medical actions, the complications are of a different nature:

Bleeding develops in 30% of patients. The risk group is children under 2 years old and the male half of humanity. The symptomatic picture is manifested by particles of blood in the feces of varying intensity. When diagnosed with Meckel's diverticulum, bleeding is accompanied by pain, anemia, and general weakness.
Intestinal obstruction worries 20% of patients. This complication is absolutely impossible to diagnose in any other way than surgery. Often with such pathologies, tumors are formed. Signs of obstruction are manifested by constipation, vomiting, pain attacks.
Perforation of the diverticulum with inflammation in it. Pain of spastic localization in the navel develops gradually, but steadily. The condition in most cases leads to peritonitis, which in turn requires emergency surgical intervention.
Umbilical pathology is diagnosed in 10% of patients. During laparotomy, this complication is found as concomitant with other diseases. The danger of this condition is a high risk of developing a hernia or volvulus.
The neoplastic process, in other words, the development of neoplasms is observed only in 5% of patients. The nature of the tumor is determined after a biopsy. The tactics of the entire treatment depend on these analyzes.

According to experts on the basis of studies of patient 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 the diverticulum in adults and features of the postoperative period

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

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

Some surgeons use a special stapler. Previously, the doctor is convinced that the bleeding formed directly in the diverticulum. Sometimes it can occur at its base or in the ileum.

Segmental resection of a section of the intestine together 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 provoked by invagination requires resection of Meckel's diverticulum with prior disinvagination. The formation of inversions or internal hernias requires their elimination.

Surgical interventions complicated by concomitant pathologies can cause adhesions.

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

The biggest difficulty in the choice of surgical tactics for the treatment of diverticulum is that the disease is very often asymptomatic. Clinical manifestations decrease with age of the patient.

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

Meckel's diverticulum is a relatively common pathology that is associated with a violation of normal intrauterine development. As a result of the influence of certain factors, a saccular protrusion is formed 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? Can you discover 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, which is a small sac-like formation located in the distal segment of the ileum. Quite often, heterotopic tissue of the pancreas and stomach is found inside this structure. In some cases, the formation is connected by a fibrous cord to the navel.

In about 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 pathology often does not cause any visible symptoms for decades, which greatly complicates the diagnosis process.

Brief historical background

The first mention of this pathology appeared in 1598. Fabricus Hildanus in his studies described the strange process of the small intestine that he had 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 even in the process of intrauterine development. In the first months of growth and development in the fetus, the so-called embryonic yolk duct functions, which connects the yolk sac to the terminal part of the ileum and is part of the umbilical cord. By about 3-5 months of pregnancy, this duct atrophies.

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

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. These elements, under certain conditions, can secrete hydrochloric acid or some enzymes that adversely affect the condition of the diverticulum wall and often lead to its manifestation.

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 rather dangerous conditions. In particular, a common consequence is inflammation - diverticulitis. 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 wall of the diverticulum with subsequent intestinal bleeding. Some umbilical pathologies are also possible.

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

Methods of modern diagnostics

Immediately it should be noted that Meckel's diverticulum in children in the absence of certain complications is diagnosed only in 10% of cases, and quite 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 study of feces for occult blood. In the presence of an inflammatory process, children are prescribed ultrasound of the abdominal organs. In addition, diagnostics may include x-rays of the small intestine using contrast, as well as scinography, colonoscopy, and abdominal CT.

In any case, it should be understood that Meckel's diverticulum is a rather serious pathology, therefore, in no case should you neglect the advice of a doctor.

Bleeding is one of the complications of the disease.

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

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 can be different. For example, increased sensitivity of the abdominal wall and the presence of scarlet blood in the feces indicates the presence of active massive bleeding. In some cases, blood loss may be minimal but permanent. These patients develop anemia and some other disorders over time. In the most severe cases, sudden massive blood loss leads to shock.

Another complication is perforation of the diverticulum, as a result of which its contents enter the abdominal cavity. Symptoms in this case resemble the clinical picture of an acute abdomen. These patients require urgent hospitalization and surgery.

Inflammation of the diverticulum

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

As a rule, such a complication occurs in adulthood. Patients complain of recurrent pain and spasms in the umbilical region. A prolonged inflammatory process leads to the formation of adhesions between the intestines. Moreover, the rupture of the inflamed diverticulum is not excluded, which is fraught with peritonitis.

Intestinal obstruction in this disease

Approximately 20-25% of cases of complications occur precisely in intestinal obstruction. How can a diverticulum lead to such a disorder? First, it can cause intussusception of the small intestine. Secondly, with a similar pathology, the umbilical-mesenteric canal can be attached to the abdominal wall: in such cases, the intestinal loop can simply wrap around it. Occasionally, a tumor also forms in the wall of the diverticulum, which constantly grows and becomes the cause of intestinal 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 similar complaints is sent for an x-ray of the intestine. After the diagnosis is completed, the doctor decides on a surgical intervention.

Unfortunately, the presence of Meckel's diverticulum, as a rule, is determined already during the operation, since such a formation can not always be seen on x-rays.

Umbilical pathologies

Meckel's diverticulum in children may be associated with some umbilical pathologies. In particular, sometimes this formation and the navel are interconnected by fibrous strands. Such an umbilical sinus can constantly become inflamed, which leads to a lot of complications. In the most severe cases, an abscess of the abdominal wall is formed. 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, when removing the appendix), then it is excised. In other cases, no specific treatment is required. There are only a few precautions that should be observed in patients diagnosed with Meckel's diverticulum. The diet should include foods rich in plant fibers and exclude foods that cause gas formation. In addition, people are advised to undergo regular examinations in order to detect the presence of complications in the early stages.

In the inflammatory process, anti-inflammatory and analgesic drugs (for example, Ibuprofen) are indicated, as well as intravenous infusions of antibiotics.

Surgical removal of the diverticulum

In some cases, doctors decide that a Meckel's diverticulum needs to be removed. The operation is necessary for such complications as intestinal obstruction, bleeding, acute inflammatory process. In addition, surgery is recommended in the presence of umbilical cords. Potentially dangerous are diverticula with a narrow neck, as well as those structures that contain tissues of the mucous membrane of the stomach or pancreas: in such cases, the risk of sudden onset of complications is extremely high.

To date, there are many techniques for performing the operation - the choice here depends on the anatomical and physiological characteristics of the patient's body. For example, a doctor may only remove a diverticulum. But in the case of acute intestinal obstruction, a resection of a part of the intestine is also needed. If there is a connection with the navel, the cord is also removed.

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

- a congenital anomaly of the ileum, resulting from a violation of the obliteration of the proximal part of the vitelline duct. Meckel's diverticulum in children is dangerous for its complications: bleeding, intestinal obstruction, inflammation, perforation, infringement, tumor processes. In order to diagnose Meckel's diverticulum in children, an x-ray 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 part of the intestine.

General information

Meckel's diverticulum in children is a malformation of the small intestine, which is a pathological sac-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, may have an asymptomatic course throughout life, or manifest itself as a clinic of an acute abdomen already in early childhood. Improving diagnostic and therapeutic algorithms for Meckel's diverticulum in children is an urgent task of 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 in the process of intrauterine development.

In the first months of fetal development, the embryonic yolk duct functions, which is part of the umbilical cord and connects the terminal part of the ileum with the yolk sac. 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 by the time of the birth of the child in one form or another, the following types of anomalies are distinguished: incomplete and complete fistulas of the navel, 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 (ileocecal) angle. Typically, the diverticulum is about 3–4 cm long, cone or cylinder shaped, and is located on the wall of the ileum opposite the mesentery. Meckel's diverticulum in children refers to true diverticula, since its wall completely repeats the morphological structure of the ileum wall. However, the wall of the diverticulum 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 atresia of the esophagus, atresia of the anus and rectum, omphalocele, 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 (invagination, strangulation), tumors.

Bleeding from a peptic ulcer, as the most common complication of Meckel's diverticulum in children, can be acute, profuse or chronic, latent. A sign of intestinal bleeding in Meckel's diverticulum in children is tarry, black stools. Bleeding is accompanied by general weakness, dizziness, tachycardia, pallor, 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 grounds" 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 the ileal loops around the diverticulum, or strangulation of the intestinal loops.

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

Less often than other complications, Meckel's diverticulum tumors occur in children, both benign (hamartomas, fibroids, lipomas) and malignant (adenocarcinomas, carcinoids). 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

The preoperative diagnosis of Meckel's diverticulum in children is established in less than 10% of cases. Physical examination usually shows signs of muscle tension, local tenderness, and peritoneal irritation. Of the laboratory studies, the most important are clinical and biochemical blood tests, feces for occult blood.

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

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

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, the appointment of massive antibiotic therapy, infusion and detoxification therapy.

The prognosis of Meckel's diverticulum in children

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

In the complicated course of Meckel's diverticulum in children, the outcome of the disease is affected by the timeliness of hospitalization and surgical treatment. The risk of surgical complications is low, but sometimes it is possible to develop postoperative

Meckel's diverticulum is a disease that was first described by Johann Friedrich Meckel. Its essence lies in violations 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 diseases of the gastrointestinal tract. In this article, we will try to determine the essence of Meckel's diverticulum, what symptoms it has, 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 there is no atrophy of the area connecting it with the ileum, Meckel's diverticulum is formed.

This diverticulum is called congenital and it stretches along the opposite edge of the mesentery 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. With regard to gender, in men, complications develop 2-3 times more often. 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 in 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, the protrusion is represented by the formation of intestinal cells.

This feature allows the diverticulum to have the usual functions of the intestine. 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 determine 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 appear brighter. 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;
chair problems.

The patient's age should be taken into account when determining symptoms. So, in childhood, bowel blockage predominates among the symptoms. As for bleeding, they appear in a child at an older age. As a rule, the detection of the disease occurs before 10 years.

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

It is extremely rare that there is 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 life of the patient. Surgery to remove Meckel's diverticulum is required.

Diverticulosis and its diagnosis

Intestinal diverticula in the model.

In determining the diagnosis of Meckel's diverticulum, the symptoms and qualifications of the attending physician play a role. Bloody stools in a child, as a rule, are a defining indicator of the disease. In 1967, a method for diagnosing the gastric mucosa called "scintigraphy" was created. This method has been in operation since 1970. The procedure is based on the examination of the gastric mucosa for its ability to absorb and excrete isotopes. As soon as the isotope enters the body, a scan is taken 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, and its nominal proximal section. Diagnostics of the kidneys of the urinary system is carried out. Scintigraphy is considered positive if there is a pathology of radionuclide accumulation.

Meckel's diverticulum is usually located in the lower abdomen. However, his mobility provides him with the ability to change location.

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. It should also take into account its size and characteristics in relation to the isotope excretion and the rate of its leaching from a given area.

In the case of a positive result, a differential type diagnosis of another part of the gastric mucosa should be carried out to determine the authenticity of the results. For this procedure, areas of gastrogenic cysts, duplications of the enteric type and the Barrett's esophagus are suitable. The cause of the first diagnosis error may be mucosal hyperemia or the presence of blood, which defines intestinal disease as an ulcer, intussusception, intestinal obstruction, and others.

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

With symptoms in the form of bowel obstruction and abdominal discomfort, the diagnosis of Meckel's diverticulum does not occur before the intervention. Given the age of the patient and the severity of symptoms, intussusception may be suspected. In this case, in the absence of peritonitis, the diagnosis is carried out by filling the colon with barium, which, in addition, has a therapeutic effect. X-ray examination for diverticulosis is not useful.

Symptoms in the form of complete intestinal obstruction or peritonitis are grounds for a trial laparotomy. In this case, the disease is diagnosed at the stage of the operation.

Treatment of diverticulosis

The therapeutic method of Meckel's disease, namely surgical intervention, depends directly on how exactly the diverticulum of the small intestine was detected: based on symptoms or during surgery. In the presence of symptoms of the disease, treatment depends on the surgical findings. As a rule, with gastrointestinal bleeding, it can suddenly stop. It is at these moments that the diverticulum should be removed by transverse suturing of the intestine.

Usually this procedure occurs with the help of a stapler. At the first stage, it is necessary to determine where the source of bleeding is localized. So, with heavy bleeding not from the diverticulum, but from the ileum, the correct decision would be to perform a segmental resection of this area of the intestine along with the diverticulum. As a rule, resection helps to eliminate bleeding.

In the case of intestinal obstruction in the form of intussusception, disinvagination should be carried out initially, if possible, and only then proceed with the 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 applied. In extreme cases, with local changes, it is necessary to apply temporary stomas.

After the operation, there is a complete recovery.

The cause of bowel obstruction in children is a volvulus or hernia, which is a consequence of the presence of remnants of the bile duct. In this case, the treatment method is the elimination of torsion or infringement and resection of the remaining section of the bile duct. Further, the 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 pathology 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 conducting a fistulogram. If communication with the gastrointestinal tract is determined, it is necessary to excise the duct by suturing the ileum.

Problems with the selection of the method of surgical intervention are associated with the presence of symptoms of the disease. The likelihood of sudden diverticulum activity decreases with age. The best option is to resect the diverticulum in childhood or if induration is found. Excision of the diverticulum is the right decision in the absence of other methods of treatment.