What is Meckel's diverticulum? This is a frequent question from patients. We will examine in more detail in it. This is a pathology that was first described by the scientist Johann Friedrich Meckel. The essence of this disease is that in the process of intrauterine development of a person, under the influence of certain factors, some disturbances occur. This is a kind of protrusion of the lower part of the ileum. Meckel's diverticulum is one of the common diseases of the gastrointestinal tract.
Pathology development
With true diverticula, all layers of the intestinal wall remain in place. And with false diverticula (pseudodiverticula), the mucous membrane constantly protrudes through the gaps in the muscle membrane. The true ones include congenital ones (this is precisely the question of the diverticulum of that same Meckel), and the acquired diverticula in the large intestine are false.
In the initial stages, the duct of the gallbladder, which is located next to the ileum, forms by the seventh week of pregnancy. In cases where atrophy of the site that connects it to the ileum does not occur, Meckel’s diverticulum forms.
Such cases are called congenital, and the diverticulum itself has all the properties of a normal gut and stretches in the area of the opposite fastening of the mesentery edge. In half the cases, it has heterotopic gastric tissue or pancreatic tissue. However, there are cases when he has two tissues at the same time.
Complications after the formation of a diverticulum are rare, in about 2% of patients. As for sexual characteristics, in men this anomaly gives complications twice as often as in women.
Complications are: bleeding (they are also called diverticulitis), obstruction, as well as various other formations in the form of tumors.
The causes of this pathology
Meckel’s diverticulum inflammation can occur due to delayed food debris. As a result, the formation of fecal stones begins, which is accompanied by an acute infection.
The inflammatory process refers exclusively to Meckel's diverticulum, but neighboring internal organs and tissues are also susceptible to this. The most common complication is the formation of an intestinal abscess and the development of peritonitis. The most obvious signs of the disease are all kinds of protrusions on the surface of the abdomen.
Meckel's diverticulum may have all the features and functions of a regular gut. In this case, the symptoms that confirm the presence of this disease are completely absent. For diagnosis, it is necessary to conduct special laboratory tests, since standard recognition methods will not be able to determine its presence.
Symptoms of the disease
In cases where such a protrusion becomes part of the intestine, its symptoms begin to manifest most clearly and often. These include the following disorders in the body:
- Anemia (iron deficiency).
- Blockage of the intestinal tract.
- An inflammatory process, the presence of which may be indicated by chills and fever, as well as blood and urine tests.
- Bleeding, in which the presence of blood in the feces is noted.
- Vomiting and bouts of nausea.
- Pain in the abdomen, which is sharp, cramping in nature.
- Difficulty with stool.
Localization of pain - more often in the left ileal region, in the projection of the sigmoid colon. It is spastic, amplified as soon as the colon is filled with feces. After bowel movements it becomes easier, as a rule. In some patients, a dull aching pain in the same sections is noted between these spasms. Palpation of the abdomen does not allow to determine the localization of the painful focus. This suggests that the organic cause of the pain syndrome is absent. It is associated in this case with the discoordination of intestinal motility.
The duration of pain is fixed by patients from several days and weeks to constant ongoing pain. The chair is broken, and this is most often manifested by constant constipation. In addition, patients have complaints of a feeling of incomplete bowel movement and increased gas formation. In some patients, diarrhea alternates with constipation, which is also quite unpleasant. Clinically pronounced diverticulosis (this is a diverticular disease) is not always harmless, as most gastroenterologists think. Frequent paroxysmal abdominal pain, regular violation of bowel movements - all this leads these patients to complete or partial disability. They constantly visit gastroenterological or coloproctology rooms, where they are unsuccessfully treated using a variety of means.
Age accounting
When identifying signs of this disease, it is necessary to take into account the age of the patient. This is due to the fact that among the symptoms in childhood, most often there is an obstruction of the intestine. As for internal bleeding, the disease can give such manifestations already at an older age. However, the detection of pathology occurs mainly up to 12 years.
In addition, the patient may experience some irregular signs of the disease. For example, internal bleeding may be minor in nature and stop on its own within a few days. A similar feature also makes it difficult to adequately diagnose this disease.
Anemia
Sometimes blood in the patient’s stool is constantly observed, but there are very few such cases. Such a symptom may be accompanied by iron deficiency anemia, which is one of the main signs of the development of Meckel's diverticulum. The same symptom indicates that the patient’s life is at risk. In such cases, patients are shown an emergency surgical solution to the problem.
Diagnostic methods
In the diagnosis of Meckel’s diverticulum in surgery, the main role is played by the symptoms of this disease. Blood stool in childhood is a clear sign of pathology.
At the end of the twentieth century, they began to use the method of diagnosis of the gastric mucosa, which is called "scintigraphy." It is based on a study on the absorption of isotopes by the stomach. This diagnosis is carried out in different projections.
With normal functioning in the bladder and stomach, a large accumulation of radionuclides is formed, which accumulate with the help of the duodenum and small intestine. Therefore, in the diagnosis of Meckel's diverticulum, a study of the kidneys and urinary system is performed.
The results of scintigraphy can be considered positive in cases where the patient has any pathology of radionuclide accumulation.
The location of the diverticulum is usually in the lower abdomen. However, he can change his position due to mobility. Pathology is often confused with intestinal doubling.
If the patient has complete intestinal obstruction or signs of peritonitis, specialists can conduct a diagnostic laparoscopy. In this case, the disease is detected already at the stage of surgical intervention.
Meckel's diverticulum: operation
Therapeutic methods that eliminate the development of pathology consist in surgical intervention, the course and methodology of which directly depends on how this pathology was discovered - based on the symptoms or during the operation itself.
In cases where symptoms were absent and the disease was diagnosed directly on the operating table, surgeons immediately begin to remove the diverticulum, which is done by transverse suturing. This procedure is carried out using special equipment.
Meckel's diverticulum treatment should be timely.
Phased operation
At the first stage of the operation, doctors determine the location of the bleeding source. If it is localized not in the diverticulum, but in the ileum, as a rule, a segmental resection of this section of the intestine is performed. This method helps to quickly eliminate the source of bleeding and save the patient's life. What else can surgery for Meckel’s diverticulum suggest?
In cases where bowel obstruction is in intussusception form, the first thing to do is to carry out a disinvasation procedure and only then begin to remove the diverticulum. If resection is the cause of narrowing of the intestinal lumen, segmental intestinal resection is necessary. The effects of invaginate become irreversible in cases of Meckel's diverticulum or intestinal gangrene. In these situations, as a rule, manipulations such as anastomosis and intestinal resection are used. In some cases, an ostomy is possible, which is used temporarily, and then removed.
Full recovery of the patient after removal of Meckel's diverticulum occurs in a few weeks.
Causes of intestinal obstruction
The causes of intestinal obstruction, including in children, may be inversion or herniation, which may be due to the presence of residues in the bile duct.
In such cases, the treatment method is the elimination of infringement of the intestine by resection of the bile duct. Further, the operation proceeds according to the same scenario as when removing Meckel’s diverticulum. However, in cases of its perforation, a worsening of the clinical picture may occur, which also occurs with intestinal gangrene and strangulated hernia. In 10% of cases during such surgical procedures, the patient dies, which may also be associated with the presence of complications of an infectious nature.
The main complication of Meckel’s diverticulum is the formation of adhesive processes and intestinal obstruction.
The child has
Such a pathology is one of the most common from the category of congenital anomalies of the gastrointestinal tract and is manifested in almost 4% of children, most often in boys. If the disease was not detected before 10 years, then up to 30 years there is a 100% probability that it will manifest itself in any way.
Meckel's diverticulum in children is a specific disease that can occur for a long time without any specific symptoms. Nevertheless, scientists around the world are working to improve the diagnostic methods for this pathology, which will help significantly reduce the rate of child mortality from its complications.
The asymptomatic course of the disease in children can be complicated and sooner or later it will become a find for surgeons during laparotomy for diagnostic purposes.
Main manifestations
In cases where the symptomatology of the disease is present, its main manifestations in children can be bleeding in the intestines, acute pain in the lower abdomen, tarry stool having a shade of black. These manifestations may be accompanied by general weakness, pallor, palpitations, dizziness. Clinical and laboratory blood tests are required. The main indicator, which is taken into account in the first place, is the level of hemoglobin. If it is too low, this indicates the development of anemia in the child, which is the result of heavy bleeding.
Symptoms such as nausea and vomiting may also be absent, but the inflammation of Meckel’s diverticulum is very much like the symptoms of appendicitis. There is a symptom of Shchetkin-Blumberg, leukocytosis, abdominal pain, etc. In most cases, surgeons begin to operate on appendicitis, however, during the surgical intervention, the true cause of the appearance of such symptoms is clarified.
Exacerbation prognosis
Only in 5% of cases, Meckel’s diverticulum makes itself felt throughout life. Most people do not even suspect that they have this disease. The main patients of surgeons with a diagnosis of diverticulitis are children under 12 years of age.
Finally
With the development of complications of Meckel’s diverticulum after surgery, the timeliness of seeking medical help is of great importance. The risk of this is low, except that adhesions may occur in the small intestine due to the inflammatory process, and this, in turn, can lead to the formation of intestinal obstruction over time.