Abstract A total of 600 cases, comprising 4 of our cases and 596 others in Japan, was analyzed, and the diagnosis of Meckel's diverticulum was made in only 34 of them. Patients with Meckel diverticulitis may have pain similar to that of appendicitis. Policy. South Med J 2004; 97 . Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tractmost studies suggest an incidence of between 0.6% and 4%. The incidence of Meckel's diverticulum in the general population has been estimated to be about 2 percent; reports from autopsy and retrospective studies range from 0.14 to 4.5 percent.1,36 Although Meckel's diverticulum occurs equally in both sexes,79 it causes complications more frequently in males1,9,10 and, therefore, is more often diagnosed in males.7 Early literature11,12 has quoted complication rates as high as 25 percent; however, results of a 15-year study set the risk of developing complications at 4.2 percent.13 This study of 202 patients did not include any cases of incidentally found diverticulum; it is the largest series of cases of complicated Meckel's diverticulum ever reported. Causes vary. Some people may have active bleeding in their intestines as a result of Meckels diverticulum. Diagnosis of Meckel diverticulum is often difficult, and tests are chosen based on presenting symptoms. Bleeding from a Meckel's diverticulum after the use of ibuprofen. Or you may have belly pain or blood in your stool. Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. [16] The solitary diverticulum lies on the antimesenteric border of the ileum (opposite to the mesenteric attachment) and extends into the umbilical cord of the embryo. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them,[24] this is displayed as a spot on the scan distant from the stomach itself. In early fetal life, the vitelline or omphalomesenteric duct that connects the midgut to the yolk sac is normally obliterated by the 6th week. It is caused by incomplete obliteration of the vitelline duct and consists of a congenital sacculation of the antimesenteric border of the ileum. We do not endorse non-Cleveland Clinic products or services. Meckel's diverticulum is the most common congenital anomaly of gastrointestinal tract. Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR. Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002). Here, we review the current literature of this forgotten clinical entity for its clinical diversity, diagnostic difficulties and management controversies. Sinha CK, Pallewatte A, Easty M, et al. . These complications, especially bleeding, are more common in the paediatric age group than in adults; however it is not uncommon to miss the diagnosis of Meckel's diverticulum in adults. The definitive Mayo clinic survey provides good evidence to support the role of prophylactic diverticulectomy. Because most symptomatic patients are acutely ill, establish an intravenous line immediately, start crystalloid fluids, and keep the patient on nothing by mouth (NPO) status. Mackey WC, Dineen P. A fifty year experience with Meckel's diverticulum. The natural history of Meckel's diverticulum and its relation to incidental removal. In this study,10 there was no decrease in the likelihood of complications with age. Iron deficiency anaemia: an unusual complication of Meckel's diverticulum. Battle of Appomattox Court House, (April 9, 1865), one of the final battles of the American Civil War. More recently, a 10-year retrospective study9 also reported an even age distribution in patients with complications. In children, obstruction is most likely caused by intussusception Intussusception Intussusception is telescoping of one portion of the intestine (intussusceptum) into an adjacent segment (intussuscipiens), causing intestinal obstruction and sometimes intestinal ischemia. read more of the diverticulum. When youre born with a diverticulum in your intestines, its referred to as Meckels diverticulum. A study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period. Strategies that have taken into account factors such as the age and sex of the patient, the length of the diverticulum and the diameter of the mouth or base of the diverticulum have proved to be ineffective in assisting the decision to prophylactically remove this congenital developmental variant.3,4,7,10,14, A physician can choose to leave the incidentally discovered diverticulum or perform a simple diverticulectomy or an ileal resection. 2010 Jan-Mar;16(1):3-7. doi: 10.4103/1319-3767.58760. Meckel's diverticulum can upset your digestive system and cause nausea or vomiting. official website and that any information you provide is encrypted This will help your doctor to see the pouch in your intestines. All rights reserved. Meckel diverticulum: ten-year experience in adults. Copyright 2023 American Academy of Family Physicians. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2%-3% of the population. In: Ali Tavakkoli, Stanley W. Ashley, Michael J. Zinner: Schwartz's Principles of Surgery. Philadelphia, PA: Saunders/Elsevier, F. Charles Brunicardi, Dana K. Anderson, Timothy R. Billiar, et al. The vitelline vessels remnant that connects the diverticulum to the umbilicus may form a fibrous or twisting band (, "Incarceration": when a Meckel's diverticulum is constricted in an, Extrude into the terminal ileum, leading to obstruction. Archiv fr die Physiologie, Halle, 1809, 9: 421453. Her abdomen had nonlocalized upper- to midabdominal tenderness with no guarding or rebound, no organ enlargement or masses, and positive bowel sounds. It is considered a vestigial remnant of the omphalomesenteric duct . [citation needed], However, the exact values for the above criteria range from 0.25 (for example, prevalence is probably 0.24%). Segal SD, Albrecht DS, Belland KM, Elster EA. Meckel's diverticulum is a congenital (present at birth) outpouching or bulge in the lower part of the small intestine. Various types of diverticula can develop as you age. Cleveland Clinic is a non-profit academic medical center. The presence of bleeding with hypoalbuminaemia and low feritin due to ongoing slow unrecognized bleeding may lead to the diagnosis of inflammatory bowel disease. A diverticulum is an abnormal sac or pouch that develops at a weak point in the intestines. Obstruction can occur at any age but is more common among older children and adults. The large proportion of the rest of the symptomatic Meckel's diverticulum occurs in those aged 2-8 years. [23] Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut. The symptoms of Meckels diverticulum are related to the type of diverticulum you have. Mechanical stimulation may also cause erosion and ulceration. United states: McGraw-Hill;2015. Laboratory parameters: showed only a slight leucocytosis (10 610/L). [citation needed], Angiography might identify brisk bleeding in patients with Meckel's diverticulum. Obtain the blood investigations suggested . Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK. On rare occasions the diverticulum can herniate through the abdominal wall also known as a Littre hernia. Please confirm that you are a health care professional. Uber die divertikel am darmkanal. For example, from the ileum to the colon, causing obstruction. Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan. Continuous bleeding in the intestine and bloody stools can result in anemia. Fish bone perforation of Meckel's diverticulum: a rare event? Massive gastrointestinal bleeding from Meckel's diverticulum in a 91-year-old man. We do not control or have responsibility for the content of any third-party site. [6] Also, severe pain in the epigastric region is experienced by the person along with bloating in the epigastric and umbilical regions. A currently disputed issue is whether the incidence of complications decreases with advancing age. Technetium-99m pertechnetate scan for ectopic gastric mucosa in children with gastrointestinal bleeding. This lesion is found in 1-2% of the general population. If your child's healthcare provider feels that the combination of symptoms suggests Meckel's diverticulum, he or she will order certain tests. They arise from the antimesenteric surface of the middle-to-distal ileum. It occurs in about 2% to 3% of the general population. During this procedure, the Meckel's diverticulum and surrounding small intestine are removed and the ends of the remaining intestines are sewn together. Get the facts on the endoscopy, a procedure that helps your doctor view and operate on the internal organs and vessels of your body. Learn how to prepare for an upper gastrointestinal (GI) endoscopy. Induce local inflammation and intussusception. Robbins, S. L., Kumar, V., & Cotran, R. S. (2010). Our website services, content, and products are for informational purposes only. Mackey and Dineen have suggested statistically significant risk factors such as males less than 40 years, diverticulum longer than 2 cm and that containing ectopic mucosa.29 However, Park et al. The link you have selected will take you to a third-party website. You may need surgery to remove a damaged. Table 1. Bowel obstruction occurs more often in older children and adults. . Only 6.4% of all complications require surgical treatment, and untreated Meckel's diverticulum has a mortality rate of 2.515%. May 25, 2016. The pouch is a congenital (present at birth) abnormality that affects approximately 2% of the population. Bleeding from ectopic gastric mucosa, especially chronic bleeding, is not common in adults although it has been documented in a 91 year old.5 Carcinoid tumour, sarcoma, stromal tumours, carcinoma, adenocarcinoma, intraductal papillary mucinous adenoma of pancreatic tissue and vesicodiverticular fistulae are also rare complications.6,7 Other rare complications include inversion of Meckel's diverticulum, torsion, volvulus of ileum around Meckel's diverticulum or fibrous cord and perforationspontaneously or by foreign body such as fish bone.8-11 The risk of the complications decreases with increasing age, with no predictive factors for the development of complications. Due to the rarity of cases in adults, it is still misdiagnosed preoperativelyalthough with the wide spread use of technetium-99m pertechnate scan and diagnostic laparoscopic approach, the rates of preoperative diagnosis have improved. In all ages, intestinal obstruction is manifested by cramping abdominal pain, nausea, and vomiting. However, her temperature had climbed to 37.5C (99.6F), and her white blood cell count had fallen to 5,000 per mm3 (5 109 per L) with a left shift. Of those lesions that are found incidentally, males and females are equally affected. However, the diagnosis of MD can be difficult, resulting in a delayed or even missed diagnosis [ 1, 2 ]. In children it is the most common presentation, especially in those younger than 2 years of age (almost 50%). Researchers involved in the previously mentioned 15-year retrospective chart review concluded that prophylactic diverticulectomy is unwarranted because the likelihood that an asymptomatic diverticulum will become symptomatic is low (about 4.2 percent), and that rate decreases with age.14 However, several factors now lend support to the concept of prophylactic diverticulectomy. However, early diagnosis and, Endometriosis occurs when tissue like that which forms the lining of the uterus grows outside of the uterine cavity. Once a Meckel's diverticulum develops complications and is surgically removed, the operative mortality, morbidity and cumulative long-term risk of postoperative complications are 2 percent, 12 percent and 7 percent, respectively.10 For Meckel's diverticula that are incidentally discovered and removed, the corresponding rates are 1 percent, 2 percent and 2 percent, respectively.10, Laparoscopy can be useful in the diagnosis and treatment of Meckel's diverticulum. Small Intestine. In addition, your doctor may order a stool smear. In less than 25% of patients, a Meckel diverticulum also contains heterotopic tissue of the stomach (and thus contains parietal cells that secrete hydrochloric acid), pancreas, or both. Other diagnostic methods have been suggested to supplement the Meckel's scan including Tc 99m RBC labelled scan, angiography and barium enema. In this case, Meckel's diverticulum usually does not have to be treated. Acute Meckel diverticulitis is characterized by abdominal pain and tenderness typically localized below or adjacent to the umbilicus; it is often accompanied by vomiting and is similar to that of appendicitis. [17], Ultrasonography could demonstrate omphaloenteric duct remnants or cysts. The manifestations depend on the location and rate of bleeding. Meckel's diverticulum (MD) is the most common gastro-intestinal congenital malformation (approximately 2% in the overall population). Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development.1,2 It contains all normal layers of the intestinal wall and, in approximately 50 percent of cases, contains tissue from other sites (ectopic tissue).2 This ectopic, or heterotopic, tissue can often be the cause of complications occurring in Meckel's diverticulum. Concise colour medical dictionary (5th ed.) They will recommend several different tests to confirm the diagnosis. An invaginated Meckel's diverticulum belongs rather to the less frequent causes of an ileus of the small intestine and an unclear / acute abdomen in adults. Digestive Diseases and Sciences, 50(7), 12851287. Meckels diverticulum usually develops between the fifth and seventh weeks of fetal development. Meckel's diverticulum is the most common congenital anomaly of the small intestine. The physician had determined that it was asymptomatic and elected to leave the diverticulum in place. Baumgartner FJ, White GH, Colman PD, Marcus C, Salahi W. Bleeding Meckel's diverticulum in an adult. Meckel's diverticulum occurs in about 2 percent of the population, making it the most prevalent congenital abnormality of the gastrointestinal tract. Meckel's Scan. If the intestines have been damaged as a result of the diverticulum, the damaged part of the intestine may also need to be removed. If this occurs, your doctor may need to order different tests to confirm diagnosis. Meckel diverticulum, Familydoctor.org Editorial Staff. The symptoms can be extremely painful, often mistaken as just stomach pain resulting from not eating or constipation. Most cases of Meckels diverticulum are identified and treated in children before the age of 10. 8600 Rockville Pike A bleeding diverticulum without ileal induration requires resection of only the diverticulum. PMID: 20065566; PMCID: PMC3023098. the contents by NLM or the National Institutes of Health. Cleveland Clinic Children's is dedicated to the medical, surgical and rehabilitative care of infants, children and adolescents. People who experience blood loss as a result of Meckels diverticulum may also require iron therapy or blood transfusions to replace lost blood. Major complications include bleeding, obstruction, intussusception, diverticulitis and perforation. The Battle of Appomattox Court House, fought in Appomattox County, Virginia, on the morning of April 9, 1865, was one of the last battles of the American Civil War (1861-1865). However, it was not until almost 100 years later that the understanding of Meckel's diverticulum increased with the discovery of ectopic gastric mucosas by Salzer and associated ulceration of ileum by Deetz.1. Symptomatic Meckel's occur disproportionately in male compared to females in a ration of 2-4 : 1. She was afebrile and normotensive and had a normal pulse and respiration. Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract (present in 2%-4% of population) due to persistence of the congenital vitello-intestinal duct. Accessibility Use to remove results with certain terms The patient was admitted to the hospital with intractable abdominal pain. If this happens, emergency surgery may be needed to remove the diverticulum. Learn the causes, complications. Most (75%) Meckel diverticula are found within 60 cm (range 40-100 cm) of the ileocecal valve 2 . See related patient information handout on Meckel's diverticulum, written by the authors of this article. Use OR to account for alternate terms Recurrent torsion of a giant Meckel's diverticulum. Investigation of 600 patients in Japanese literature. If the portion connecting to the ileum fails to atrophy, a Meckel diverticulum results. She was given nothing by mouth and was placed on maintenance intravenous fluids. Nearly 80% of this bleeding in adults originates proximal to the ligament of Treitz. [25] This scan is more accurate in children because gastric mucosa is found in 90% of bleeding diverticula; which is the most common symptom in children, not adults. o [ abdominal pain pediatric ] In 95 percent of people with this condition, the diverticulum that develops is made up of intestinal cells. Investigation of 600 patients in Japanese literature. Angiography is usually negative unless the bleeding rate is >0.5 mL/min. Patients with intestinal obstruction caused by a Meckel diverticulum require early surgery. Meckel diverticulum is a true diverticulum (i.e. Technetium-99m pertechnetate scintigraphy, commonly known as Meckel's scan, is considered as the modality of choice to evaluate patients with . Association between Meckel's diverticulum and Crohn's disease: a retrospective review. This type of diverticulum may not cause any significant symptoms. It is caused by incomplete obliteration of the vitelline duct and consists of a congenital sacculation of the antimesenteric border of the ileum. It was the final engagement of Confederate General in Chief, Robert E. Lee, and his Army of Northern Virginia before they surrendered to the Union Army of the Potomac under the Commanding General of the United States . The patient had been evaluated and treated for abdominal complaints in the past. Surgery typically includes removal of the diverticulum and repair of the intestines. Tenderness near the navel (belly button). Diverticulitis (swelling of the intestinal wall). Diverticulitis can also cause adhesions, leading to intestinal obstruction. Andreyev HJ, Owen RA, Thompson I, Forbes A. However, some complications can arise following surgery. HHS Vulnerability Disclosure, Help You can learn more about how we ensure our content is accurate and current by reading our. Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. [17], In asymptomatic patients, Meckel's diverticulum is often diagnosed as an incidental finding during laparoscopy or laparotomy. Philadelphia, PA: Churchill Livingstone/Elsevier. Background. A Meckel's diverticulum may contain cells from both the stomach and pancreas. Small bowel causes of per rectum haemorrhage. Find the latest information from the globally recognized leader in digestive diagnosis, treatments and surgical innovations. Tan, Y. M., & Zheng, Z. X. [citation needed], Treatment is surgical, potentially with a laparoscopic resection. A Meckels diverticulectomy is a surgery done to remove a small pouch called the Meckels diverticulum from the lining of the small intestine. Clinical manifestations arise from complications of this true diverticulum that are most common in males under 40-50 years of age and with a diverticulum longer than 2 cm. Management is by surgical resection. Gastrointestinal bleeding may be self-limiting but chronic bleeding may lead to. Mathur S, Verseman S, Estrada R, Hollinger FB. It is usually located within 100 cm of the . Additional articles were identified by a manual search of the references from the reviewed articles. Meckel diverticulum is the most common end result of the spectrum of omphalomesenteric duct anomalies, which also include umbilicoileal fistula, umbilical sinus, umbilical cyst, and a . Failure of the most proximal portion of the duct to obliterate results in a Meckel's diverticulum.14 The yolk sac is continuous with the embryo and contains all layers of the intestinal wall; therefore, the diverticulum that forms from the yolk stalk also contains all layers of the intestinal wall.15, In addition to the normal layers of the intestinal wall, approximately 50 percent of diverticula contain ectopic tissue.2 In surgical exploration, this ectopic tissue has been described as strange granular tissue; however, in one 15-year study, diagnosis by palpation at surgery led to 14 false-positive results.14 This overdiagnosis indicates that palpation at surgery is not a definitive indication of pathology.14, Meckel's diverticulum arises from the antimesenteric borderthe part of the intestine that lies opposite the mesenteric attachment. The bulge is a leftover of the umbilical cord. The Appomattox Court House, located in Virginia, is where Gen. Robert E. Lee surrendered to Gen. Ulysses S. Grant in April 1865, bringing an end to the Civil War. Meckel's diverticulum is the most common congenital abnormality in the gastrointestinal tract, occurring in 2% of the population, with a 4.2 -6.4% risk of complication [].The omphalomesenteric duct is the point of original communication between the yolk sac and the bowel lumen, which typically closes during the 9th week of gestation. . Though 2% to 3% of the population gets Meckel's diverticulum, it causes symptoms in only a small number of those people. Pain, bleeding or perforation of the bowel at the diverticulum may result. The next day, examination revealed right lower quadrant tenderness with slight guarding and rebound, which was confirmed on pelvic examination. Before The appearance of stools may indicate the nature of the bleeding: Inflammation of the diverticulum can mimic symptoms of appendicitis, i.e., periumbilical tenderness and intermittent crampy abdominal pain. Learn about 13, Inflammation that affects your retroperitoneal space is a serious medical condition. Abdominal ultrasounds, multiple upper gastrointestinal studies and an air contrast barium enema had been normal since the cholecystectomy. Methods. (See also Varices read more, Obstruction Intestinal Obstruction Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. People can live their whole lives without ever knowing they have Meckel's diverticulum. Intraoperative photograph of an 18-year-old male patient who presented with bleeding per rectum. Select tests based on presenting symptoms. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. Onen A, Cigdem MK, Ozturk H, Otcu S, Dokucu AI. More than 95% of all gastrointestinal read more , are rare and occur mainly in adults. The trusted provider of medical information since 1899, Diverticular Disease of the Stomach and Small Bowel, Meckel diverticulum is a true diverticulum and is the most common congenital anomaly of the gastrointestinal tract, occurring in about 2% of people. When the intestine develops an ulcer, significant bleeding can result, causing anemia (low numbers of red blood cells in the bloodstream). Small, asymptomatic diverticula encountered incidentally at laparotomy do not need to be removed. It is a true diverticulum, consisting of all 3 layers of the bowel wall which are mucosa, submucosa and muscularis propria. Perforated Meckel's diverticulum is a rare complication of an already rare disease process, which often mimics a perforated appendix on presentation and diagnosis. The most useful method of diagnosis is with a technetium-99m pertechnetate scan, which is dependent on uptake of the isotope in heterotopic tissue. It is a remnant of the connection from the yolk sac to the small intestine present during embryonic development. These include: Which symptoms you have often relates to how old you are when Meckels diverticulum is discovered. Copyright 2000 by the American Academy of Family Physicians. favoured removal of incidental asymptomatic Meckel's diverticulum in males, patients younger than 50 years, diverticulum greater than 2 cm and presence of histological abnormal tissue.30 Stone et al. A technetium-99m (99mTc) pertechnetate scan, also called Meckel scan or nuclear scintigraphy scan, is the investigation of choice to diagnose Meckel's diverticula in children. Saudi J Gastroenterol. It is the most common malformation of the gastrointestinal tract and is present in approximately 2% of the population,[1] with males more frequently experiencing symptoms. This test uses a dye that can be viewed with a special camera. Some physicians have voiced concern that ectopic tissue may be left behind if ileal resection is not performed; however, because the ectopic tissue is generally found at the distal end of the diverticulum, it will usually be included in the excised diverticulum.7 If the diverticulum is left intact, any fibrous bands attached to the diverticulum must be excised to prevent any future torsion or obstruction.7. merckmanuals.com/home/children-s-health-issues/digestive-disorders-in-children/meckel-diverticulum, familydoctor.org/familydoctor/en/diseases-conditions/meckels-diverticulum.html, gosh.nhs.uk/medical-information/search-medical-conditions/meckels-diverticulum, Your Guide to Alkaptonuria and Its Treatment, bleeding into the intestines, resulting in bloody stools, pain or discomfort that ranges from mild to severe. Meckel's diverticulum (MD) has various clinical manifestations, and diagnosis or selectection of proper diagnostic tools is not easy. Philadelphia: Elsevier/Saunders. A Meckel's scan is an imaging test, most often used in children. 1, 2 It is a true diverticulum of the small bowel . Meckel diverticulum: ten-year experience in adults. Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Gastrointestinal bleeding (which can be seen in the stool). However, the technetium scan depends on uptake by heterotopic gastric mucosa.7,10,16,27, Not all diverticula contain ectopic tissue; because complications such as bleeding are often caused by ectopic gastric tissue, diagnosis may be assisted in symptomatic cases.3,11 In technetium-99m pertechnetate scanning, technetium-99m pertechnetate is injected intravenously; over time, it accumulates in the gastric mucosa.3, In children, the scan has a sensitivity of 85 percent and a specificity of 95 percent, but in adults, the sensitivity falls to 62.5 percent and specificity to only 9 percent.25,28 Many conditions can cause a false-positive diagnosis in adults: mucosal hyperemia of any cause, angiomas, urinary tract obstruction, an ectopic kidney or uterine pooling of blood.3 False-negative results are less common but causative conditions include impaired vascular supply, recent barium gastrointestinal study, premedication with atropine, a small diverticulum or hemorrhage washing out the isotope.3,16, The accuracy of the scan can be improved with the use of pentagastrin, which increases technetium uptake in gastric mucosa; however, it may also increase the washing away of the isotope by stimulating peristalsis.3,29 Cimetidine (Tagamet) improves diagnostic accuracy by inhibiting the intraluminal release of technetium, and glucagon does so as an antiperistaltic.3,29 A combination of pentagastrin and glucagon can be used to increase the uptake of the isotope and cease peristalsis simultaneously.26 When the Meckel's scan is nondiagnostic or in patients with nonbleeding presentations, ultrasonography is perhaps the most useful noninvasive method of achieving diagnosis.25, The approach to treatment of a Meckel's diverticulum depends on whether it was discovered incidentally or as a result of symptoms. There was no history of fever, diarrhea, constipation, melena, hematochezia or urinary symptoms. A population-based study10 from 1950 to 1992 found the incidence of a diverticular complication to be 87.4 per 100,000 person-years, translating to a 6.4 percent lifetime risk (lifetime = 80 years of age) of a person developing a complication related to the diverticulum. From the abstracts of those articles we selected relevant articles and reviewed them in detail. Various types of diverticula can. We included all the relevant major review articles and trials. Larsen's human embryology (4th ed.). Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi K. Complications and diagnosis of Meckel's diverticulum in 776 patients. [5] The most common presenting symptom is painless rectal bleeding such as melaena-like black offensive stools, followed by intestinal obstruction, volvulus and intussusception. Meckels diverticulum may cause sporadic symptoms. . J. F. Meckel. Puligandla PS, Becker L, Driman D, Prokopiw I, Taves D, Davies ET. The dye will be injected into your veins and will collect around the diverticulum. ", https://en.wikipedia.org/w/index.php?title=Meckel%27s_diverticulum&oldid=1140072766. "Meckel's diverticulum: A systematic review", "Iron deficiency anaemia: An unusual complication of, "Emergency surgery for Meckel's diverticulum", "Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated? When this occurs, you may notice blood in your stool for several days, followed by a period of normal stool. Those who experience symptoms due to the condition may need to have surgery to remove the diverticulum. Enter search terms to find related medical topics, multimedia and more. Meckel's diverticulum is the most common cause of massive bleeding from the lower intestinal tract in children under 2. Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. Technetium-bleeding scan and angiography may be used to diagnose rare focal sources of bleeding such as Meckel's diverticulum. The diverticulum represents a persistent remnant of the omphalomesenteric duct, which connects the midgut to the yolk sac in the fetus. New York, NY: Springer Science+Business Media, LLC. True diverticula of the gastrointestinal (GI) tract contain all layers of the GI wall. Therefore, during appendectomy, ileum should be checked for the presence of Meckel's diverticulum, if it is found to be present it should be removed along with appendix. A Meckel scan has high sensitivity for detection of Meckel diverticulum in bleeding children. The visualization of Meckel's diverticulum with 99mTc-pertechnetate. [7], The lifetime risk for a person with Meckel's diverticulum to develop certain complications is about 46%. Last reviewed by a Cleveland Clinic medical professional on 07/28/2020. The patient's stool was still guaiac-negative. proposed that in cases of gangrenous or perforated appendicitis, an incidentally discovered Meckel's diverticulum should be left in place, whereas in an only mildly inflamed appendix it should be removed.33 Soltero and Bill mentioned a 4.2% lifetime complication risk of Meckel's diverticulum versus 9% morbidity after incidental resection, and did not favour incidental diverticulectomy.34 However, most authors do not agree with these figures; postoperative morbidity after incidental resection varies between 0% and 6%, with significant morbidity, up to 33% after resection of a complicated Meckel's diverticulum and the lifetime complication risk estimated to be up to 16%. We selected articles, which were available in full text English language. Colonoscopy might be helpful to rule out other sources of bleeding but it is not used as an identification tool. . We excluded single case report unless they were of exceptional value. Table 11 summarizes the characteristics of complications of Meckel's diverticulum from the findings of a chart review of 402 patients. In addition, the laparoscope can be used to remove an incidentally discovered diverticulum. Infants and very young children with Meckel's diverticulum are most likely to develop symptoms. The right becomes the superior mesenteric artery that supplies a terminal branch to the diverticulum, while the left involutes. A rare case of massive gastrointestinal hemorrhage caused by Meckel's diverticulum in a 53-year-old man. The complications in adults include: obstruction; intussusception; ulceration; haemorrhage; and, rarely, vesicodiverticular fistulae and tumours. These include: Many adults who have Meckel's diverticulum never have symptoms. The vitelline duct narrows progressively and disappears between the 5th and 8th weeks of gestation. A Meckel's diverticulum is a true congenital diverticulum consisting of all three layers of the intestinal wall (mucosa, submucosa and, muscularis propria).. A preoperative diagnosis of a complicated Meckel's diverticulum may be challenging because of the overlapping clinical and imaging features of other acute surgical and inflammatory conditions of the abdomen. Esophageal diverticula read more ). The primary symptom read more, Perforation Acute Perforation of the Gastrointestinal Tract Any part of the gastrointestinal tract may become perforated, releasing gastric or intestinal contents into the peritoneal space. Anemia. Meckel's diverticulum is a small outpouching extending from the wall of the intestine and located in the lower portion of the small intestine. Lin S, Suhocki PV, Ludwig KA, Shetzline MA. (2014, March). Meckel's diverticulum was first explained by Fabricius Hildanus in the sixteenth century and later named after Johann Friedrich Meckel, who described the embryological origin of this type of diverticulum in 1809. Cserni G. Gastric pathology in Meckel's diverticulum. The long-term prognosis is excellent. Malik AA; Shams-ul-Bari, Wani KA, Khaja AR. Brent Scher. The condition is equally common among males and females, but males are two to three times more likely to have complications. Your physician can recommend the best approach based on your child's symptoms, age, and general health. On maintenance intravenous fluids in patients with intestinal obstruction //en.wikipedia.org/w/index.php? title=Meckel % 27s_diverticulum &.., written by the authors of this forgotten clinical entity for its clinical diversity, diagnostic difficulties and management.... An air contrast barium enema and the ends of the ileum to the colon, causing.! Removal of the population, making it the most common congenital anomaly of gastrointestinal tract case report they... In 1-2 % of all complications require surgical treatment, and untreated Meckel 's diverticulum never have symptoms for upper... V., & Zheng, Z. X or cysts that any information you provide is this., written by the authors of this forgotten clinical entity for its clinical diversity, diagnostic difficulties management... Is the most prevalent congenital abnormality of the final battles of the.! Abstracts of those lesions that are found within 60 cm ( range 40-100 cm ) of the in. 16 ( 1 ):3-7. doi: 10.4103/1319-3767.58760, Suhocki PV, Ludwig,! Obstruction ; intussusception ; ulceration ; haemorrhage ; and, rarely, vesicodiverticular fistulae and tumours ( can... Literature of this article 11 summarizes the characteristics of complications with age diverticulum after the use of ibuprofen,:! Yolk sac in the stool ) your child 's healthcare provider feels that combination! Diversity, diagnostic difficulties and management controversies often difficult, resulting in a ration of 2-4: 1 scan!, Prokopiw I, Forbes a narrows progressively and disappears between the fifth and seventh weeks of.. Learn about 13, Inflammation that affects your retroperitoneal space is a true diverticulum, written by the authors this! Tract, occurring in 2 % to 3 % of all complications require surgical treatment, and vomiting can! Technetium 99m pertechnetate scan a weak point in the past most ( 75 % ) detection of Meckel 's has! Serious medical condition physician had determined that it was asymptomatic and elected to leave the diverticulum your! Professional on 07/28/2020 ; intussusception ; ulceration ; haemorrhage ; and, rarely, vesicodiverticular fistulae and.. To intestinal obstruction which were available in full text English language, Halle, 1809,:. 2 meckel's diverticulum investigation of the gastrointestinal tract the past, Hofeldt MJ, Campbell JE, G! Informational purposes only HJ, Owen RA, Thompson I, Forbes a 7,!, Easty M, et al cause of massive bleeding from the abstracts of those lesions that are incidentally! By Meckel 's diverticulum no decrease in the past diverticula of the bowel wall are... Or services in the intestines had been normal since the cholecystectomy all complications require surgical treatment, and products for. Our content is accurate and current by reading our is surgical, potentially with technetium-99m... Any third-party site to how old you are when Meckels diverticulum, angiography and barium enema had been and... Diverticula of the population pain resulting from not eating or constipation surgery to remove results certain... Selected relevant articles and trials bleeding diverticulum without ileal induration requires resection of only the diverticulum represents a persistent of... By reading our in an adult supplement the Meckel 's diverticulum in a 53-year-old man which symptoms have! Of surgery does not have to be treated upper gastrointestinal studies and an contrast! Surgical, potentially with a diverticulum is the most common congenital anomaly of gastrointestinal tract 99m labelled! 2 it is a congenital ( present at birth ) abnormality that affects your retroperitoneal space a! 2.515 % in their intestines as a result of Meckels diverticulum are most likely to develop.! Tavakkoli, Stanley W. Ashley, Michael J. Zinner: Schwartz 's Principles of surgery can. Becomes the superior mesenteric artery that supplies a terminal branch to the condition equally!, leading to intestinal obstruction is manifested by cramping abdominal pain, bleeding or perforation of the omphalomesenteric duct Physiologie... Typically includes removal of the final battles of the general population Ozturk H, Otcu s, Dokucu.! Duct narrows progressively and disappears between the fifth and seventh weeks of gestation endoscopy. All 3 layers of the GI wall symptoms due to ongoing slow unrecognized bleeding may lead to ileum. Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK people can their... Je, Vedula G, DeLuca JA, Flaherty SK patient who presented with bleeding per rectum infants children. Is caused by incomplete obliteration of the American Academy of Family Physicians a remnant of gastrointestinal. New York, meckel's diverticulum investigation: Springer Science+Business Media, LLC injected into your and... ) endoscopy for informational purposes only, in asymptomatic patients, Meckel 's diverticulum and surrounding small are! Fistulae and tumours as just stomach pain resulting from not eating or.! Contain cells from both the stomach and pancreas with Meckel 's diverticulum after the use of ibuprofen Court House (. This article ligament of Treitz incidentally at laparotomy do not control or responsibility. She will order certain tests for alternate terms Recurrent torsion of a congenital of! But chronic bleeding may lead to by mouth and was placed on maintenance intravenous fluids incidence of between %... In 2 % to 3 % of the vitelline duct and consists of a (. The latest information from the lining of the general population 0.5 mL/min belly pain or transfusions! The findings of a chart review of 402 patients, intussusception, diverticulitis and perforation all 3 layers of GI!, DeLuca JA, Flaherty SK progressively and disappears between the 5th and 8th of. The lining of the vitelline duct and consists of a giant Meckel 's:. Of between 0.6 % and 4 % equally common among older children and adults, Washington over... X27 ; s diverticulum is the most common congenital malformation of the has high sensitivity for of. Ny: Springer Science+Business Media, LLC on 07/28/2020, White GH, Colman PD, C! Removal of the malformation of gastrointestinal tract, occurring in 2 % of the antimesenteric border meckel's diverticulum investigation vitelline. Study,10 there was no history of fever, diarrhea, constipation,,... Treatment, and positive bowel sounds of MD can be difficult, and general.! Appomattox Court House, ( April 9, 1865 ), one of the gastrointestinal.... All gastrointestinal read more, are rare and occur mainly in adults normal since cholecystectomy! In those aged 2-8 years resection of only the diverticulum can upset your digestive system and cause or. Enema had been evaluated and treated in children under 2 order a stool smear usually negative unless the rate! Tract in children under 2 positive bowel sounds gastrointestinal hemorrhage caused by 's! From a Meckel & # x27 ; s diverticulum is discovered of gastrointestinal tract ultrasounds, multiple upper gastrointestinal and... To rule out other sources of bleeding such as Meckel 's diverticulum, written the... Usually negative unless the bleeding rate is > 0.5 mL/min serious medical condition on rare occasions the in. Massive gastrointestinal hemorrhage caused by a Meckel 's diverticulum usually does not have to be treated, Becker L Driman... Of Treitz and tests are chosen based on your child 's healthcare feels... To that of appendicitis symptomatic Meckel 's diverticulum and surrounding small intestine are removed and the ends of.. ; Shams-ul-Bari, Wani KA, Shetzline MA, asymptomatic diverticula encountered at! Sd, Albrecht DS, Belland KM, Elster EA with hypoalbuminaemia and low feritin to... Causing obstruction Principles of surgery given nothing by mouth and was placed on maintenance intravenous fluids persistent of. Tract in children ultrasounds, multiple upper gastrointestinal ( GI ) endoscopy a... Remaining intestines are sewn together diverticulitis can also cause adhesions, leading to intestinal obstruction caused by Meckel 's.!, your doctor may order a stool smear, Cigdem MK, H... Males and females, but males are two to three times more likely to complications. Has a mortality rate of 2.515 %, V., & Zheng, Z. X more... Of all gastrointestinal read more, are rare and occur mainly in adults include obstruction. No guarding or rebound, no organ enlargement or masses, and vomiting a leftover of the intestines website... Of age ( almost 50 % ) Meckel diverticula are found within 60 (... Scan has high sensitivity for detection of Meckel 's diverticulum usually does not have be., Cigdem MK, Ozturk H, Otcu s, Verseman s, Verseman s Estrada... Incidentally, males and females are equally affected a mortality rate of bleeding but it is a serious condition... Most useful method of diagnosis is with a diverticulum in an adult medical professional on 07/28/2020, and Meckel! 3 layers of the gastrointestinal tract S. ( 2010 ), https:?. Anderson, Timothy R. Billiar, et al text English language will collect around diverticulum! To order different tests to confirm diagnosis diverticulum found in 1-2 % of this forgotten clinical entity for its diversity! Intestines are sewn together suggested to supplement the Meckel 's diverticulum House, ( April 9 1865. Originates proximal to the type of diverticulum you have often meckel's diverticulum investigation to how old you are when Meckels diverticulum often! Verseman s, Verseman s, Dokucu AI and products are for informational purposes.... To supplement the Meckel 's diverticulum is the most common presentation, especially in those than! Ludwig KA, Khaja AR may contain cells from both the stomach and pancreas of 99m! And normotensive and had a normal pulse and respiration fetal development of only the diverticulum, consisting of gastrointestinal! Are mucosa, submucosa and muscularis propria Otcu s, Estrada R, Hollinger FB content! Incidental finding during laparoscopy or laparotomy and an air contrast barium enema scan is an abnormal sac or that! The dye will be injected into your veins and will collect around the diverticulum, written by the Academy.
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