What is Meckel's diverticulum? This is a common question from patients. Let's take a closer look at it. This is a pathology that was first described by the scientist Johann Friedrich Meckel. The essence of this disease lies in the fact that in the process of intrauterine development of a person, under the influence of certain factors, some violations 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.
Development of pathology
In 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 muscular membrane. The true ones are congenital (we are talking about the same Meckel's diverticulum), and the acquired diverticula in the colon are false.
In the initial stages, the gallbladder duct, whichlocated near the ileum, formed by the seventh week of pregnancy. In cases where there is no atrophy of the area that connects it to the ileum, Meckel's diverticulum is formed.
Such cases are called congenital, and the diverticulum itself has all the properties of a normal intestine and stretches in the region of the opposite attachment of the edge of the mesentery. In half of the cases, it has heterotopic gastric tissue or pancreatic tissue. However, there are cases when he possesses two tissues at the same time.
Complications after diverticulum formation are rare, occurring in about 2% of patients. As for sexual characteristics, in men such an 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.
Causes of this pathology
Inflammation of Meckel's diverticulum may occur due to the retention of food debris. As a result, the formation of fecal stones begins, which is accompanied by an acute infection.
The inflammatory process concerns exclusively Meckel's diverticulum, however, 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 can have all the features and functions of a normal gut. In this case, the symptoms that confirm the presence of thisdiseases are completely absent. For diagnosis, it is necessary to conduct special laboratory tests here, 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 themselves most clearly and often. These include the following disorders in the body:
- Anemia (iron deficiency).
- Blocking the intestinal tract.
- Inflammatory process, which may be indicated by chills and fever, as well as blood and urine tests.
- Bleeding, in which there is blood in the stool.
- Vomiting and bouts of nausea.
- Pain in the abdomen, which is a sharp cramping character.
- Difficulty with stool.
Localization of pain - more often in the left iliac region, in the projection of the sigmoid colon. It is spasmodic, aggravated as soon as the large intestine is filled with feces. It usually gets easier after a bowel movement. In some patients, in the period between these spasms, dull aching pain in the same departments is noted. Palpation of the abdomen does not make it possible to determine the localization of the painful focus. This suggests that there is no organic cause of the pain syndrome. It is associated in this case with the discoordination of intestinal motility.
The duration of the pain syndrome is fixed by patients from several days andweeks to constant incessant pain. The chair is disturbed, and this is most often manifested by constant constipation. In addition, patients have complaints of a feeling of incomplete emptying of the intestines and increased flatulence. In some patients, diarrhea alternates with constipation, which is also quite unpleasant. Clinically pronounced diverticulosis (this is diverticular disease) is not always harmless, as most gastroenterologists think. Frequent paroxysmal pain in the abdomen, regular violation of bowel movements - all this leads these patients to complete or partial disability. They constantly visit gastroenterology or coloproctology rooms, where they are unsuccessfully treated with 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, blockage of the intestine most often occurs. As for internal bleeding, the disease can give such manifestations already at an older age. Nevertheless, the detection of pathology occurs mainly before the age of 12.
In addition, the patient may experience some irregular symptoms of this disease. For example, internal bleeding may be minor and stop on its own within a few days. This feature also makes it difficult to adequately diagnose this disease.
Development of anemia
Sometimes blood in the patient's stool is observed constantly, but such casesextremely few. 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 in danger. 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. Bloody stools in childhood are a clear sign of pathology.
At the end of the twentieth century, they began to use a method for diagnosing the gastric mucosa, which is called "scintigraphy". It is based on a study on the absorption of isotopes by the stomach. This diagnostic is carried out in different projections.
During normal functioning, a large accumulation of radionuclides is formed in the bladder and stomach, accumulating with the help of the duodenum and small intestine. Therefore, when diagnosing Meckel's diverticulum, a study of the kidneys and urinary system is performed.
Scintigraphy results can be considered positive in cases where the patient has any pathology of radionuclide accumulation.
The diverticulum is usually located in the lower abdomen. However, he can change his position due to mobility. Pathology is often confused with intestinal doubling.
If a patient has complete intestinal obstruction or signs of peritonitis, specialists may perform a diagnostic laparoscopy. In this case, the disease is detected already at the stage of surgical intervention.
Meckel's diverticulum: surgery
Therapeutic methods that eliminate the development of pathology consist in surgical intervention, the course and method of which directly depend on how this pathology was detected - based on the symptoms or during the operation itself.
In cases where there were no symptoms and the disease was diagnosed directly on the operating table, surgeons immediately begin to remove the diverticulum, which is performed by transverse suturing. This procedure is carried out using special equipment.
Treatment of Meckel's diverticulum should be timely.
Step-by-step operation
At the first stage of the operation, doctors determine the location of the source of bleeding. If it is localized not in the diverticulum, but in the ileum, a segmental resection of this section of the intestine is usually 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 involve?
In cases where bowel obstruction is observed in the intussusception form, the first step is to carry out the disinvagination procedure and only after that begin to remove the diverticulum. If the resection causes narrowing of the intestinal lumen, a segmental intestinal resection is necessary. The consequences of intussusception become irreversible in cases of Meckel's diverticulum or intestinal gangrene. In these situationsas a rule, manipulations such as anastomosis and intestinal resection are used. In some cases, it is possible to apply stomas, which are used temporarily, after which they are removed.
Complete recovery of the patient after removal of Meckel's diverticulum occurs in a few weeks.
Causes of intestinal obstruction
Intestinal obstruction, including in children, may be caused by volvulus or herniation, which may be due to debris in the bile duct.
In such cases, the method of treatment is to eliminate the 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, the clinical picture may worsen, which also occurs with intestinal gangrene and strangulated hernia. In 10% of cases, during such surgical procedures, the death of the patient occurs, 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 adhesions and intestinal obstruction.
At the child
This pathology is one of the most common of the category of congenital anomalies of the gastrointestinal tract and manifests itself in almost 4% of children, most often in boys. If the disease was not detected before the age of 10, then by the age of 30 there is a 100% chance that it will manifest itself in some way.
Meckel's diverticulum in children is a specific disease,which can proceed for a long time without any specific symptoms. Nevertheless, scientists around the world are working to improve the methods of diagnosing this pathology, which will help to significantly reduce the child mortality rate from its complications.
The asymptomatic course of the disease in children can be complicated and sooner or later will become a godsend for surgeons during laparotomy for diagnostic purposes.
Main manifestations
In cases where the symptoms of the disease are present, its main manifestations in children may be bleeding in the intestines, acute pain in the lower abdomen, tarry stools that have a shade of black. These manifestations may be accompanied by general weakness, pallor, increased heart rate, dizziness. Clinical and laboratory blood tests are required. The main indicator that 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.
There may also be no symptoms such as nausea and vomiting, but the inflammation of Meckel's diverticulum closely resembles the symptoms of appendicitis. Here there is a symptom of Shchetkin-Blumberg, leukocytosis, abdominal pain, etc. In most cases, surgeons begin to operate on appendicitis, however, during surgery, the true cause of such symptoms appears.
Forecast for exacerbation
Only in 5% of cases Meckel's diverticulum makes itself felt throughout life. Most people don't evenare suspected of having the disease. The main patients of surgeons diagnosed with diverticulitis are children under 12 years old.
In conclusion
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 there may be adhesions in the small intestine due to the transferred inflammatory process, and this, in turn, can eventually lead to the formation of intestinal obstruction.
