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What is Meckel’s diverticulum?
Meckel’s diverticulum is a small outpouching extending from the wall of the bowel, located in the lower portion of the small intestine. This abnormal pouch is a persistent remnant of tissue from the embryonic development of the fetal digestive system. The lining of this pouch is made up of either pancreatic tissue and/or acid-secreting tissue such as that seen in the lining of the stomach.
While Meckel’s diverticulum is the most common congenital (present at birth) abnormality of the digestive system (present in 2% of the population), most people with this abnormality do not develop symptoms or problems. However, in some individuals, the secretion of acid by Meckel’s diverticulum may cause peptic ulcerations in the small intestinal lining. This is because this area of the intestine normally never experiences an acidic environment and is not protected from the strong acid secreted by the cells within the diverticulum. These ulcers typically bleed leading to passage of blood from the rectum; however, they can also perforate (rupture), causing intestinal waste products to leak into the abdomen. This can result in a serious abdominal infection called peritonitis.
Meckel’s diverticulum can also cause intestinal obstruction. It can do this by telescoping into itself within the passageway of the intestine (intussusception). A portion of small intestine may also twist around an anchored Meckel’s diverticulum. This is known as segmental volvulus or internal hernia and may be associated with compromised blood supply and intestinal obstruction.
Why is Meckel’s diverticulum of concern?
When the intestine develops an ulcer, significant bleeding can occur, resulting in anemia (low red blood cell count). Rapid blood loss can be associated with shock, which is life threatening. Intestinal obstruction and serious infection may also occur.
Who is at risk for developing complications from Meckel’s diverticulum?
Complications from Meckel’s diverticulum can develop at any age, and it is estimated that there is a 4 to 6% lifetime risk of complications occurring in any individual with this disorder. However, this risk decreases with age. Infants and children appear to be at highest risk for complications, with over 50% of symptomatic Meckel’s diverticula occurring in children less than 2 years of age. The condition is twice as common in males.
An increased incidence of Meckel’s diverticula is seen in association with other congenital anomalies, including esophageal atresia, imperforate anus (anorectal malformations), omphalocele, Crohn’s disease, and various neurological and cardiovascular malformations.
What are the symptoms of Meckel’s diverticulum?
As indicated above, most people with this condition have no signs or symptoms. Symptoms occur only if the diverticulum bleeds, becomes infected or causes an obstruction. The symptom most commonly seen in young children is painless rectal bleeding. The color of blood may vary from bright red (35%) to dark red or maroon (40%) to black tarry (7%).
While symptoms of infection and blockage generally occur before adolescence, they can appear at any time in life and can cause mild to severe abdominal pain and discomfort.
How is the diagnosis of Meckel’s diverticulum made?
Rectal bleeding requires a systematic approach to evaluation. When patients are stable and when bleeding is slow or episodic, a variety of tests may be performed.
- Blood Test -This is done to determine if anemia or infection is present. A stool sample may also be obtained to check for frank (obvious) or occult (hidden) blood.
- Meckel’s Scan– A radioactive substance called technetium, which is preferentially absorbed by stomach tissue, is injected into the bloodstream through an intravenous (IV) line. This substance can be seen on special X-rays (gamma cameras)and indicates areas where acid-secreting stomach tissue exists, including that seen in the Meckel’s diverticulum.
- Rectosigmoidoscopy– a small, flexible tube with a camera on the end is inserted into the rectum and sigmoid colon (last part of the large intestine). The inside of the rectum and large intestine are evaluated for bleeding, blockage, and other problems.
- Barium Enema and Small Bowel Series– This procedure is performed to examine the large intestine, thereby helping to rule out other possible causes of gastrointestinal bleeding. A chalky fluid called barium, which coats the inside of the colon so that it shows up on X-rays, is given into the rectum as an enema. These X-rays show strictures (narrowed areas), obstructions, and other problems.
With significant and ongoing blood loss, additional tests such as bleeding scan, colonoscopy, and angiography may be performed. In rare cases, life threatening blood loss may necessitate urgent exploratory surgery.
What is the treatment for Meckel’s diverticulum?
A symptomatic Meckel’s diverticulum should be resected (removed) with an operation. This operation can be performed using either an open or a laparoscopic surgical approach. With both approaches, Meckel’s diverticulum is resected, the ulcerated area is identified, and the bleeding is stopped. At the preference of the surgeon, a Meckel’s diverticulum not associated with symptoms may be removed if incidentally encountered during an operation for another, unassociated problem.
As with other gastrointestinal surgical procedures, possible postoperative complications include a small risk of wound infection and developing adhesions (scar tissue) later in life.
What is the long-term outlook after treatment?
After recovery, resection of Meckel’s diverticulum generally has no effect on gastrointestinal functioning or nutrition.