Background: Meckel's diverticulum is the most common congenital anomaly of the small bowel and is caused by the incomplete obliteration of the omphalomesenteric duct during the eighth week of gestation. Methods: We report the case of a year-old male who presented to the emergency department with epigastric pain, vomiting, and abdominal distension. Clinically, he had a high intestinal obstruction without any mechanical cause on computed tomography scan. A median laparotomy was proposed. Results: An internal ileum hernia was identified twisted around a giant Meckel's diverticulum with a mesodiverticular artery, coursing from the base of the mesentery to the diverticulum. A small bowel segmental resection was performed, containing the diverticulum.
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A Meckel's diverticulum , a true congenital diverticulum , is a slight bulge in the small intestine present at birth and a vestigial remnant of the omphalomesenteric duct also called the vitelline duct or yolk stalk. 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 The majority of people with a Meckel's diverticulum are asymptomatic.
An asymptomatic Meckel's diverticulum is called a silent Meckel's diverticulum. The most common presenting symptom is painless rectal bleeding such as melaena -like black offensive stools, followed by intestinal obstruction , volvulus and intussusception. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis. Also, severe pain in the epigastric region is experienced by the person along with bloating in the epigastric and umbilical regions.
At times, the symptoms are so painful that they may cause sleepless nights with acute pain felt in the foregut region, specifically in the epigastric and umbilical regions. In some cases, bleeding occurs without warning and may stop spontaneously. The symptoms can be extremely painful, often mistaken as just stomach pain resulting from not eating or constipation. Rarely, a Meckel's diverticulum containing ectopic pancreatic tissue can present with abdominal pain and increased serum amylase levels, mimicking acute pancreatitis.
Only 6. Table 1 — Complications of Meckel's Diverticulum: . Bleeding of the diverticulum is most common in young children, especially in males who are less than 2 years of age. Inflammation of the diverticulum can mimic symptoms of appendicitis, i. Perforation of the inflamed diverticulum can result in peritonitis. Diverticulitis can also cause adhesions , leading to intestinal obstruction. Symptoms: Vomiting, abdominal pain and severe or complete constipation. Anomalies between the diverticulum and umbilicus may include the presence of fibrous cord, cyst , fistula or sinus, leading to: .
Tumors in Meckel's diverticulum may cause bleeding, acute abdominal pain, gastrointestinal obstruction, perforation or intussusception. The omphalomesenteric duct omphaloenteric duct, vitelline duct or yolk stalk normally connects the embryonic midgut to the yolk sac ventrally, providing nutrients to the midgut during embryonic development.
The vitelline duct narrows progressively and disappears between the 5th and 8th weeks gestation. In Meckel's diverticulum, the proximal part of vitelline duct fails to regress and involute, which remains as a remnant of variable length and location. The right becomes the superior mesenteric artery that supplies a terminal branch to the diverticulum, while the left involutes. It is a remnant of the connection from the yolk sac to the small intestine present during embryonic development.
It is a true diverticulum , consisting of all 3 layers of the bowel wall which are mucosa , submucosa and muscularis propria. Heterotopic means the displacement of an organ from its normal anatomic location. 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 memory aid is the rule of 2s: . However, the exact values for the above criteria range from 0. A case report of strangulated umbilical hernia with Meckel's diverticulum has also been published in the literature. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, ischemia , and necrosis.
A technetiumm 99mTc pertechnetate scan, also called Meckel scan, is the investigation of choice to diagnose Meckel's diverticula in children. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence. Therefore, other tests such as colonoscopy and screenings for bleeding disorders should be performed, and angiography can assist in determining the location and severity of bleeding.
Colonoscopy might be helpful to rule out other sources of bleeding but it is not used as an identification tool. Angiography might identify brisk bleeding in patients with Meckel's diverticulum.
Ultrasonography could demonstrate omphaloenteric duct remnants or cysts. In asymptomatic patients, Meckel's diverticulum is often diagnosed as an incidental finding during laparoscopy or laparotomy.
Treatment is surgical, potentially with a laparoscopic resection. Most cases of Meckel's diverticulum are diagnosed when complications manifest or incidentally in unrelated conditions such as laparotomy, laparoscopy or contrast study of the small intestine. Classic presentation in adults includes intestinal obstruction and inflammation of the diverticulum diverticulitis. Painless rectal bleeding most commonly occurs in toddlers.
Inflammation in the ileal diverticulum has symptoms that mimic appendicitis, therefore its diagnosis is of clinical importance. Detailed knowledge of the pathophysiological properties is essential in dealing with the life-threatening complications of Meckel's diverticulum. From Wikipedia, the free encyclopedia.
Meckel's diverticulum Schematic drawing of a Meckel's diverticulum with a part of the small intestine. Clin Radiol. Meckel's diverticulitis masquerading as acute pancreatitis: A diagnostic dilemma. Larsen's human embryology 4th ed. British Journal of Surgery. Journal of the Royal Society of Medicine. Indian Pediatrics. Medical Principles and Practice. World J Emerg Surg. Recurrent torsion of a giant Meckel's diverticulum. Digestive Diseases and Sciences, 50 7 , — Gray's anatomy for students 2nd ed.
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ICD - 10 : C Congenital malformations and deformations of digestive system Q35—Q45 , — Pyloric stenosis Hiatus hernia. Intestinal atresia Duodenal atresia Meckel's diverticulum Hirschsprung's disease Intestinal malrotation Dolichocolon Enteric duplication cyst.
Imperforate anus Rectovestibular fistula Persistent cloaca Rectal atresia. Annular pancreas Accessory pancreas Johanson—Blizzard syndrome Pancreas divisum. Choledochal cysts Caroli disease Biliary atresia. Alagille syndrome Polycystic liver disease. Categories : Congenital disorders of digestive system Diseases of intestines General surgery Medical mnemonics. Hidden categories: All articles with unsourced statements Articles with unsourced statements from May Commons category link is on Wikidata.
Medical genetics. Intestinal obstruction. Wikimedia Commons has media related to Meckel's diverticulum. Intestines Intestinal atresia Duodenal atresia Meckel's diverticulum Hirschsprung's disease Intestinal malrotation Dolichocolon Enteric duplication cyst.
Surgical pathology associated with Meckel's diverticulum in a tertiary hospital. Rubio Chaves 1 , J. Padillo Ruiz 1. Seville, Spain. Huelva, Spain. Objective: we want to present our experience about surgical pathology of Meckel's diverticulum by means of a retrospective study. Material and methods: we report a group of patients of our Department of General and Abdominal Surgery and Paediatric Surgery of our Hospital with Meckel's diverticulum since January to January
Intestinal Obstruction by Giant Meckel's Diverticulum
Meckel diverticulitis is the inflammation of Meckel diverticulum , which is the most common congenital structural abnormality of the gastrointestinal tract 3. Despite this, it is an uncommon cause of acute abdomen and is often not correctly diagnosed pre-operatively. This article focuses on Meckel diverticulitis. For a general discussion of the un-inflamed diverticulum, please refer to the article on Meckel diverticulum.