Treatment and Outlook for Meckels Diverticulum

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Treatment and Outlook for Meckels Diverticulum

What is the long-term prognosis (outlook) for patients who have Meckel’s diverticulum? The long-term prognosis is excellent. Patients can expect a full recovery after treatment. Last reviewed by a Cleveland Clinic medical professional on 07/28/2020.Jul 28, 2020

What is the treatment for Meckel’s diverticulum?

Doctors will usually recommend that a Meckel’s diverticulum that is causing symptoms (such as bleeding) be surgically removed. Under general anesthesia, an incision will be made in the abdomen and the abnormal tissue will be removed.

How serious is Meckel’s diverticulum?

These ulcers can bleed or 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.

How long does it take to recover from Meckel’s diverticulum surgery?

The swelling generally decreases within 2 or 3 weeks, but for some, this can take up to 4-6 months. You should be careful not to lift your hands above your head for at least 2 to 3 weeks after surgery.

Is Meckel’s diverticulum an emergency?

Meckel’s diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications.

What is the the safest and most definitive approach to treat a bleeding Meckel diverticulum?

Definitive treatment of a complication, such as bleeding, is excision of the diverticulum along with the adjacent ileal segment.

Is Meckel’s diverticulum a true diverticulum?

Meckel’s diverticulum is a true diverticulum, containing all layers of the small bowel wall. They arise from the antimesenteric surface of the middle-to-distal ileum. The diverticulum represents a persistent remnant of the omphalomesenteric duct, which connects the midgut to the yolk sac in the fetus.

How do you diagnose Meckel’s diverticulum?

Diagnosis of Meckel’s Diverticulum

A blood sample is required for the test. Meckel’s scan. It’s a scan used to detect Meckel’s diverticulum by injecting a substance called technetium-99m through your vein. The technetium can be detected in an X-ray in areas of your stomach tissue, such as the Meckel’s diverticulum.

Is Meckel’s diverticulum curable?

Meckel’s diverticulum is a congenital (present at birth) outpouching or bulge in the lower part of the small intestine. The bulge is a leftover of the umbilical cord. If it causes symptoms, Meckel’s diverticulum can be repaired with surgery.

Can Meckel’s diverticulum return?

Children and adults who have surgery to remove and repair a Meckel’s diverticulum usually make a full recovery. The diverticulum won’t return because it is a congenital defect that one is born with and not something that develops over time.

Is Meckel’s diverticulum painful?

Patients with Meckel’s diverticulum can present with acute abdominal pain, typically due to inflammation. They can also present with GI bleeding and bowel obstruction, and should be considered in the differential diagnosis for these clinical problems.

Why is there bleeding in Meckel’s diverticulum?

Complications arising from Meckel’s diverticulum include gastrointestinal bleeding, intussusception, intestinal obstruction, abdominal pain, and incarcerated hernia [3]. The main cause of bleeding is the acid secreted from the ectopic mucosa, leading to ulceration of the adjacent ileal mucosa.

What is the cause of Meckel’s diverticulum?

Meckel diverticulum, also known as Meckel’s diverticulum, is the most common congenital abnormality of the small intestine; it is caused by an incomplete obliteration of the vitelline duct (ie, failure of the omphalomesenteric duct to close).

Is a positive 99mtc pertechnetate scan 100% diagnostic for a Meckel’s diverticulum?

Technetium Tc 99m pertechnetate scintigraphy is the most widely used method for diagnosing bleeding Meckel’s diverticula, and it has a sensitivity of 85%. The isotope localizes in the right lower quadrant or hypochondrium (Fig. 120-5) on positive scans.

What is the most common complication of Meckel’s diverticulum among adults?

The most widespread complication of Meckel’s diverticulum in adults is bowel obstruction, whereas this presentation occurs as the second most common complication in childhood 9,10,14.

How proximal to the cecum is a Meckel’s diverticulum usually found?

Generally, a Meckel diverticulum ranges from 1 to 12 cm in length and is found 45-90 cm proximal to the ileocecal valve.

What is perforated Meckel’s diverticulum?

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 majority of case reports for perforation involve either a foreign body or fecalith.

What is a Meckel’s scan?

A Meckel’s scan is an imaging test used to detect a Meckel’s diverticulum. This is a small, abnormal pocket that forms in the wall of your child’s small intestine. During normal development of the gastrointestinal tract, a small duct forms off an area of what will eventually become the small intestine.

What is Meckel’s diverticulum NHS?

Meckel’s diverticulum is one of the most common congenital digestive system disorders congenital means that the disorder was present at birth. When a child’s small intestine was developing, a small pouch formed consisting of tissue from elsewhere in the body.

What is differential diagnosis that most often confused with Meckel’s diverticulum?

The differential diagnosis is broad, including any cause of GI bleeding. Massive GI bleeding is uncommon in childhood. Stool may be mistaken for hematochezia if children ingest bismuth, iron, or spinach.

What is the rule of two in Meckel diverticulum?

The rule of two’s: Meckel diverticulum occurs in 2% of the population, 2% are symptomatic, mostly in children < 2 years, affects males twice as often as females, is located 2 feet proximal to the ileocecal valve, is ? 2 inches long, and can have 2 types of mucosal lining.

When do you remove Meckel’s diverticulum?

Based on the above, when the indication of surgery is: (1) simple diverticulitis of a long MD, diverticulectomy can be performed; (2) simple diverticulitis of a short MD, wedge resection should be performed; (3) complicated intestinal obstruction, complicated diverticulitis with inflamed or perforated base and tumor, …

Is Meckel’s diverticulum genetic?

INCIDENCE. Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, found in approximately 1% to 2% of the population in large autopsy and surgical series. The underlying genetic defects that cause Meckel’s diverticulum have not yet been identified.

How do you prevent Meckel’s diverticulum?

You cannot prevent or avoid a Meckel’s diverticulum.

What is the ileal diverticulum?

Ileal diverticula are false diverticula when compared with the more common true Meckel’s diverticulum occurring in the ileum. They are usually multiple and occur at the mesenteric border, sometimes hidden in the mesentery and overlooked during surgery [2].

How can you tell the difference between appendix and Meckel’s diverticulum?

In contrast to the appendix there is no association with the cecum. A diameter of up to 40 mm and a well-defined wall of small bowel with 3 definite layers visible by ultrasound may help to distinguish between a Meckel’s diverticulum and the appendix.

When do you need surgery for diverticulitis?

Your NYU Langone gastroenterologist may recommend surgery if symptoms of diverticulitis haven’t improved after nonsurgical treatment; if a perforation or fistula, a connection that forms between the intestines and another organ, develops in the colon wall; or if a diverticular pouch ruptures.

What happens when a diverticulum ruptures?

Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care.

What foods should not be eaten if you have diverticulosis?

In the past, doctors had recommended that people with diverticular disease (diverticulosis or diverticulitis) avoid hard-to-digest foods such as nuts, corn, popcorn, and seeds, for fear that these foods would get stuck in the diverticula and lead to inflammation.

Does Meckel’s diverticulum cause Melena?

Inverted Meckel’s diverticulum can cause two clinical manifestations: GI bleeding and intussusception, as in our two cases. Most complaints are of hematochezia and/or melena due to ulceration of the inverted Meckel’s diverticulum.

Is Meckel’s diverticulum more common in males or females?

There are no differences in the prevalence of asymptomatic MD between males and females; however, symptomatic MD has a distinct male predominance with a male-to-female ratio ranging from 2:1 to 5:1 in children. Furthermore, if the ectopic tissue contains gastric mucosa, MD has a greater chance of becoming symptomatic.

How is pertechnetate produced?

Sodium [99mTc]pertechnetate is most commonly obtained from the 99Mo/99mTc generator (from 99Mo extracted from fission product of uranium). Alternatively it may also be accelerator-produced.

How is technetium-99m detected?

Technetium-99m (Tc-99m) can be readily detected in the body by medical equipment because it emits 140.5 keV gamma rays (these are about the same wavelength as emitted by conventional X-ray diagnostic equipment), and its half-life for gamma emission is six hours (meaning 94% of it decays to 99Tc in 24 hours).

What is 99mtc pertechnetate?

Tc-99m pertechnetate (Na+ 99mTc O4) is one of the technetium radiopharmaceuticals used in imaging of thyroid, colon, bladder and stomach. Technetium (99mTc) has eight oxidation states 6, from -1 to +7; specifically, the oxidation state of technetium in the pertechnetate anion (99mTcO4) is +7.

How does Meckel’s diverticulum cause obstruction?

There are plenty of mechanisms for bowel obstruction arising from a Meckel’s diverticulum. Obstruction can be caused by trapping of a bowel loop by a mesodiverticular band, a volvulus of the diverticulum around a mesodiverticular band, and intussusception, as well as by an extension into a hernia sac (Littre’s hernia).

What is the most common presentation of a child with Meckel’s diverticulum?

The most common presentation of Meckel diverticulum was lower gastrointestinal bleeding, which was observed in 41 patients (40.2%).

Is Meckel’s diverticulum palpable?

We also know that in 13% of the patients with palpable ectopic tissue, the tissue is at the base of the Meckel diverticulum and that in 62% of patients with ectopic tissue, the tissue is not palpable.

Can Meckel’s diverticulum cause anemia?

Ongoing bleeding from a Meckel diverticulum can cause iron deficiency anemia. However, megaloblastic anemia can also be seen due to vitamin B12 or folate deficiency. These can occur secondary to small bowel overgrowth if chronic dilatation and/or stasis related to the diverticulum is present.

How you differentiated acute appendicitis from Meckel’s diverticulum preoperatively?

Tenderness medial to McBurney’s point suggesting a Meckel diverticulum should be distinguished from typical appendicitis tenderness. The presence of dilated loops of bowel by palpation or percussion is an important finding that should be sought along with the degree of tenderness associated with the distended bowel.

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