Intestinal diverticula in children: why they arise, how they manifest themselves, principles of therapeutic nutrition. Meckel's diverticulum: a secret health threat
Meckel's diverticulum is most often a congenital anomaly of the gastrointestinal tract, a remnant of the umbilical duct, which usually disappears in children by the 7th week of pregnancy and is a pouch-shaped protrusion of the intestinal wall, as in the photo above. Usually found in men (ratio to women 2:1). Average length diverticulum 5 cm.
Normally, Meckel's diverticulum is localized in the ileum, approximately 60 cm from the ileocecal (bauginian) valve.
Half of the diverticula ileum contains normal mucous membrane, the second half has heterotopic foci, that is, studies reveal the mucous membrane of the stomach, duodenum, colon or pancreas.
Video: symptoms of Meckel's diverticulum
Types of Meckel's diverticulum
There are 2 types of Meckel's diverticulum:
- False, in which such diverticula are located on the side of the mesentery, i.e. at the passage of blood vessels. In their structure they do not have a muscular membrane.
- True when all layers of the intestinal wall are present. The true diverticulum is located on the antimesenteric side, where there are no vessels. Also, depending on the presence of complications, they are divided into: complicated and uncomplicated.
Symptoms of Meckel's diverticulum
All clinical symptoms can be divided into general signs, cardiovascular, gastrointestinal and complicated.
It is important to understand that Meckel’s diverticulum itself is not a concern, but the appearance of certain clinical signs indicates the occurrence of complications.
Common symptoms include:
- Increased temperature - in the absence of inflammatory changes and other complications may not be observed.
- General poor health.
- Weakness and fatigue.
Cardiovascular clinic of Meckel's diverticulum:
1. Tachycardia - caused by pain or blood loss.
2. Hypotension and shock due to bleeding.
Gastrointestinal symptoms:
1. Abdominal pain, often similar to appendicitis.
2. Vomiting and changes in bowel movement.
3. Bloody stool and melena.
4. Peritonitis and septic shock- as a late complication.
Complicated symptoms
Complications of Meckel's diverticulum (the most common symptoms!):
- Intestinal obstruction. It is caused by the fact that the diverticulum is attached to the navel, abdominal wall or other internal organs and thereby contributes to the development of diverticular obstruction.
Other causes of obstruction with Meckel's diverticulum:
Invagination - the diverticulum is screwed into the intestinal cavity.
Volvulus - a fibrous band causes the intestine to turn.
- Diverticulitis due to the opening of the diverticulum closing, followed by bacterial infection and inflammation of the diverticulum wall. This complication manifests itself like appendicitis and is often diagnosed with appendicitis before surgery.
- Bleeding with Meckel's diverticulum occurs more often in children, as does obstruction. In adults, diverticulitis occurs more often than hemorrhages.
It is detected in children under 5 years of age with episodic painless rectal bleeding. The bleeding is heavy with bright red blood. In children, there is ectopia in the wall of the diverticulum with replacement of the normal mucous membrane - the gastric mucosa. As a result, gastric secretion leads to the formation of erosions and then bleeding.
Long-term erosion leads to perforation and/or gangrene of the intestine.
Diagnosis of Meckel's diverticulum
History and physical examination may not reveal signs specific to Meckel's diverticulum. Mandatory rectal examination: there is feces on the glove with signs of bleeding.
Laboratory research:
1. Full clinical analysis blood: there is a decreased hematocrit with acute bleeding, leukocytosis is detected in diverticulitis, gangrene and intestinal perforation.
2. Electrolytes, blood urea nitrogen, creatinine and glucose. These indicators are necessary for differential diagnosis and making the correct diagnosis.
3. Blood group with Rh factor with significant gastrointestinal bleeding for blood transfusion.
Special research methods:
Video: symptoms and treatment of Meckel's diverticulum
Conservative and surgical treatment (surgery)
After detecting Meckel's diverticulum, a wedge-shaped resection of the ileum along with the diverticulum is performed
Treatment for Meckel's diverticulum is only surgical, but preoperative conservative preparation is still necessary.
Conservative treatment consists of preoperative antibiotics, placement of a Foley balloon catheter, and nasogastric intubation.
Medicinal preoperative preparation:
1. Ampicillin + sulbactam (unasin): for adults - 3 g, for children - 100-200 mg of ampicillin per kg/day: for both adults and children every 8 hours intravenously.
2. Dopamine: 2-20 mcg/kg/min intravenously.
3. Cefoxitin (mefoxin): adults 1-2 g, children - 100-160 mg/kg/day: every 6 hours intravenously.
Diverticulectomy
Surgery for Meckel's diverticulum is called diverticulectomy and involves removing the section of intestine with the diverticulum and applying sutures.
Progress of the operation: after detecting Meckel's diverticulum, a wedge-shaped resection of the ileum along with the diverticulum is performed. The intestinal defect that forms after removal of the diverticulum is sutured with a double-row suture.
If there is invagination of the diverticulum, it is necessary to perform disinvagination, but if this cannot be done, then the entire section of the intestine with the pathological process is removed.
Meckel's diverticulum is congenital disease and occurs in one in fifty people. This disease mainly affects men. Inflammation of the diverticulum in both adults and children can occur with symptoms acute abdomen Therefore, it is important to know the manifestations of the disease and its distinctive features.
Characteristics of the disease in adults and children
Meckel's diverticulum is a pouch-like protrusion of the ileum that occurs at a distance of 20 cm from the point of its transition into the blind section of the large intestine. This pathology is congenital and is an open vitelline duct. At the stage of embryonic development, it connects the ileum and the yolk sac. A wall may enter the cavity of Meckel's diverticulum duodenum, gastric mucosa or part of the pancreas. Its length is on average 3 cm.
Meckel's diverticulum - pouch-like protrusion small intestine
This formation in children is most often detected before the age of 10 years, but it can be asymptomatic and manifest at a later age. Pathology in children is dangerous because it can suddenly manifest itself with manifestations of an acute abdomen. In adults, Meckel's diverticulum is most often detected before the age of 30.
The mechanism of formation of Meckel's diverticulum - video
Causes
Meckel's diverticulum is a pathology that occurs in the prenatal period. In the first weeks of life, the fetus has a vitelline duct. It is part of the umbilical cord and is necessary to connect the ileum and the yolk sac. During fetal development, the vitelline duct gradually becomes overgrown and atrophies. If this process has not been completed by the time of birth, then there is either a direct connection between the small intestine and the anterior abdominal wall, or a pathological protrusion called Meckel's diverticulum.
Meckel's diverticulum is classified as a true diverticulum, since it follows the structure of the small intestine. It may include part of the gastric mucosa or pancreatic tissue. In the first case, there is a selection hydrochloric acid, which leads to ulceration of the protrusion and the development of bleeding. This phenomenon most often develops in children. At this age, it can be combined with such malformations of the digestive system as:
- Crohn's disease;
- esophageal atresia;
- atresia of the anus and rectum.
The diverticulum is usually freely located in abdominal cavity and may have its own mesentery.
According to research, gastric mucosa as part of a diverticulum occurs in 10% of cases, and pancreatic tissue in 6% of cases. Very rarely it contains the ileum, jejunum, and duodenum.
Classification of the disease
Depending on the mechanism of occurrence, the following types of diverticula are distinguished:
- Congenital. It involves the entire wall of the small intestine.
- Acquired. This diverticulum is composed of mucosa and arises from the mesenteric side of the ileum.
Depending on the volume of patency of the vitelline duct, there are different types pathological protrusions of the small intestine:
- Patency of the entire vitelline duct:
- open diverticulum;
- partially open diverticulum;
- closed diverticulum.
- Patency of part of the vitelline duct:
- omphalocele - open from the navel;
- Meckel's diverticulum - open from the intestinal side:
- enterocystoma - open in the middle.
Symptoms and signs
Meckel's diverticulum is most often asymptomatic. Whenever inflammatory process in the protrusion cavity (diverticulitis), a clinical picture similar to appendicitis develops. In this case, the following symptoms occur:
- increased body temperature;
- pain in the navel or right side of the abdomen;
- vomit;
- positive Shchetkin-Blumberg sign, which is a sign of an inflammatory process of the peritoneum. It is considered positive if, after pressing on the abdominal wall and sharply withdrawing the hand, the patient experiences severe pain.
- leukocytosis.
Often, with such manifestations, the patient is suspected of appendicitis and the diverticulum is discovered only during surgery.
It is believed that Meckel's diverticulum is asymptomatic in 95% of cases.
With the development of bleeding caused by a peptic ulcer of the protrusion wall, the following symptoms occur:
- pale skin;
- dizziness;
- black color of stool;
- general weakness;
- frequent heartbeat.
Diverticulum entrapment or development intestinal obstruction will also be manifested by intense pain, vomiting, and intoxication.
In rare cases, it is possible for a neoplasm to develop in a pathological protrusion - both benign and malignant. In this case, the clinical picture of the disease will be determined by its nature.
Features of the clinical picture - video
Methods for diagnosing the disease
Due to the fact that the disease has a nonspecific clinical picture, most often the diverticulum is detected during surgery. To facilitate diagnosis, a number of instrumental and laboratory tests are used.
Diagnostic methods - table
| Study | Characteristic |
| General analysis blood | Leukocytosis is detected as a sign of inflammation and iron deficiency anemia is the result of bleeding. |
| Fecal occult blood test | Determination of bleeding in the digestive system. |
| Irrigoscopy | This method applies to X-ray examinations with introduction contrast agent into the intestinal lumen. Allows you to identify protrusion and assess the condition of the wall of the entire intestine. |
| MRI | This study allows you to get a complete picture of the condition of the abdominal organs. |
| Colonoscopy | Using a special probe that is inserted into the intestinal lumen, you can determine the location of the diverticulum and examine its contents. |
| Laparoscopy | If the effectiveness of the above methods is low, a laparoscope is inserted through a small incision in the abdominal wall. If a Meckel's diverticulum is identified, it can be removed immediately. |
It is possible to use research methods such as ultrasound of the abdominal cavity and FGDS, but they are not very informative and only allow one to exclude other causes of bleeding.
Treatment
If the disease is asymptomatic, then, as a rule, treatment is not required. In other cases, it is prescribed complex therapy, which includes:
- surgical removal;
- drug treatment;
- diet.
Surgical intervention
Removal of a diverticulum in the absence of a clinical picture is recommended only in the following cases:
- the length of the formation is more than 3 cm;
- very thin walls of the protrusion;
- the patient's age is over 40 years;
- narrow neck of the diverticulum;
- Fibrous cords are identified in the abdominal cavity.
If diverticulitis or intestinal bleeding develops, immediate surgical treatment is necessary. It is carried out in two ways:
- Abdominal surgery (laparotomy). This method provides wide access to the abdominal cavity, which allows for complete visualization of the diverticulum area and its excision.
- Laparoscopy. This method is based on the introduction through a small incision of a special tube with a camera, which allows you to detect the formation and carry out its resection without a significant incision in the abdominal wall.
Drug therapy
Drug treatment is carried out in childhood and after surgical intervention. The following groups of drugs are distinguished to eliminate the manifestations of pathology:
- Non-steroidal anti-inflammatory drugs. They eliminate inflammation and have an analgesic effect. The most commonly used drugs are Ibuprofen, Piroxicam, Indomethacin.
- Antispasmodics. Used for pain relief and regulation of intestinal motility (Drotaverine, Duspatalin, Trimedat).
- Antibacterial agents. These include Azithromycin, Clarithromycin, Erythromycin. These drugs are most often prescribed after surgical treatment in order to reduce the risk of an inflammatory process.
- Detoxifying agents. Among the drugs in this group are Trental, plasma substitutes, and Complamin. This therapy helps with the development of complications and reduces the severity of inflammation.
In addition, antisecretory drugs are used in treatment practice. They reduce the acidity of the stomach, which is especially important when part of the mucous membrane of this organ gets into the protrusion and increased risk ulcer development.
When intestinal bleeding develops, hemostatic agents are used, for example, Vikasol.
Medicines in the photo
Trental improves nutrition of inflamed tissues 
Azithromycin eliminates the bacterial component of inflammation 
Ibuprofen effectively relieves inflammation 
Drotaverine relieves pain
If the above treatment is carried out in a timely manner and in full, then the prognosis is favorable. In case of late presentation, development of complications and absence adequate therapy may come death.
Nutrition rules
From start to use medications to reduce the risk of complications and speed up recovery, prescribe special diet. The main principle of this diet is to consume foods rich in fiber and exclude foods from the diet that increase bloating and gas formation. Food should be well boiled or steamed. You should not eat foods that are difficult to digest, too hot or cold. It is recommended to eat frequently, in small portions.
Table of permitted and prohibited products
Soup is a nutritious and easily digestible dish.
Compote promotes digestion without irritating the intestinal mucosa Possible consequences and complications
Most often, Meckel's diverticulum leads to complications such as:
- intestinal obstruction;
- internal bleeding caused by a peptic ulcer;
- diverticulitis;
- diverticulum rupture;
- hernia formation;
- neoplasms - both malignant and benign.
Frequency of occurrence peptic ulcer is 43%, diverticulitis - 14%, intussusception - 25%, hernia - 11%.
The occurrence of internal bleeding is indicated by symptoms such as:
- general weakness;
- rapid heartbeat;
- dizziness;
- pale skin;
- anemia.
Manifestations of intestinal obstruction are:
- nausea and vomiting;
- pale skin;
- dizziness;
- spasmodic abdominal pain.
In addition, complications can be postoperative, these include:
- pulmonary embolism;
- failure of sutures;
- intra-abdominal abscess.
Meckel's diverticulum is often asymptomatic and is detected after the development of complications. In this regard, it is necessary to know its possible manifestations and immediately consult a doctor if they occur, since only timely and adequate treatment can protect against the development of dangerous complications.
Meckel's diverticulum is otherwise called an ileal diverticulum. As a result of this pathology, there is pathological disorder reverse development of the proximal small intestine. This area is responsible for the movement of bile.
What is Meckel's diverticulum?
According to the medical definition, already at the first stage of fetal development, the functioning of the yolk and urinary duct. They make up the umbilical cord and are necessary for receiving nutrition to the fetus and excreting urine into the amniotic fluid.
After five months, the process of reverse development of the ducts and their fixation on inner surface peritoneum.
Changes in vitelline duct atrophy have varying degrees localizations:
- Complete or incomplete umbilical fistulas.
- Meckel's diverticulum.
- Enterocystoma.
Doctors consider this pathology to be quite common, because almost 3% of the world's inhabitants have been diagnosed with this disease. The risk of deviations due to such violations occurs even in early childhood about 50% of all cases. 
Often visible signs Diseases begin to appear only at age 30. A sac-like formation in the distal ileum is important and must be treated.
Heterotopic tissue components of the stomach and pancreas can cause serious disruptions in the body, requiring urgent surgical intervention.
Meckel's diverticulum is located between the intestine and the navel.
Main causes, clinical symptoms
Doctors call deviations during embryonic development the leading cause of pathology. Non-fusion of the bile duct provokes the formation of a protrusion.
The diverticulum reaches a size of about 3-4 cm. It resembles the shape of a cone or cylinder.
Symptomatic manifestations of this disease
It is possible to detect an asymptomatic course of a diverticulum when examining a patient for other diseases:
- atresia of the esophagus or rectum;
- Crohn's disease.
These pathologies very often accompany a congenital anomaly leading to the formation of a diverticulum.
The process of exacerbation can be caused by the accumulation of food in Meckel's diverticulum.
The patient begins to experience the following symptoms:
- painful sensations;
- bloating;
- fever;
- nausea;
- vomiting attacks;
- bowel disorders;
- general weakness;
- irritability.
The listed signs are not always present. For a long time The diverticulum develops without any symptoms. However, at the same time, a dangerous damage process can develop, provoking dangerous conditions- peritonitis and internal bleeding.
Development of an attack in an adult
Doctors emphasize that various factors can cause attacks:
- poor nutrition;
- excess weight;
- insufficient fluid intake;
- sedentary lifestyle;
- motor disorder digestive system and other organs.
The progression of the disease can be stopped by rational principle lifestyle and nutrition. The importance of antimicrobial or surgical treatment cannot be ruled out.
Signs indicating inflammation
Inflammation of Meckel's diverticulum is observed in 10-20% of cases. This happens due to stagnation of fluid in the saccular process.
The process of secondary infection occurs when pathogenic microflora multiply.
The risk group consists of adults over 40 years of age. Main symptom- frequent spasmodic pain in the navel area.
If the inflammation is prolonged, there is a high probability of formation intestinal adhesions. The danger of this condition is that the diverticulum may rupture as a result of inflammation, causing peritonitis.
The clinical picture of the development of inflammation of the diverticulum is similar to an attack of appendicitis.
The whole process is intense and quickly spreads to other internal organs.
The patient suffers from severe pain, complains of difficulty breathing and headache. I start vomiting and constantly feel nauseous. Body temperature rises.
Often, no painkillers help block the pain syndrome. Acute attack may cause loss of consciousness. You need to call an ambulance immediately.
It is very difficult to diagnose a protrusion - Meckel's diverticulum without pronounced complications. 
Therefore, diagnostic specialists use several methods simultaneously:
- A blood test helps determine your red blood cell levels. Low level confirms the diagnosis and indicates problems in the diverticulum in the presence of blood in the stool. An important condition is a stool smear. The level of hemoglobin is important, as is the hematocrit.
- Technetium-based scanning ( radioisotope research) is indicated for patients with suspected protrusion of pouches in the intestines. This method is aimed at diagnosing diverticulitis and is based on the injection of a special dye, technetium, into a vein. His active ingredients They gather around education.
- Irrigoscopy is an X-ray examination of the colon with the introduction of barium into the colon. The patient is given 700-1000 ml of the product through an enema, which gradually covers the intestinal walls. With this study, all affected or impassable areas become visible.
- Colonoscopy is prescribed for patients who have severe bleeding and it is absolutely impossible to scan the intestines. The intestines are examined by a doctor using a medical probe inserted through the anus.
- Endoscopy allows you to identify pathological processes in upper sections gastrointestinal tract. These two examinations are often carried out as a complement to the other.
- Laparoscopy is one of the most radical, but also the most definitive methods in diagnosing Meckel's diverticulum. It is indicated when none of the above methods have brought results.
Diagnostic tests are effective only if strictly individual approach and careful consideration of the patient's medical history.
Video
How is differential diagnosis performed?
The main condition for effective differential diagnosis is the exclusion of other diseases with a similar clinical picture.
For example, intestinal bleeding can develop for reasons:
- hemorrhagic capillary toxicosis;
- intussusception;
- neoplasms in the intestines;
- blood diseases.
Thus, using the exclusion method as the most predominant method when diagnosing Meckel’s diverticulum, the disease can be identified in the shortest possible time.
It is important to note that diverticulum is often combined with other developmental anomalies:
- heart disease;
- malformations of the limbs;
- delayed obliteration of the urinary duct;
- embryonic hernia;
- malformations of internal organs.
Differential diagnosis is important for bleeding from the gastrointestinal tract and intestinal obstruction.
A council of doctors makes a diagnosis based on studying the patient’s medical history, all tests and complaints. A thorough external examination of the patient and exclusion of cancer pathologies is necessary.
Features of conservative treatment
Drug therapy is used only to relieve some of the symptoms of Meckel's diverticulum during acute inflammation.
More often, medications are prescribed to children, provided that the disease has appeared for the first time and is not complicated by life-threatening pathological processes.
Specialists, guided by the immediate provision of assistance to the patient, prescribe:
- Antibacterial drugs to stop an infection that can cause an exacerbation of the disease.
- Anti-inflammatory medications help relieve pain and reduce inflammation symptoms.
- Infusion and detoxification agents are indicated for the development of peritonitis.
The recurrent nature of the disease and the absence of a positive trend in drug therapy is an indication for surgical treatment.
In a situation where the diverticulum is not complicated associated pathologies, doctors recommend focusing on improving nutrition. This will help to stop the development of the disease to a greater extent.
Compliance is important balanced nutrition, consumption of vitamins and microelements and for normal functioning intestines.
Shown to comply medicinal features power supply:
- Products including dietary fiber, should form the main diet. Fiber is found in sprouted grains and bran. You can add it to food and with plant elements, you just need to take into account the difficult digestion of bran.
- Adjusting your water intake will help improve the absorption of coarse fibers and normalize the overall water-salt balance.
- It is recommended to exclude products that enhance the process of gas formation, namely: legumes, cabbage, milk, fruits of fruit trees. Nuts and seeds are also prohibited for most patients. When prescribing a diet for diverticulum, doctors take into account the individual characteristics of the body and eating habits every patient.
- To normalize stool and for constipation, it is recommended to consume dried fruits and fermented milk products. It is imperative to drink at least 2 liters of water during the day.
Any changes in diet should be gradual. Possible appearance adverse reactions such a diet, namely bloating and some soreness.
You should eat food much more often, up to 8 times a day, but in small portions. Solids should make up a minimal portion.
Vegetables need to be stewed or boiled. Overeating and consumption of spicy, fatty or smoked foods are contraindicated.
A healthy diet for Meckel's diverticulum should include only healthy foods:
- milk porridges and dietary puree soups;
- pasta, bran and bran bread;
- fermented milk products;
- dishes from vegetables and fruits, purees, mousses, jellies, jelly, etc.
Alcohol, carbonated drinks and coffee must be excluded from the menu. It is important to limit baking and white bread, hard raw vegetables and seaweed. Heavy food includes semolina porridge and mushrooms.
Separate nutrition in a gentle mode can short terms restore the activity of the gastrointestinal tract. This will help stop pathological process with diverticulum.
Possible complications in the area where the growth is localized
According to medical research diverticulum provokes life-threatening complications in 6.4% of cases. Each of them requires surgical manipulation. 
Complications discovered spontaneously, but requiring drastic medical action, are of a different nature:
- Bleeding develops in 30% of patients. The risk group includes children under 2 years of age and the male half of humanity. The symptomatic picture is manifested by blood particles in feces Oh varying intensity. When diagnosed with Meckel's diverticulum, bleeding is accompanied by pain syndrome, anemia and general weakness.
- Intestinal obstruction worries 20% of patients. This complication is absolutely impossible to diagnose in any way other than surgery. Tumors often form in such pathologies. Signs of obstruction include constipation, vomiting, and painful attacks.
- Perforation of a diverticulum due to inflammation in it. Spastic localized pain in the navel area develops gradually but steadily. The condition in most cases leads to peritonitis, which in turn requires emergency surgery.
- Umbilical pathology is diagnosed in 10% of patients. When performing laparotomy, this complication is detected as concomitant with other diseases. The danger of this condition is the high risk of developing a hernia or volvulus.
- The neoplastic process, in other words, the development of neoplasms is observed in only 5% of patients. The nature of the tumor is determined after a biopsy. The tactics of the entire treatment depend on these tests.
According to experts, based on studies of patient histories, men get sick three times more often than women. This is due to multiple factors, the leading of which are: physiological characteristics and norms of behavior, lifestyle.
Resection of diverticulum in adults and features of the postoperative period
Cardinal surgery indicated in situations of complex clinical manifestations. Quite often, a diverticulum is discovered during surgery for another reason.
Gastrointestinal bleeding stops spontaneously, but if it needs to be stopped, certain methods are used. The diverticulum is removed, and the affected intestine is sutured in the transverse direction.
Some surgeons use a special stapler. First, the doctor makes sure that the bleeding has formed directly in the diverticulum. Sometimes this may occur at its base or in the ileum.
Segmental resection of a section of the intestine along with a diverticulum is indicated for bleeding from the intestine itself. Such manipulations give excellent results, and the discovery of secondary bleeding occurs in exceptional cases.
Intestinal obstruction caused by intussusception requires resection of Meckel's diverticulum with preliminary disintussusception. The formation of torsions or internal hernias requires their elimination.
Surgical interventions complicated by concomitant pathologies can cause adhesions.
Often intestinal obstruction develops and another operation is required. There is a risk of death in 10% of all such cases.
The biggest difficulty in choosing surgical tactics Treatment of diverticulum is that the disease is very often asymptomatic. Clinical manifestations decrease with patient age.
Therefore the most best period for disinvagination - at the first signs of diverticulum. Timely treatment will help ease the postoperative period.
During pregnancy, it is very important that the expectant mother maintains a correct lifestyle and is not exposed to negative factors, since this can lead to the development of congenital anomalies in the baby, one of which is Meckel’s diverticulum. What is a disease and why does it occur?
A disease in which there is a pouch-like protrusion in the ileum of the small intestine is called Meckel's diverticulum. The pathology is congenital in nature and occurs in approximately 2–3% of babies born, and boys are more susceptible to developing this anomaly.
Meckel's diverticulum - a protrusion in the small intestine
The danger of the disease lies in the fact that it can be asymptomatic and, under the influence of certain factors, manifest itself with a clinical picture characteristic of an acute abdomen. In most cases, diverticulum is diagnosed before the age of 10 years, sometimes the disease can only be identified closer to 30.
Causes and mechanism of development
The main cause of this defect is improper embryonic development. Until 3–5 months of intrauterine formation, the fetus has bile duct, which passes through the umbilical cord and provides nutrients from mother. Closer to the second half of pregnancy, this structure atrophies and turns into the middle ligament, which is localized on the inner surface of the peritoneum.
If this process is disrupted, then the bile duct does not completely close and a protrusion is formed from it - a diverticulum.
In most cases, the diverticulum is localized 60–100 cm from the ileocecal angle, has the shape of a cylinder or cone, and its dimensions vary between 3–4 cm.
Since a diverticulum is characterized asymptomatic, then it can be identified when other diseases occur, which often accompany a congenital anomaly. These include:
- Crohn's disease;
- atresia of the rectum, esophagus.
Sometimes the accumulation of food in it can provoke an exacerbation of the diverticulum.
Classification
Depending on the degree of closure of the duct, a diverticulum can be:
- fully open;
- partially closed;
- completely overgrown.
If you pay attention to which direction the diverticulum opens, the disease can be divided into the following types:
- omphalocele - opens from the umbilical side;
- enterocystoma - in the middle;
- Meckel's diverticulum - opens into the intestinal lumen.
The last type is the most common. By morphological structure Meckel's diverticulum is considered a true type, since it consists of all the membranes that form the intestine. In other types, the tissues may contain epithelium lining the walls of the stomach, as well as glandular cells pancreas.
a - incomplete umbilical fistula; b - complete umbilical fistula; c - enterocystoma; d - Meckel's diverticulum Clinical picture
Diverticulum can occur for many years without any symptoms. As a rule, it is diagnosed accidentally during certain manipulations to treat other pathologies.
With inflammation of Meckel's diverticulum, patients develop a clinical picture that almost coincides with appendicitis. The following signs of the disease are observed:
If the above symptoms are present, the patient is prescribed surgery to remove the inflamed appendix. However, during the operation it becomes obvious that this structure is not affected, and doctors detect the presence of Meckel's diverticulum.
In addition, the disease can be detected if complications develop, each of which has its own symptoms:
- Internal bleeding. The patient complains of dizziness, weakness, anemia, pale skin, and tachycardia. As a rule, this complication is chronic.
- Intestinal obstruction. Causes nausea, which alternates with vomiting, cramping pain, signs of intoxication of the body:
- weakness;
- decreased performance;
- pallor;
- dizziness.
- Intussusception. Accompanied by severe pain, weakness, internal bleeding.
- Perforation of the diverticulum causes the development of peritonitis and requires immediate surgical intervention.
- Development of benign and malignant tumors.
It should also be noted that with diverticulum, black feces resembling tar are observed. When the disease worsens, it contains an admixture of scarlet blood.
How to recognize a diverticulum (video)
Diagnostics
It is not easy to identify Meckel's diverticulum, since it is asymptomatic, and with the development of an inflammatory process or complications it manifests itself with signs that are characteristic of other diseases.
To diagnose this disease, it is necessary to carry out a series of instrumental studies. These include:
- X-ray examination. It involves the introduction of a contrast agent into the body, which fills the intestines and allows you to see the exact location and size of the formation. It is the main method for diagnosing the disease.
- Ultrasound. It makes it possible to see inflammatory changes, but it is definitely impossible to determine the presence of diverticula using this method.
- CT scan of the abdomen. Allows you to identify formation, as well as possible complications in the form of intestinal obstruction, inflammation, intussusception, their localization and degree of neglect.
- Scintigraphy. It is mandatory to use if Meckel’s diverticulum is suspected, since only this method makes it possible to detect ectopic gastric tissue, which is often present in the formation.
- Esophagogastroduodenoscopy. This method is endoscopic and is used to exclude other causes that could lead to internal bleeding. Allows you to examine the walls of the esophagus, stomach and duodenum.
- Laparoscopy and laparotomy. These methods are used when other pathologies of the abdominal cavity are suspected, which may occur with the same symptoms. The first involves several punctures of the abdominal tissue, the second - their dissection.
- Colonoscopy. Endoscopic examination of the large intestine. Allows you to eliminate bleeding caused by other diseases.
If Meckel's diverticulum is suspected, the doctor must completely exclude possible inflammation appendix, duodenal ulcer, polyposis.
Treatment
Therapy for diverticulum depends on the clinical picture. If the disease is asymptomatic and was discovered by chance, then in such cases most specialists are inclined to excise the formation. This will make it possible to prevent the development of complications characteristic of the disease.
Surgical intervention
There are a number of indications for which it is necessary to remove a diverticulum, even if it is not accompanied by pathological symptoms, for example
- the walls of the ileum are very thin;
- there are signs of inflammation of the protrusion;
- fibrous cords were found in the abdominal cavity;
- the size of the formation exceeds 20 mm.
Resection of Meckel's diverticulum is performed only if there are certain indications. - In cases where Meckel's diverticulum is accompanied by a bright clinical picture, patients are immediately hospitalized for urgent surgical intervention. Surgical manipulation involves excision of the diverticulum.
- If there are changes in the walls of the small intestine, they are also removed, and both ends are connected using an anastomosis.
- If peritonitis develops, it is necessary to carry out sanitation and drainage of the abdominal cavity.
Drug therapy
Drug treatment is also sometimes used to relieve signs of inflammation of Meckel's diverticulum. However, this approach is used mainly in children if the disease first manifests itself with certain symptoms and is not accompanied by complications.
Medicines are used to eliminate the inflammatory process. Patients are prescribed the following drugs:
- Antibacterial agents. Contribute to the death of infection, which could provoke an exacerbation of the disease.
- Anti-inflammatory. Helps eliminate inflammation and pain.
- Infusion and detoxification therapy. Used in cases of peritonitis development.
If the expected effect from the use of medications is not observed or the disease recurs, the issue of surgical treatment is decided.
Diet
During treatment and after surgery, patients must adhere to a diet. It involves eating fiber-rich foods. The following foods are allowed:
- boiled or steamed vegetables;
- lean meat and fish;
- fruits;
- dried fruit compotes;
- fruit drinks;
- herbal teas;
- slimy soups;
- porridge.
All these products contribute normal operation intestines, which is very important in postoperative period to reduce the load on the digestive canal.
Approved products (gallery)
- fatty and spicy foods;
- marinades;
- white cabbage;
- legumes;
- smoked meats.
Prohibited products (gallery)
Fatty dishes Smoked meats
Besides proper nutrition, after treatment for diverticulum, patients should follow recommendations regarding the organization of their day. It is necessary to devote more time to rest, and also avoid physical activity and nervous overstrain. This will help prevent the risk of complications and relapse.
Complications
If left untreated, Meckel's diverticulum can lead to the following consequences:
- intestinal obstruction;
- perforation of the diverticulum with subsequent development of peritonitis;
- internal bleeding;
- intussusception.
After surgical treatment Complications such as the formation of scar tissue in the intestines and the formation of adhesions may develop. However, such conditions are extremely rare. Following a diet and the right image life.
Forecast
Meckel's diverticulum has a fairly favorable prognosis. In the vast majority of cases, the pathology is asymptomatic throughout life. Only about 5% of all patients are treated due to the development of complications.
After the operation, a complete recovery and return to to the usual way life. In this case, a favorable prognosis depends on timely provision medical care.
Diverticulum can occur without obvious signs for many years, however, in cases of complications of this disease, the patient needs emergency medical care, since in its absence, death can occur. That is why it is important to listen to your well-being and monitor the health of your child.
Meckel's diverticulum - congenital pathology small intestine, which occurs in 2% of people. It is difficult to judge her character unambiguously. On the one hand, in 50% of cases the anomaly does not cause any symptoms and is discovered accidentally during preventive examinations or operations. On the other hand, in 25–30% of cases it causes conditions life-threatening. What exactly is Meckel's diverticulum: a simple congenital feature body or a serious illness?
Meckel's diverticulum - what is it?
IN early period(from 7–8 weeks to 3–5 months) of intrauterine development, the embryo is nourished by the yolk sac (special embryonic tissue). In the first trimester, when the placenta has not yet formed, it is located in the navel area, connected to the small intestine of the fetus through a narrow canal - the vitelline duct. After the formation of a full-fledged umbilical cord and placental blood circulation, the reverse development of temporary embryonic structures occurs. Yolk sac collapses with the duct and resolves. If this does not happen, the part of the vitelline duct connected to the small intestine may take on the appearance of a protrusion on its surface - this is Meckel’s diverticulum.
Meckel's diverticulum is congenital anomaly(feature) of the small intestine in the form of an additional pouch-like or tubular protrusion of the wall of the ileum. It looks like a process connected to the intestinal lumen. The anomaly received its name in honor of the scientist Johann Meckel, who first discovered and described it in 1809.
Typical characteristics of Meckel's diverticulum:
- location - antimesenteric (free from fatty deposits and blood vessels, facing the abdominal cavity) section of the ileum;
- length - from 1–2 cm to 16–20 cm;
- shape - bag-shaped with a wide base (more than 2 cm wide) or tubular with a narrow base (about 1–2 cm wide);
- appearance - a blindly ending process, similar to the intestinal wall in color and structure, may have a commissure connecting to the navel.
Video about the problem
Causes
There is no reliable data on the causes of the violation of the reverse development of the vitelline duct and the occurrence of Meckel's diverticulum. There are only assumptions about possible cause-and-effect relationships with certain factors. However, the causes of complicated forms of this anomaly are well studied.
Reasons for the development of pathology and its complications - table
Complications of Meckel's diverticulum occur more often and are more severe in childhood. If they do not appear before the age of 30, the probability of their development does not exceed 5–10%.
Classification
Both in childhood and in adults, Meckel's diverticulum can be of several types:
- Asymptomatic - does not cause any manifestations or symptoms throughout life (about 75–80% of cases). Discovered as an incidental finding during diagnostic procedures(tomography, abdominal scintigraphy, laparoscopy), during operations for various diseases abdominal cavity.
- Complicated acute conditions- diseases requiring emergency medical care (15–20%): diverticulitis, intestinal bleeding, intestinal obstruction, intussusception.
- Complicated chronic diseases- health problems caused by diverticulum over a long period of time (weeks, months, years): anemia, tumor neoplasms (about 5%).
Types and symptoms of complications
Intestinal bleeding
The most common manifestation of Meckel's diverticulum is bleeding into the intestinal lumen. Occurs due to the formation of ulcers (wounds) on the mucous membrane. Their cause is the cells of the stomach and pancreas, which are present on the mucous membrane of the diverticulum in 80%. They secrete aggressive enzymes that damage the vessels of the mucous membrane. The bleeding that occurs can be minor, chronic - the stool does not change color, or immediate heavy - the stool becomes bloody.
Symptoms of bleeding - table
Diverticulitis
Inflammatory changes in Meckel's diverticulum are called diverticulitis. Inflammation either involves only the mucous membrane, or spreads to the entire thickness of the wall. In the first case, chronic diverticulitis occurs, in the second - acute. The latter poses an immediate threat to life and comes in the following types:
- Catarrhal. A simple inflammation that resolves with timely medical treatment.
- Phlegmonous. Purulent inflammation leading to destruction of the diverticulum.
- Gangrenous or gangrenous-perforated. Destruction (destruction) of the wall, leading to the spread of pus, harmful bacteria, and feces throughout the abdominal cavity. As a result, the most dangerous disease occurs - general peritonitis.
Symptoms of diverticulitis - table
Intestinal obstruction
Meckel's diverticulum, which is long, wide, or has a cord-like adhesion to the abdominal wall, can cause mechanical compression of the intestine and obstruction. There are two options:
- intussusception - the introduction of a diverticulum with a wide base into the lumen of the small intestine;
- volvulus of the intestine around the diverticulum or the formation of a node between them.
Typical symptoms of intestinal obstruction:
- paroxysmal or constant pain all over the abdomen;
- bloating, enlargement of the abdomen;
- fecal retention;
- violation of the passage of gases;
- nausea, vomiting;
- discharge of dark cherry-colored mucus with blood from the anus.
Intestinal bleeding and diverticulitis are the most common complications of Meckel's diverticulum in both adults and children.
Tumor formation
The presence of abnormal cells in the gastric mucosa, chronic inflammation, infections, mechanical irritation of the mucous membrane can cause the formation of malignant tumors in Meckel's diverticulum. This complication is rare (less than 5%). The tumor may manifest itself clinically as any of the other complications of a diverticulum: bleeding, inflammation, intussusception, intestinal obstruction, anemia.
Features of pathology in adults and children
Meckel's diverticulum is not a disease in itself. It's just anatomical feature intestines, which in no more than 20–25% of cases can become the basis for the development of serious complications.
Features of Meckel's diverticulum in adults and children - table
| Peculiarities | Adults | Children | |
| Detection rate | About 2% of the population | 3–5% of the population | |
| Complication rate | About 10–15% of patients | More than 30–40% of patients | |
| Age of patients with complications | Before 30 years 80%, after 30 years 20% | 60–70% before 10 years, 30–40% after 10 years | |
| Predominant nature of complications | Inflammation, tumor development, obstruction | Bleeding, inflammation, intussusception | |
| Gender of patients | Uncomplicated forms of Meckel's diverticulum are recorded equally often in males and females, while complicated forms are recorded three times more often in men. | ||
| Mortality | From complications 1–2% | From complications 4–6% | |
| Additional yolk sac abnormalities | 70–80% are absent. In 10% there is a cord-like adhesion between the abdominal wall and the intestines. | Complete and incomplete umbilical fistulas, less often cord-like adhesion of the abdominal cavity. | |
Diagnostics
An accurate diagnosis of Meckel's diverticulum can only be made during surgery, visually examining the intestines. According to symptoms and clinical manifestations complications are diagnosed. Existing modern diagnostic methods are not 100% reliable.
Under the mask of any disease of the abdominal organs, complications of Meckel's diverticulum may be hidden.
Diagnostic methods used - table
| Methods for visual diagnosis of diverticulum | Scintigraphy | Intravenous administration of the radioisotope drug technetium (Tc 99). Using special X-ray equipment, the places where the isotope accumulates are monitored. They correspond to the location of Meckel's diverticulum (both complicated and uncomplicated). The reliability of the results is 50–60%. |
| Tomography | Reinforced intravenous administration reagent computer or magnetic resonance imaging - layer-by-layer images of the abdomen in a three-dimensional image. The effectiveness of the method is more than 90%. | |
| Laparoscopy | Diagnostic surgery - insertion of a special video camera into the abdominal cavity under anesthesia. Using manipulators, the intestines are examined. The method is 99.9% reliable. | |
| Ultrasound | It is possible to detect a diverticulum no more often than in 30%, mainly in children. | |
| Diagnosis of complications | X-ray of the abdomen | Determines signs of intestinal obstruction (swollen loops filled with fluid in the form of horizontal levels). |
| General blood test | An increase in leukocytes is characteristic of inflammation of the diverticulum, anemia (low hemoglobin, red blood cells) with complications of bleeding. | |
| Fecal occult blood test | If all the rules for taking the test are followed, and hidden blood detected in the stool, this may be due to chronic bleeding from the diverticulum. |
Modern approaches to treatment
The only way to get rid of Meckel's diverticulum is by removing it. To do this, either traditional surgery is performed through an abdominal incision, or laparoscopic intervention using punctures and a video camera. The second type of operation is preferable, but it is not always possible to remove the diverticulum in this way.
Not in all cases the presence of Meckel's diverticulum is absolute indication to its removal. It is better not to remove small (less than 2 cm) uncomplicated broad-based diverticula in children and adults under 30 years of age.
Surgical tactics and types of operations - table
| Clinical situation | Choosing the optimal therapeutic tactics |
| Diverticulum diagnosed before surgery with chronic complications | The operation is indicated as planned after full examination patient and correction of existing health deviations. The diverticulum is removed in the most in a suitable way(cutting off, wedge-shaped or segmental resection of the small intestine along with a diverticulum), suturing the resulting wound of the small intestine. |
| Emergency surgery for diverticulum with acute complications | Mandatory removal in one of the following ways:
|
| Incidentally discovered uncomplicated diverticulum | Removal is advisable in the following cases:
|
Treatment of Meckel's diverticulum - photo gallery
Antibiotics, antispasmodics, hemostatics and other drugs do not relieve diverticulum 
The second stage of the operation is suturing the wound of the small intestine after excision of the diverticulum 
The first stage of the operation is excision of the diverticulum
Drug treatment
Medications are complementary complex treatment complications of Meckel's diverticulum. Used:
- Antibiotics: Cefotaxime, Ceftriaxone, Levofloxacin, Ornidazole. Indicated for diverticulitis.
- Antispasmodics: Renalgan, Spazmalgon, No-shpa, Platifilin. Reduce pain and inflammation.
- Hemostatics (hemostatic agents): Dicinone, Etamsylate, Tranexamic acid, Vikasol. Indicated for acute intestinal bleeding.
- Infusion solutions: Ringer, Glucose 5%, Reosorbilact, Xylate. Restore water balance, reduce intoxication, replenish blood volume deficiency.
- Antisecretory agents: Kvamatel, Omeprazole, Pantoprazole, Nexium. Reduces the secretion of gastric and intestinal juices.
Diet features
General principles of dietary nutrition:
- frequent - 5–6 times a day;
- fractional - small single portions;
- correct characteristics of food - warm or cool, mushy;
- no irritating effect - exclude spices, hot foods, marinades, seasonings;
- cooking method - boil, stew, bake, steam. Avoid fried and smoked foods.
Foods for Meckel's diverticulum - table
| Products | Can | It is forbidden |
| Meat | Rabbit, chicken, young beef, turkey, lean fish | Goose, duck, pork, fatty beef and fish |
| Dairy | Low-fat kefir, fermented baked milk, yogurt, cottage cheese | Whole milk, high-fat fermented milk products |
| Bakery | Day-old bread, bran, crackers, dry biscuits | Fresh bread, baked goods, cakes, pastries |
| Vegetables and fruits | Cabbage, banana, plums, beets, carrots, small quantities of tomatoes, grapes, apples | Radish, radish, garlic, hot pepper |
| Cereals, porridge | Rice, oatmeal, buckwheat, barley | Legumes, peas, wheat pearl barley |
| Drinks | Compote, weak black and green tea, uzvar, jelly | Coffee, alcoholic drinks, strong tea, any soda | Baking
