Meckel’s diverticulum . Meckel’s diverticulum is an appendix more or less developed at the apex of the umbilical handle the primitive gut, structures remaining in the digestive tract of the fetus that is not fully reabsorbed before birth.
Summary
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- 1 A little history
- 2 Description
- 3 Gender affected
- 4 Age
- 5 Complications
- 1 Diverticulitis. Symptoms
- 6 Diagnosis
- 7 Diagnostic tests
- 8 Treatment
- 9 Sources
A little history
In 1809, Joahn Frederich Meckel , professor at the University of Halle , explained the embryological origin of the diverticulum, without suspecting that with his contribution he created an extremely interesting chapter in malformative pathology . In 1824, Rayer reported the first case of gangrenous diverticulum , the characteristics of which were well studied by Piquet and GuiIlermont (1897), making it possible to clearly differentiate it from suppurative appendicitis .
Description
Meckel’s diverticulum is an appendix more or less developed at the apex of the umbilical handle of the primitive gut , structures remaining in the digestive tract of the fetus that is not fully reabsorbed before the birth . It is generally located between approximately 20 and 120 cm from Bauhin’s balbula .
In 25% of cases, heterotopic tissue can be found on the walls of the diverticulum ; mainly gastric and pancreatic tissue and very rarely duodenal mucosa .
Very rarely, a Meckel’s diverticulum has been observed, followed by a patent ductus , constituting an omphalomasenteric fistula . In these cases, the intestinal bolus is discharged intermittently through the fistula . Note that a normal individual (without malformations) does not have a Meckel diverticulum or any other omphalomasenteric duct , since by the eighth week of intrauterine life these disappear.
Gender affected
It is the most frequent malformation of the digestive tract , and although it occurs equally in men and women , men are more likely than women to experience complications.
Age
Complications due to Meckel’s diverticulum can occur at any age. However, they are more likely to occur in infants and children . During childhood and adolescence, it is an important clinical rule to always remember Meckel’s diverticulum against painful or bleeding abdominal pictures.
Complications
Approximately 2% of the population has Meckel’s diverticulum, but only a few people have symptoms, this is because in cases where there is only a simple diverticulum, symptoms do not usually appear, these only manifest when there is a complication, among those that stand out:
- Bleeding.
- Intestinal obstruction(can be by strangulation, volvulus , intussusception or neoplasia ). Invagination .
- Neoplastic degeneration.
Diverticulitis. Symptoms
Inflammation of the diverticulum (diverticulitis) occurs in approximately 5% of all patients with this malformation. Meckel’s diverticulitis generally occurs in older patients. It can simulate acute appendicitis , with complications similar to this one.
It generally occurs as a consequence of the acid secretion produced by the heterotopic gastric mucosa , although it can also be caused by obstruction of the diverticular lumen by an enterolith . Among the most common symptoms are:
- Abdominal discomfort or painthat ranges from mild to severe.
- Presence of bloodin the stool.
- Vomitingand fever .
Diagnosis
In his first description, Meckel distinguished three qualities, which still must be taken into account for diagnosis today:
- The diverticulum has the same structure as the underlying intestine.
- It is always located on the antimesenteric border.
- Its irrigationis independent.
It should be noted that the diagnosis of Meckel’s diverticulum is very difficult and, above all, it is based on three findings:
- Visualization of an abnormal artery feedingthe diverticulum.
- The fact that the diverticular ectopic gastric mucosais contrasted more densely than the mucosa of the surrounding ileum since it has a richer capillary network .
- The extravasation of contrast in cases with active bleeding in general should be greater than 1 ml / min.
Diagnostic tests
- In cases of complications, the diverticulum can usually be detected with a test called a Meckel scan.
- Examination with higher performance in childrenis the radionuclide imaging with pertechnetate Tc-99m . However, this is of little use in adults.
- The abdominal ultrasonographycan identify the Meckel’s diverticulum when there are complications.
- The angiographyis often used when a patient is active or in cases where it is intermittent bleeding.
Treatment
Surgery is recommended to remove the diverticulum in case of bleeding. In these rare cases, the segment of the small intestine containing the diverticulum is surgically removed and the intestine is repaired . If the condition is discovered by chance and has not caused him problems, some surgeons recommend prophylactic removal , surgical removal to avoid future complications.
A full recovery can be expected with surgery.
