What can you eat after removal of Meckel's diverticulum? Meckel's diverticulum: a secret health threat

Intrauterine development is an important stage in the formation of the future person. Failures in the functioning of the mother’s body often lead to disturbances in the structure of the fetal organs. One such disease is Meckel's diverticulum. What are the features of the pathology and methods of its treatment?

Features of the pathology

Meckel's diverticulum is a sac-like protrusion that occurs in the small intestine. The condition is considered congenital - about 2–3% of children are born with the disorder.

Meckel's diverticulum - a protrusion in the ileum of the small intestine

The danger of the condition is its asymptomatic course. Meckel's diverticulum is often detected before age 10, but sometimes later, at age 30.

Meet different sizes diverticulum - usually 3–4 cm, but sometimes more. The form of formations also varies:

• cone-shaped;
• flask-shaped;
• cylinder.

How to recognize a diverticulum - video

Reasons for education

On the stage early development embryo, the small intestine communicates with the yolk sac through a special duct, which, during normal development, resolves at 4–5 months. Otherwise, there are 2 scenarios:

• part of the formation remains - Meckel's diverticulum;
• the duct remains unchanged - the intestine will have an outlet into the anterior abdominal wall.

Pathological formation is often asymptomatic, appearing only with the development of other diseases:

• atresia of the esophagus and rectum;
• Crohn's disease.

The provoking factor is the accumulation of pieces of food in the diverticulum.

Classification of pathological formation

Depending on the side in which the diverticulum is open, the following types are distinguished:

• Meckel's diverticulum - opens into the intestinal lumen;
• enterocystoma - in the middle;
• omphalocele - on the umbilical side.

a) incomplete umbilical fistula; b) complete umbilical fistula; c) enterocystoma; d) Meckel's diverticulum

According to the degree of closure there are:

• completely closed;
• partially closed;
• completely open.

Signs of Meckel's diverticulum

Pathology is discovered by chance - during the treatment of other pathologies or during various manipulations. When inflammation occurs, the following symptoms occur:

The symptoms of Meckel's diverticulum are similar to those of appendicitis, so patients are often prescribed removal of the appendix. The doctors understand that they made a mistake only during the operation.

Diagnostic methods

To identify pathological condition apply research:

1. Colonoscopy. Other diseases that can lead to bleeding are excluded.
2. Laparotomy and laparoscopy. Used when other diseases are suspected abdominal cavity.
3. Esophagogastroduodenoscopy. The walls of the digestive organs are studied, which helps to exclude other pathologies manifested by internal bleeding.
4. Scintigraphy. Ectopic (abnormally located) stomach tissues are identified.
5. CT scan. Inflammation and complications occurring against the background of pathology are detected.
6. Ultrasonography. Inflammatory changes are detected.
7. X-ray diagnostics. The location of the pathology, as well as the size of the formation, are determined.

Treatment

In the absence of symptoms, treatment for Meckel's diverticulum is not required. Statistics show that only 5% of patients with a pathological formation consult a doctor as a result of complications. Nevertheless, they keep their condition under control; any deterioration in well-being is a reason to seek medical help.

Treatment is required for bleeding and inflammation. Timely appeal seeking medical help improves the prognosis for the development of pathology and the outcome of the intervention.

Drug therapy

The drugs are more often prescribed for the treatment of children and after surgery. When inflammation develops, use:

1. Detoxification and infusion therapy: Complamin, Trental, Antithrombin III, plasma substitutes.
2. Anti-inflammatory drugs: Ibuprofen, Indomethacin, Diclofenac sodium, Piroxicam.
3. Antibacterial drugs: Clarithromycin, Erythromycin, Azithromycin.

Medicines for inflammation of Meckel's diverticulum - gallery

Surgical intervention

Surgery in the absence of signs of inflammation is prescribed in the following cases:

• the size of the diverticulum is more than 2 cm;
• fibrous cords are present in the abdominal cavity;
• The ileum has thin walls.

A randomly identified formation that has unchanged tissue is removed when:

• narrow neck of the diverticulum;
• thinning of the walls of the diverticulum;
• the length of the formation is more than 3 cm;
• the patient's age is over 40 years.

During the intervention, the following methods are used:

1. Excision. An incision is made in the abdominal wall, providing access to the diverticulum.
2. Resection. A device equipped with a camera is inserted into the abdominal cavity through small incisions. The technique allows you to study the formation and remove it if necessary.

Diverticulectomy - excision of the formation and restoration of normal intestinal tissue. In serious situations, segmental resection is used - removal of the diverticulum and a certain part of the ileum.

Patient nutrition

During therapy and after surgery, they adhere to a diet. Proper nutrition reduces the load on the digestive organ. The patient is allowed to eat:

• porridge;
• soups (mucoid);
• herbal teas;
• fruit drinks and compotes;
• rosehip decoction;
• fermented milk products (homemade);
• baked goods made from coarse (whole grain) flour;
• fruits;
• lean meats: rabbit, beef, chicken;
• vegetables, steamed or boiled.

Hard-to-digest and heavy foods are completely prohibited. These include:

• smoked meats;
• peas and beans;
• alcohol;
• canned food;
• strong coffee and tea;
• semi-finished products;
• fatty foods;
• radish;
• fried products;
• cookies and cakes;
• baked goods made from premium flour;
• chocolate and cocoa;
• marinades;
• spicy foods and dishes with spices;
• White cabbage.

Processing methods include boiling and steaming. Another important point- drinking regime. The liquid is consumed based on the calculation - 0.3 liters of water per 10 kg of weight.

Prohibited products - gallery

Possible complications and consequences

Complications may occur after surgery:

• adhesions;
• scar tissue.

To reduce the risk of developing postoperative complications follow the doctor's instructions and follow the diet.

If there is no therapy, the patient's condition worsens. The following conditions occur:

1. Intestinal obstruction:
   • cramping pain;
   • vomiting and nausea;
   • dizziness;
   • pale skin;
   • weakness.
2. Tumors of malignant and benign nature.
3. Internal bleeding:
   • tachycardia;
   • anemia;
   • pale skin;
   • weakness;
   • dizziness.
4. Penetration of one part of the intestine into another:
   • internal bleeding;
   • weakness;
   • sharp pain.
5. Diverticulum rupture.

Meckel's diverticulum is a pathological formation that can be hidden for a long time. Symptoms appear only when inflammation develops and complications arise. In this case, treatment is required; delay will lead to a worsening of the condition.

What is Meckel's diverticulum? This frequently asked question from patients. Let's take a closer look at it. This is a pathology that was first described by the scientist Johann Friedrich Meckel. The essence of this disease is that in the process intrauterine development In humans, certain disorders occur under the influence of certain factors. This is a kind of protrusion of the lower part of the ileum. Meckel's diverticulum is one of the common gastrointestinal diseases.

Development of pathology

With true diverticula, all layers of the intestinal wall remain in place. And with false diverticula (pseudodiverticula), the mucous membrane constantly protrudes through the gaps in the muscular layer. True ones include innate ones (just we're talking about about the diverticulum of the same Meckel), and to false acquired diverticula in the colon.

In the initial stages, the gallbladder duct, which is located next to the ileum, is formed by the seventh week of pregnancy. In cases where there is no atrophy of the area that connects it to the ileum, Meckel's diverticulum is formed.

Such cases are called congenital, and the diverticulum itself has all the properties of a normal intestine and extends in the area of ​​​​the opposite attachment of the edge of the mesentery. In half of the cases it has heterotopic gastric tissue or pancreatic tissue. However, there are cases when he possesses two tissues at the same time.

Complications after diverticulum formation are rare, occurring in approximately 2% of patients. As for gender characteristics, in men this anomaly causes complications twice as often as in women.

Complications are: bleeding (they are also called diverticulitis), obstruction, as well as various other formations in the form of tumors.

The causes of this pathology

Inflammation of Meckel's diverticulum may occur due to retention of food debris. As a result, education begins fecal stones which is accompanied by acute infection.

The inflammatory process concerns exclusively Meckel's diverticulum, but neighboring internal organs and fabrics are also susceptible to this. The most a common complication is the formation of an interintestinal abscess and the development of peritonitis. The most clear signs diseases are all kinds of protrusions on the surface of the abdomen.

Meckel's diverticulum may have all the features and functions of a normal bowel. In this case, symptoms that confirm the presence of this disease, are completely absent. To diagnose here, it is necessary to carry out special lab tests, because the standard methods recognition systems will not be able to detect its presence.

Symptoms of the disease

In cases where such a protrusion becomes part of the intestine, its symptoms begin to appear most clearly and often. These include the following disorders in the body:

Localization of pain - most often in the left iliac region, in projection sigmoid colon. It is spastic and intensifies as soon as the colon is filled with feces. After defecation, it usually becomes easier. In some patients, during the period between these spasms, dull It's a dull pain in the same departments. does not make it possible to determine the localization of the painful focus. This suggests that organic cause pain syndrome absent. In this case, it is associated with discoordination of intestinal motility.

The duration of the pain syndrome is recorded by patients from several days and weeks to constant, incessant pain. The stool is disrupted, and this most often manifests itself as constant constipation. In addition, patients complain of feeling incomplete emptying intestines and increased gas formation. In some patients, diarrhea alternates with constipation, which is also quite unpleasant. Clinically expressed and not always harmless, as most gastroenterologists think. Frequent paroxysmal pain in the abdomen, regular violation of bowel movements - all this leads these patients to complete or partial loss of ability to work. They constantly visit gastroenterological or coloproctological offices, where they are unsuccessfully treated with the most different means.

Age consideration

When identifying signs of this disease, it is necessary to take into account the age of the patient. This is due to the fact that among the symptoms in childhood Most often, intestinal blockage occurs. As for internal bleeding, the disease can show such manifestations already at an older age. However, the detection of pathology occurs mainly before the age of 12.

In addition, the patient may experience some irregular symptoms of this disease. For example, internal bleeding may be minor and stop on their own within a few days. Similar feature also makes it difficult to adequately diagnose this disease.

Development of anemia

Sometimes blood is constantly observed in the patient’s stool, but such cases are extremely rare. This symptom may be accompanied by iron deficiency anemia, which is one of the main signs of the development of Meckel's diverticulum. The same symptom indicates that the patient’s life is at risk. In such cases, patients are shown emergency surgical solution Problems.

Diagnostic methods

In making a diagnosis of Meckel's diverticulum in surgery, the main role is played by the symptoms of this disease. Bloody stool in childhood is an unambiguous sign of pathology.

At the end of the twentieth century, a method for diagnosing the gastric mucosa, called “scintigraphy,” began to be used. It is based on a study of the absorption of isotopes by the stomach. This diagnostic carried out in different projections.

During normal functioning, the bladder and stomach produce large cluster radionuclides accumulating through the duodenum and small intestine. Therefore, when diagnosing Meckel's diverticulum, an examination of the kidneys and urinary system is performed.

The location of the diverticulum is usually in the lower abdomen. However, he can change his position due to mobility. The pathology is often confused with intestinal duplication.

If a patient has complete intestinal obstruction or signs of peritonitis, specialists may perform diagnostic laparoscopy. In this case, the disease is detected already at the stage surgical intervention.

Meckel's diverticulum: surgery

Treatment methods, eliminating the development of pathology, consist of surgical intervention, the course and technique of which directly depend on how it was discovered this pathology- based on symptoms or during the operation itself.

In cases where there were no symptoms and the disease was diagnosed directly on the operating table, surgeons immediately begin to remove the diverticulum, which is performed by transverse suturing. This procedure carried out using special equipment.

Treatment for Meckel's diverticulum should be timely.

Step-by-step operation

At the first stage of the operation, doctors determine the location of the source of bleeding. If it is localized not in the diverticulum, but in the ileum, segmental resection of this section of the intestine is usually performed. This method helps to quickly eliminate the source of bleeding and save the patient’s life. What else might surgery involve for Meckel’s diverticulum?

In cases where intestinal obstruction in intussusception is observed, the first step is to carry out a disinvagination procedure and only then begin to remove the diverticulum. If resection is the cause of narrowing of the intestinal lumen, segmental intestinal resection is necessary. The consequences of intussusception become irreversible in cases of Meckel's diverticulum or In these situations, manipulations such as anastomosis and intestinal resection are usually used. In some cases, it is possible to create stomas, which are used temporarily and then removed.

The patient's complete recovery after removal of Meckel's diverticulum occurs within a few weeks.

Causes of intestinal obstruction

The causes of intestinal obstruction, including in children, may be volvulus or hernial formations, which may be a consequence of the presence of residues in bile duct.

In such cases, the treatment method is to eliminate intestinal strangulation by resection of a section of the bile duct. Next, the operation follows the same scenario as when removing Meckel’s diverticulum. However, in cases of perforation, deterioration may occur clinical picture, which also occurs with intestinal gangrene and strangulated hernia. In 10% of cases during such surgical procedures the patient's death occurs, which may also be associated with the presence of complications of an infectious nature.

The main complication of Meckel's diverticulum is the formation of adhesions and intestinal obstruction.

The child has

This pathology is one of the most common of the category of congenital anomalies of the gastrointestinal tract and manifests itself in almost 4% of children, most often in boys. If the disease was not detected before the age of 10, then before the age of 30 there is a 100% chance that it will manifest itself in some way.

Meckel's diverticulum in children is specific disease, which can proceed for a long time without any certain symptoms. Nevertheless, scientists around the world are working to improve methods for diagnosing this pathology, which will help significantly reduce the rate of child mortality from its complications.

The asymptomatic course of the disease in children can be complicated and sooner or later it will become a finding for surgeons when performing laparotomy for diagnostic purposes.

Main manifestations

In cases where symptoms of the disease are present, its main manifestations in children may be bleeding in the intestines, sharp pains in the lower abdomen, tarry stools that are black in color. These manifestations may be accompanied by general weakness, pallor, increased heart rate, and dizziness. Clinical and laboratory blood tests are required. The main indicator that is taken into account first is the hemoglobin level. If it is too low, this indicates the development of anemia in the child, which is a consequence of heavy bleeding.

There may also be no symptoms such as nausea and vomiting, but inflammation of Meckel's diverticulum is very similar to the symptoms of appendicitis. Here the Shchetkin-Blumberg symptom, leukocytosis, abdominal pain, etc. are observed. In most cases, surgeons begin to operate on appendicitis, but during surgery it becomes clear the real reason occurrence of such symptoms.

Prognosis for exacerbation

Only in 5% of cases does Meckel's diverticulum make itself felt throughout life. Most people don't even know they have this disease. The main patients of surgeons diagnosed with diverticulitis are children under 12 years of age.

Finally

When complications of Meckel's diverticulum develop after surgery, timely seeking medical help is of great importance. The risk of this is low, except that an adhesive process may occur in the area of ​​the small intestine due to an inflammatory process, and this, in turn, over time can lead to the formation intestinal obstruction.

5286 0

Three types of symptoms are most characteristic of Meckel's diverticulum: GI bleeding, intestinal obstruction, and abdominal pain.

Among patients with clinical manifestations of Meckel's diverticulum, bleeding occurs in 25-56% of cases. It may be insignificant, with the release of tarry stool, which indicates a slow passage of intestinal contents through the distal parts of the gastrointestinal tract. Sometimes the bleeding is massive, and then the stool is brighter red. In some cases, stool looks like currant jelly, which is explained by the secretion of mucus. In such a situation, it is necessary to carry out differential diagnosis with intussusception.

Since bleeding with diverticulum occurs from the distal parts of the small intestine, bloody vomiting is completely unusual for patients with this pathology. Bleeding is usually not accompanied by pain. The child develops anemia. According to one study, of 48 patients with GI bleeding due to Meckel's diverticulum, 41 required at least one blood transfusion. In most cases, bleeding stops spontaneously. Once the diagnosis has been established, indications for surgical intervention are made selectively. Sometimes the blood loss is so great that emergency surgery is required.

The source of bleeding from a diverticulum is usually ectopic gastric mucosa, peptic ulcerated. In typical cases, a bleeding ulcer is located in the place where the gastric mucosa borders the ileal mucosa, or on the mesenteric wall of the ileum “opposite” the diverticulum.

The second most common clinical manifestation of diverticulum is intestinal obstruction, occurring in 30-35% of patients. It usually occurs in patients more younger age, in older children other clinical manifestations of diverticulum are observed. Preoperative diagnosis of diverticulum as a cause of intestinal obstruction is rarely made. The mechanism of intestinal obstruction due to diverticulum can be associated with several reasons, one of them is intussusception. In cases where the diverticulum is fixed by a cord to the abdominal wall, a volvulus or internal hernia sometimes occurs around this cord. Intestinal obstruction due to diverticulum is caused by each of the following with equal frequency. listed reasons- intussusception, volvulus or internal hernia y.

One of the manifestations of a diverticulum may be abdominal pain or symptoms of inflammation in the abdominal cavity. Similar symptoms are observed in 25% of patients. Symptoms of inflammation are usually associated with diverticulitis and before surgery are almost always regarded as a manifestation of appendicitis. Feelings of discomfort are usually initially localized in the umbilical region, but can then be noted in any part of the abdomen, since the diverticulum is most often not fixed. Diverticulum perforation occurs in one third of patients with diverticulitis, usually when there is gastric mucosa with peptic ulceration in the diverticulum.

Abdominal pain and signs of inflammation can sometimes be caused by the inversion of the diverticulum itself on its own narrow base. This complication leads to ischemia and even necrosis of the diverticulum. As a result, perforation or cellulitis may develop.

Diagnostics

Normally, there is a dense concentration of radionuclide in the stomach and bladder; both the duodenum and the proximal jejunum accumulate it. The kidneys and urinary system can also be determined, which depends on the amount of diuresis and the presence or absence of abnormalities urinary system. Scintigraphy results are considered positive if abnormal accumulation of radionuclide is detected. Meckel's diverticulum is usually located in the right lower quadrant of the abdomen, but can have any other location, and sometimes, being mobile, changes its location.

A, On a scintigram with technetium, a radionuclide is visible in the stomach (S), duodenum (D), proximal part jejunum(J) and in the bladder (B), as it should be normally. Excess accumulation (MD) above is also visible Bladder, the localization of which during the operation corresponded to the location of Meckel's diverticulum.
B, Scintigram shows radionuclide in the stomach (S) and bladder (B). The large area of ​​nuclide accumulation above the bladder is associated with the location of the duplication of the jejunum here. The presence of a significant area of ​​ectopic gastric mucosa should raise suspicion of enteral duplication rather than Meckel's diverticulum.

If positive scan results are obtained, it is necessary to carry out a differential diagnosis with ectopia of the gastric mucosa of another location (not in the diverticulum), as well as with a possible false-positive examination result. Other localization (not in the diverticulum) can be observed in gastrogenic cysts, enteral duplications and Barrett's esophagus. False Positives are associated with mucosal hyperemia or bleeding and can be obtained from intussusception, intestinal obstruction, ulcers, arteriovenous anomalies, and malformations of the urinary tract.

Of the types of pathology in which scanning gives positive results, intestinal duplications are in second place in frequency after Meckel's diverticulum. To improve the diagnostic accuracy of scintigraphy, different ways, in particular, the use of pentagastrin - to stimulate the absorption capacity of the gastric mucosa, cimetidine - to inhibit the process of nuclide release from the area of ​​interest, as well as research in the lateral projection and after urination - for differential diagnosis with its accumulation in genitourinary system. If, with sufficiently serious and reasonable suspicions of Meckel’s diverticulum, negative results scintigraphy, the examination must be repeated.

In patients with intestinal obstruction or abdominal pain, Meckel's diverticulum is rarely diagnosed preoperatively. If the patient's age and the totality of symptoms raise suspicions of intussusception and there are no signs of peritonitis, to diagnose intussusception, the colon should be filled with barium, which may turn out to be therapeutic measure. As for the diagnosis of Meckel's diverticulum, contrast X-ray examination as upper sections(passage) and lower (irrigogram) are of no value. The literature describes only one case of diagnosing a diverticulum using a study of the passage of a contrast agent; in this case, the scintigram picture was normal.

Often, symptoms of complete intestinal obstruction or peritonitis force one to undergo a trial laparotomy (trial in the sense that the cause of the obstruction or peritonitis is not known) with a diagnosis of " acute stomach“, and Meckel’s diverticulum in some cases is discovered only during surgery.

Treatment

This can be done using a stapler. It is very important to ensure that the source of bleeding is within the diverticulum and not at its base or on the mesenteric wall of the ileum (“opposite” the diverticulum). In patients with heavy bleeding from the ileum (and not from the diverticulum), it is necessary to perform a segmental resection of this section of the intestine along with the diverticulum. The results of diverticulum resection are excellent, and bleeding usually does not recur.

For intestinal obstruction associated with intussusception, intussusception should be performed first, if possible, and then the diverticulum should be removed. If resection of the diverticulum can lead to narrowing of the intestine, then segmental resection of the intestine is performed. Unfortunately, intussusception often cannot be straightened in the presence of Meckel's diverticulum or intestinal gangrene. In such cases, it is necessary to perform intestinal resection and anastomosis. Sometimes, with significant changes, resection with temporary stomas may be required.

In children, intestinal obstruction may be caused by a volvulus or internal hernia associated with vitelline duct remnants. Treatment in such cases consists of eliminating the volvulus or strangulation and resection of the remnants of the vitelline duct. The diverticulum is removed following the principles described above. Severe complications develop in patients with perforation of a diverticulum or gangrene of the intestine due to intussusception, volvulus or strangulated internal hernia. Mortality in such cases in young children is 10% and is mainly associated with infectious complications. In such situations, in the long term after surgery, there is a high risk of developing adhesions and intestinal obstruction, just like in any child who has undergone laparotomy.

The most common navel anomaly is granuloma, which responds well to cauterization with silver nitrate. Lack of effect from use this method should raise suspicion of the presence of a communication with the gastrointestinal tract, an open vitelline duct or urachus. The diagnosis can be made on the basis of a fistulogram in the lateral projection. The remnants of the vitelline duct in the umbilical area are usually simply excised. If there is a connection with the gastrointestinal tract, then excision of the duct with suturing of the ileum is indicated.

Difficulties in choosing surgical tactics arise when Meckel's diverticulum is asymptomatic. Since the risk of developing clinical manifestations of a diverticulum decreases with age, it is advisable to perform resection of an incidentally discovered diverticulum only in young children, or if a lump is palpable within the diverticulum, which may be an area of ​​​​the gastric mucosa. It is especially correct to remove the diverticulum in such situations, if no other intervention other than diverticulectomy is performed.

K.U. Ashcraft, T.M. Holder

- This is a small protrusion in the wall of the intestine, near the junction of the small and large intestines. This "pocket" is remnant tissue from prenatal development digestive system. The type of tissue that makes up this pouch is different from that of the small intestine. A similar material structure was found in the stomach and pancreas.

In 1809, Johann Friedrich Meckel published an article about the diverticular remnant of the vitelline (umbilical)-intestinal duct (the canal connecting the yolk sac with the fetal intestinal cavity), located in the ileum. The document was quite detailed and included a description of the anatomy and embryonic origins. The pathology got its name from the doctor, although in 1598 the disorder was first described as an unusual diverticulum of the small intestine by Fabricius Hildanus.

The yolk sac (the embryonic organ that stores nutrients for the embryo) is the first element that must be formed in fertilized egg(structure surrounding the embryo). The yolk sac is involved in the transfer of maternal nutrients at an early stage of pregnancy during the critical period of organogenesis (the final stage of individual development of the embryo).

Pathogenesis of diverticulum formation

Early in the embryo's life, its midgut (from which parts of the small and large intestines subsequently develop) receives its nutrition from yolk sac through the umbilical duct. The canal then gradually narrows and usually disappears after 7 weeks of pregnancy. If the canal does not completely resolve, Various types anomalies of the vitelline duct, one of which is Meckel's diverticulum.

The mucous membrane is most often gastric. This is important because peptic ulcerations of this or adjacent mucosa can result in painless bleeding, perforation, or both. One study found:

• in 62% of cases, the diverticulum contained gastric mucosa;
• pancreatic tissue was found in 6% of patients;
• pancreatic tissue and gastric mucosa in 5% of cases;
• in 2% of patients the jejunal mucosa;
• mucous membranes of the stomach and duodenum were found in 2% of cases;
• Colon tissue is rarely noted.

Symptoms

Symptoms of Meckel's diverticulum usually appear in the 1st or 2nd year of life (average 2.5 years), but initial symptoms may occur in the 1st decade. Meckel's diverticulum is most often diagnosed during testing associated with other abdominal conditions.

Complications as a marker of the presence of a diverticulum

The occurrence of pathological symptoms is actually associated with the development of complications. It is estimated that this occurs in 4–16% of patients. Complications result from obstruction, ectopia (displacement) of tissue, or inflammation. In one study of 830 patients of all ages, complications included:

• intestinal obstruction (35%);
• hemorrhage (32%);
• diverticulitis (22%);
• umbilical fistula (10%);
• other umbilical injuries (1%).

Complications of Meckel's diverticulum can develop at any age. However, the risk decreases with age. It is highest in children.

In one study of 65 children, 10 cases with obstruction had isolated gangrene of Meckel's diverticulum.

In children, hematochezia (bright scarlet blood in the stool) is the most common indicative sign.

Acute gastrointestinal bleeding

Acute bleeding from lower sections The gastrointestinal tract is secondary to hemorrhage from an ulcer. This ulceration occurs when the acid secreted in the diverticulum of the stomach lining damages adjacent vulnerable tissue. Clinically, hemorrhage is usually noted as significant, painless rectal bleeding. However, some patients may experience pain that precedes the onset of hematochezia. The pain can be quite significant.

The stool is usually the color of red currant jelly. Bleeding can cause significant anemia, but is usually self-limiting due to tendon contraction as patients have reduced circulating blood volume.

Meckel's diverticulum sometimes becomes inflamed, the condition manifests similarly acute appendicitis. Inflammation can lead to perforation and peritonitis.

Meckel's diverticulum in children often occurs in combination with other congenital anomalies, including atresia (occlusion) of the esophagus and anus, omphalocele (form), Crohn's disease and various neurological and cardiovascular malformations.

Diagnosis of Meckel's diverticulum in children

The diagnosis of symptomatic or complicated Meckel's diverticulum is difficult to confirm based on history, physical examination, and laboratory tests. He always counts differential diagnosis with intestinal obstruction and hemorrhage. Painless, abundant hematochezia in a child should be a signal to the doctor about the possibility of such a diagnosis and should prompt further investigation.

Laboratory research

Routine laboratory findings including general analysis blood, determination of the level of electrolytes, glucose, urea, creatinine and coagulogram results do not help establish the diagnosis of Meckel's diverticulum, but are necessary to monitor a patient with gastrointestinal bleeding.

Hemoglobin and hematocrit levels are low with significant bleeding.

Persistent bleeding from Meckel's diverticulum can cause iron deficiency anemia. However, megaloblastic anemia is also seen due to vitamin B12 deficiency or folic acid. Low levels albumin and ferritin may lead to an erroneous diagnosis - inflammatory disease intestines.

Visual research methods

History taking And physical examination are of paramount importance to establish clinical diagnosis. Imaging studies are performed to confirm the clinical suspicion of Meckel's diverticulum.

Regular abdominal cavity has limited value. It may reveal signs of complications other than bleeding.

When a patient has gastrointestinal bleeding suggestive of Meckel's diverticulum, the diagnostic evaluation should focus on the method radioisotope scintigraphy with technetium(“Meckel scan”) A radioactive substance called technetium, which is preferentially absorbed by the stomach tissue, is injected into the bloodstream intravenously. This substance can be seen on x-rays, it indicates areas where acid-resistant gastric tissue exists, including Meckel's diverticulum.

X-ray studies with barium have been largely replaced by other imaging techniques; however, if a barium study is ordered, it should never precede the Meckel scan. This procedure is done to examine the colon, which helps rule out other possible reasons gastrointestinal bleeding. A fine liquid called barium that covers inner part colon so that it appears on x-rays is inserted into the rectum using an enema. The images show narrowed areas, obstructions, and other problems.

Treatment

Children with Meckel's diverticulum in the absence of manifestations do not require treatment. Those who have symptoms due to the condition will drink too much surgical intervention . Surgery usually involves removing the diverticulum and repairing the intestine.

Children with severe blood loss should take iron supplements and may need blood transfusions to replace the lost blood.

Surgery to correct Meckel's diverticulum usually involves low risk complications. However, there may be some consequences after the intervention. In particular, scar tissue may develop, which leads to intestinal blockage. A bowel blockage is life-threatening and requires additional operation to eliminate it.

Conclusion

The prognosis for treatment is favorable. Removing the diverticulum surgically usually normalizes bowel function and stops blood loss. Children who have surgery usually make a full recovery.

Diverticula are intestinal defects that can be congenital or occur during life. They accumulate food debris and feces, which are not subjected to intestinal processing and begin to rot inside the “pocket,” causing all sorts of diseases.

Localization

Meckel's diverticulum (MD) occurs in the womb. Often forms at 5-7 weeks embryonic development and is a protrusion formed as a result of incomplete fusion of the embryonic bile duct, which normally atrophies by the end of the 20th week. It is shaped like a bag or pocket and has an intestinal structure.

Mainly localized in the lower part of the ileum, 40-45 above the junction with the cecum ( primary department large intestine).

A little bit of history

The sac-like process was first identified in the mid-16th century by F. Hildanus, but no research was carried out at that time. The anomaly received its name somewhat later, in honor of the German pathologist I. F. Meckel, who described it at the beginning of the 19th century. The pathology, unlike similar ones, was congenital and had some differences.

Statistics

According to the Ministry of Health, the disease is one of the most common problems of the gastrointestinal tract (GIT). Meckel's diverticulum affects 1 person and 50 healthy people (2-3%). It is more often diagnosed in males. What this is connected with is unknown.

General symptoms and complications

DM can long time proceed without visible symptoms. It is often discovered by chance, during a routine examination or suspicion of other pathologies. Despite the absence of manifestations, the defect is quite dangerous due to the development of complications.

Some patients may develop severe pathologies, such as:

• Heavy, internal bleeding. This type complications occur most often (20-30% of cases), with the majority of such patients being men and children under 2 years of age. The discharge can be heavy, medium, light, and bright red in color. In some cases, there may be painful sensations in the abdominal area. The appearance of blood in the stool is an ominous sign that requires careful diagnosis. Such a diverticulum must be removed.
• Obstruction (obstruction) of the intestine. An equally common pathology that occurs against the background of DM. Often develops when the small intestine wraps around the fibrous periumbilical mesentery. Sometimes a diverticulum causes one part of the intestine to invade another, a phenomenon called intussusception. Less commonly, the condition is caused by growing tumors, benign or malignant.
• Peritonitis. A dangerous condition characterized by inflammation of the peritoneum as a result of contact with feces or infections. It may occur as a result of thinning of the intestinal walls, intestinal obstruction, fistula formation, etc.
• Diverticulitis represents inflammatory process in the walls of the diverticulum. It is observed in older patients and accounts for 10-15% of total number patients with the presence of protrusion. The disease can cause peritonitis and the formation of adhesions between the intestines, which in turn cause.

Complications of the pathology are quite dangerous, so if you have any complaints from the gastrointestinal tract, you should consult a doctor to find out the cause.

Such conditions occur in 4-5% of patients and require urgent medical attention. It is not possible to determine the cause of deterioration in well-being at home, but you should pay close attention to the following symptoms:

• dizziness;
• prostration;
• fainting;
• pale skin;
• black, tarry stool;
• increased heart rate;
• pain in the abdomen, on the right or in the navel area;
• increased body temperature;
• changes in laboratory tests;
• nausea and profuse vomiting.

Bloody, black vomiting is not typical for DM, so the appearance of such a symptom almost always indicates another pathology. In any case, it is imperative to call an ambulance and not self-medicate.

Seeing a doctor and getting examined

Initial visit to medical institution includes:

• collection of necessary information (complaints, lifestyle, concomitant pathologies, genetic factors);
• palpation (feeling) of the abdominal area;
• carrying out laboratory tests;
• instrumental studies.

• general and biochemical analysis blood;
• coprogram (hidden blood test);
• coagulogram (to assess blood clotting);
• ultrasound examination (ultrasound) of the abdominal cavity and small intestine;
• X-ray of the intestines with contrast;
• scintigraphy (radioisotope diagnostics);
• colonoscopy (examination of the intestinal mucosa through the anus);
• esophagogastroduodenoscopy (examination of the esophagus, stomach, 12th intestine);
• computed tomography (CT) of the abdominal region.

Depending on the patient’s condition and the presence of other pathologies, the list may differ slightly.

DM forms

In most cases, the pathology does not particularly bother patients. Symptoms may occur when the bulge becomes inflamed, called diverculitis. The disease can occur in one of the following forms:

• Catarrhal. The initial form of inflammation, characterized by swelling and hyperemia (redness) of the affected area of ​​the intestine and neighboring tissues.
• Phlegmonous. At this stage, the walls of the diverticulum begin to thicken and become covered with purulent plaque, the lining of this part of the intestine becomes loose.
• Gangrenous. It occurs as a result of suppuration of the diverticulum, followed by tissue death (necrosis).
• Perforated. The final form of the disease with perforation of holes and infection of the abdominal cavity. If at this stage the patient is not provided medical care, then death will inevitably occur.

General treatment regimen

The choice of therapy mainly depends on the patient's condition and the development or absence of complications.

With the help of drugs

Treatment of uncomplicated diverticulum begins with the use of medicines. Can be used:

• anti-inflammatory drugs;
• antibiotics.

Surgical intervention

Regarding the need to remove asymptomatic diverculitis, this moment, does not exist consensus. But still most of Doctors say that there is no need to delay its removal.

Indications for surgery are:

• thin walls of the diverticulum;
• the length of the anomaly is more than 3 centimeters;
• narrow neck of the DM;
• patient's age (over 40 years).

If there are complications in the form of bleeding, perforation or intestinal obstruction, the patient undergoes immediate intervention in the small intestine, which is carried out using one of the following methods:

• Endoscopic resection is carried out by cutting off the affected area followed by an anastomosis to restore the integrity of the intestine. This operation is considered the safest and therefore is preferable when identifying pathology in childhood.
• Segmental resection is selected in the case of the presence of blood clots in the mesenteric vessels or necrosis of the pathological section of the intestine, which is cut off along with part of the arteries and vessels to the unchanged area, after which the parts of the intestine are connected to each other. As a result, the ileum shortens, which can cause subsequent digestive problems.
• Excision of the diverticulum. Can be prescribed to patients with uncomplicated pathology. During such an operation small intestine inflated with air to identify the defect and cut it off, followed by a double-row suture.

The choice of type of operation is determined by the attending physician, based on the results of the examination and other factors (age, gender, additional pathologies, etc.).

Nutrition

During treatment, the patient will need to avoid the following foods:

• all types of cereals;
• slimy soups with weak broth;
• dairy products with a fat content of no more than 1% (kefir, milk, yogurt);
• hard cheese, butter and sour cream in small quantities;
• soft-boiled eggs (no more than 1 pc.);
• natural juices, fruit drinks, compotes;
• fresh fruits;
• vegetables (raw, boiled, steamed, baked in the oven, etc.).

Proper nutrition will reduce stress on gastrointestinal tract, and will contribute to a speedy recovery.

Use of medicinal herbs

DM therapy can be supplemented by alternative means, relieving the inflammatory process. For this, with the permission of a doctor, the following can be used:

• Chicory with milk. 1 tbsp. pour a spoonful of crushed plant roots into 200 ml. boiled, hot milk and leave for 60 minutes. Use 4 times a day, 50 ml. regardless of food intake.
• Sage leaves. 10 gr. raw materials are poured into 500 ml. boiling water and leave for a couple of hours. Then filter and take half a glass, 4 times a day.
• Flax seeds. To prepare the infusion, 15 g. seeds pour 1 cup of boiling water. Leave for 1-2 hours, then filter and drink all the prepared product on an empty stomach. The procedure is performed daily.

Facilities traditional medicine may have a number of contraindications, so before use, consultation with a doctor is required.