Downloaded 238 times
Uploaded bySelvaraj Balasubramani
Meckel's Diverticulum - Pediatric Surgery
Meckel's diverticulum is a congenital anomaly resulting from the failure of the vitelline duct to obliterate, commonly presenting with symptoms like bleeding and obstruction. It is most frequently diagnosed in children and often requires surgical intervention in symptomatic cases, with a variety of surgical techniques available. Diagnosis is primarily confirmed through technetium-99m pertechnetate scintigraphy and management depends on the presence of complications or symptoms.
More Related Content
Similar to Meckel's Diverticulum - Pediatric Surgery
More from Selvaraj Balasubramani
Meckel's Diverticulum - Pediatric Surgery
- 1. MECKEL’S DIVERTICULUM AN OVERVIEW Dr.B.SelvarajMS;Mch;FICS; Professor of Surgery Melaka Manipal Medical College Melaka 75150 Malaysia
- 2. Learning Outcomes • Tounderstand the embryological origin of Meckel’s diverticulum •To be familiar with its clinical presentation and methods of investigation •To be aware of management options
- 3. PLAN • Introduction • Epidemiology& Etiology • History & Physical • Workup • Differential Diagnosis • Treatment
- 4. Introduction • Meckel’s diverticulumis a true diverticulum arising from the antimesenteric border of the distal ileum • It is the remnant of the vestigial vitello-intestinal duct or omphalo-mesenteric duct or yolk stalk • The ‘rule of 2s’ is often used for Meckel’s diverticulum: within 2 feet of the ileocaecal valve, 2 inches in length, occurring in about 2% of the population, two times more symptomatic in males, symptomatic by 2 years of age and potentially containing 2 heterotopic tissues, gastric and pancreatic.
- 5. Epidemiology & Etiology •The first known description of Meckel’s diverticulum was made in 1598 by Hildanus. • In 1809, the anatomist and physician Johann Friedrich Meckel identified the origin of the diverticulum as the vitellointestinal duct. • Heterotopic pancreatic tissue in the diverticulum was identified in 1861 by Zenker and gastric mucosa in 1904 by Salzer. • Meckel’s diverticulum is the most common vitelline duct abnormality and the most common congenital anomaly of the gastrointestinal tract.
- 6. Epidemiology & Etiology •The fetal midgut is attached to the yolk sac via the vitellointestinal duct, also known as the omphalomesenteric duct or yolk stalk. • This duct normally obliterates between 5 and 8 weeks’ gestation. Meckel’s diverticulum results from failure of the proximal duct to obliterate.
- 7. History & Physical •Meckel’s diverticulum has been called the ‘great imitator’ because of its varied manifestations. • The common presenting problems of a Meckel’s diverticulum are bleeding, obstruction, pain (inflammation) and umbilical discharge • Bleeding accounts for > 50% of all instances of lower gastrointestinal bleeding in children, usually occurring in infants and toddlers. • The bleeding is due to ulcer formation from the acid secreted from the ectopic gastric mucosa and can be severe.
- 8. History & Physical •Meckel’s diverticulum can cause intestinal obstruction by one of the several mechanisms: -Meckel’s band -Intussusception -Volvulus -Internal herniation -Prolapse through a patent vitellointestinal duct • Pain(Inflammation): Mimic like Acute Appendicitis • Umbilical discharge: When complete patency of V.I. duct
- 9.
- 10.
- 11.
- 12. WORKUP • Technetium-99m pertechnetatescintigraphy (Meckel’s scan) is the investigation of choice. • It is used to detect heterotopic gastric mucosa. Pentagastrin, histamine blockers and glucagon may enhance the accuracy of diagnosis. • Mesenteric Angiography in patients with severe active bleeding
- 13. WORKUP Tch 99 SCAN-Meckel’s Scan Mesenteric Angiogram
- 14. Differential Diagnosis • Malrotation •Acute appendicitis • Gastroenteritis • Peptic ulcer disease • Intestinal duplication • Cow’s milk protein intolerance/allergy
- 15. TREATMENT • In incidentallydiscovered diverticulum, no need for surgical excision. However, if there is thickening of diverticulum suggestive of heterotopic mucosa elective resection can be done • The bleeding child should be placed nil by mouth and appropriately resuscitated. • In symptomatic patients, the diverticulum is removed using a laparoscopic, laparoscopic-assisted or open technique.
- 16. TREATMENT • In incidentallydiscovered diverticulum, no need for surgical excision. However, if there is thickening of diverticulum suggestive of heterotopic mucosa elective resection can be done • The bleeding child should be placed nil by mouth and appropriately resuscitated. • In symptomatic patients, the diverticulum is removed using a laparoscopic, laparoscopic-assisted or open technique.
- 17. TREATMENT • The techniquecomprises either a simple resection of the diverticulum-wedge resection- and transverse closure across the base or resection of a short segment of ileum, containing the diverticulum, followed by end-to-end ileal anastomosis. • The latter technique is recommended in bleeding patients because it deals with any ulcer which may be present in the adjoining 5 cm of distal ileum • The feeding diverticular artery on the surface of the ileum should be clearly identified and ligated.
- 18.
- 19.
- 20.