Mekel’s diverticulum
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Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It results from incomplete obliteration of the vitelline duct during fetal development. It contains all three layers of the small intestine and often contains heterotopic gastric or pancreatic tissue. Symptoms are rare but can include painless rectal bleeding, intestinal obstruction, or diverticulitis. Diagnosis is often made through imaging tests like a Meckel's scan or CT scan. Surgery to remove the diverticulum is recommended if it is symptomatic or complicated.
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Merkel's diverticulum
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, affecting approximately 2% of the population. It is a true diverticulum that forms from incomplete closure of the vitelline duct during fetal development. Meckel's diverticulum can contain heterotopic gastric or pancreatic tissue which can lead to ulceration and bleeding. Clinical presentations include hemorrhage, intestinal obstruction, diverticulitis, and intussusception. Diagnosis is often made through scans like a Meckel's scan or CT scan, and treatment involves surgical resection of the diverticulum.
Meckel's Diverticulum
Meckel's diverticulum is the most common congenital anomaly of the small bowel. It is a remnant of the vitelline duct that normally disappears during fetal development. Meckel's diverticulum occurs in approximately 2% of the population and is located in the ileum about 2 feet from the ileocecal junction. It can contain ectopic gastric, pancreatic, or colonic mucosa. While often asymptomatic, complications can include bleeding, diverticulitis, intestinal obstruction, and intussusception. Treatment of symptomatic Meckel's diverticulum involves surgical resection of the diverticulum through open or laparoscopic surgery.
Meckel's diverticulum
Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct that connects the fetal intestine to the umbilical cord. It is the most common congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the population. Meckel's diverticulum can occur anywhere along the small intestine but is usually located about 2 feet from the ileocecal valve. It often contains heterotopic or abnormal tissue such as gastric or pancreatic cells. Symptoms generally occur in children under 2 years of age and include bleeding, intestinal obstruction, or diverticulitis. Diagnosis can be made through scintigraphy or surgery is usually recommended for symptomatic cases.
Mekelsdiverticulum.
The document summarizes Meckel's diverticulum, which is the most common congenital abnormality of the gastrointestinal tract. It arises from incomplete obliteration of the vitelline duct during fetal development. Key points include:
- Meckel's diverticulum contains all three layers of the bowel and can contain ectopic gastric or pancreatic tissue.
- It is usually found within 2 feet of the ileocecal valve and is symptomatic in only about 2% of adults but more commonly in children under 2 years old.
- Common presentations include bleeding, intestinal obstruction, diverticulitis, and intussusception. Bleeding can be caused by ulceration from acidic secretions of
Rectal Prolapse
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-Dr. Prashant Sharma
MS, General Surgery, JNMC Belagavi
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OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Meckelsdiverticulum
Meckel's diverticulum is a small bulge in the small intestine present at birth that occurs in around 2% of the population. It is a remnant of fetal tissue and can cause symptoms like painless rectal bleeding. Diagnosis is often made using a Meckel's scan to detect ectopic gastric mucosa tissue. Treatment involves surgical resection of the affected part of the bowel.
Femoral hernia
Femoral hernias occur when abdominal contents protrude through the femoral canal in the groin. They are less common than inguinal hernias but more common in females, especially multiparous women. Contents can include fat, lymphatics, and the lymph node of Cloquet. Femoral hernias are often missed on examination and can become obstructed or strangulated, causing pain, tenderness, and vomiting. Surgical repair options include open techniques like the Lockwood Low operation through a transverse incision or laparoscopic approaches using mesh.
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Merkel's diverticulum
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, affecting approximately 2% of the population. It is a true diverticulum that forms from incomplete closure of the vitelline duct during fetal development. Meckel's diverticulum can contain heterotopic gastric or pancreatic tissue which can lead to ulceration and bleeding. Clinical presentations include hemorrhage, intestinal obstruction, diverticulitis, and intussusception. Diagnosis is often made through scans like a Meckel's scan or CT scan, and treatment involves surgical resection of the diverticulum.
Meckel's Diverticulum
Meckel's diverticulum is the most common congenital anomaly of the small bowel. It is a remnant of the vitelline duct that normally disappears during fetal development. Meckel's diverticulum occurs in approximately 2% of the population and is located in the ileum about 2 feet from the ileocecal junction. It can contain ectopic gastric, pancreatic, or colonic mucosa. While often asymptomatic, complications can include bleeding, diverticulitis, intestinal obstruction, and intussusception. Treatment of symptomatic Meckel's diverticulum involves surgical resection of the diverticulum through open or laparoscopic surgery.
Meckel's diverticulum
Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct that connects the fetal intestine to the umbilical cord. It is the most common congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the population. Meckel's diverticulum can occur anywhere along the small intestine but is usually located about 2 feet from the ileocecal valve. It often contains heterotopic or abnormal tissue such as gastric or pancreatic cells. Symptoms generally occur in children under 2 years of age and include bleeding, intestinal obstruction, or diverticulitis. Diagnosis can be made through scintigraphy or surgery is usually recommended for symptomatic cases.
Mekelsdiverticulum.
The document summarizes Meckel's diverticulum, which is the most common congenital abnormality of the gastrointestinal tract. It arises from incomplete obliteration of the vitelline duct during fetal development. Key points include:
- Meckel's diverticulum contains all three layers of the bowel and can contain ectopic gastric or pancreatic tissue.
- It is usually found within 2 feet of the ileocecal valve and is symptomatic in only about 2% of adults but more commonly in children under 2 years old.
- Common presentations include bleeding, intestinal obstruction, diverticulitis, and intussusception. Bleeding can be caused by ulceration from acidic secretions of
Rectal Prolapse
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-Dr. Prashant Sharma
MS, General Surgery, JNMC Belagavi
Karnataka
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#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Meckelsdiverticulum
Meckel's diverticulum is a small bulge in the small intestine present at birth that occurs in around 2% of the population. It is a remnant of fetal tissue and can cause symptoms like painless rectal bleeding. Diagnosis is often made using a Meckel's scan to detect ectopic gastric mucosa tissue. Treatment involves surgical resection of the affected part of the bowel.
Femoral hernia
Femoral hernias occur when abdominal contents protrude through the femoral canal in the groin. They are less common than inguinal hernias but more common in females, especially multiparous women. Contents can include fat, lymphatics, and the lymph node of Cloquet. Femoral hernias are often missed on examination and can become obstructed or strangulated, causing pain, tenderness, and vomiting. Surgical repair options include open techniques like the Lockwood Low operation through a transverse incision or laparoscopic approaches using mesh.
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Testicular torsion refers to twisting of the spermatic cord and loss of blood supply to the testicle. It is a urological emergency as early diagnosis and treatment are needed to save the testicle. Ultrasound with Doppler is the primary imaging method and shows absent or decreased blood flow in the affected testicle compared to the normal side. Prompt surgical detorsion and orchioplexy are the definitive treatments.
Femoral Hernia
Femoral hernias occur when abdominal contents protrude through the femoral ring into the femoral canal. They are more common in elderly women and often present without a visible lump. Half of patients are unaware of the hernia prior to strangulation. Treatment involves surgical repair via open or laparoscopic surgery to reduce hernia contents and reinforce the femoral ring with sutures or mesh. Complications are higher if the hernia is incarcerated or strangulated at time of emergency surgery. With elective repair, prognosis is generally good with low recurrence rates.
Meckel’s diverticulum
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, occurring in approximately 2% of the population. It results from incomplete obliteration of the vitelline duct during fetal development. While most cases are asymptomatic, Meckel's diverticulum can cause complications like bleeding, diverticulitis, intestinal obstruction, and intussusception due to heterotopic gastric or pancreatic tissue. Diagnosis is often made through scans like a technetium-99m pertechnetate scan or CT scan. Treatment involves surgical resection of the diverticulum and adjacent bowel segment for symptomatic cases.
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Abdominal surgery and stomas are discussed, including:
- Common abdominal procedures for colorectal cancer like right/left hemicolectomy and anterior resection are described.
- Complications of surgery like anastomotic leaks and paralytic ileus are also covered.
- Stomas, specifically ileostomies and colostomies, are defined as ways to divert feces after removal of part of the colon and rectum. Differences between ileostomies and colostomies and potential complications are outlined.
Acute appendicitis
This document discusses the anatomy, clinical presentation, diagnosis, and treatment of acute appendicitis. It notes that the appendix is considered a vestigial organ but can be important in surgery. Acute appendicitis is commonly caused by obstruction of the lumen. Clinical features include pain shifting to the lower right abdomen, anorexia, nausea, and fever. Diagnosis involves blood tests, urine analysis, and imaging like ultrasound or CT scan. Treatment is typically open or laparoscopic appendicectomy. Complications can include perforation, infection, or abscess. Conservative treatment with antibiotics may be used for appendicular masses.
Appendicitis
This document summarizes appendicitis, including the anatomy of the appendix, aetiology, clinical presentation, diagnosis, and treatment. Key points include:
- The appendix is a tubular structure located in the lower right abdomen that can become inflamed (appendicitis).
- Appendicitis is caused by obstruction of the appendix lumen, often by a fecolith. Common symptoms include abdominal pain that starts around the navel and moves lower.
- Diagnosis is usually clinical but can be supported by blood tests showing leukocytosis and imaging like CT scans. Treatment involves intravenous fluids, antibiotics, and an appendectomy to remove the appendix.
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This document discusses Vitello-intestinal duct anomalies including Meckel's diverticulum. Meckel's diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2% of the population. It can cause hemorrhage, intestinal obstruction, or diverticulitis. Investigations like USG, CT, and 99m Tc scans can help detect Meckel's diverticulum. Treatment involves resection of symptomatic diverticula with adjacent ileum, while asymptomatic cases may be resected or left alone.
Obstructed & stragulated hernia1
Strangulated inguinal hernias occur when herniated tissue becomes trapped within the hernia sac, cutting off blood flow. This can lead to tissue death. Symptoms include swelling, pain, and signs of bowel obstruction. Diagnosis is usually made through surgical exploration, which may involve bowel resection. While tension-free mesh repairs have been successfully used in strangulated hernias, non-mesh techniques are generally preferred due to the risk of mesh infection in contaminated fields. Proper surgical technique and mesh choice can help reduce infection risks for tension-free repairs in strangulated hernias.
duodenal atresia
This document provides an overview of duodenal atresia, including its definition, epidemiology, etiology, clinical features, diagnosis, management, complications, and differential diagnosis. Duodenal atresia is a congenital absence or closure of part of the duodenum due to defective fusion during development. It commonly presents after birth with vomiting, jaundice, and abdominal distension. Diagnosis is typically made through imaging findings like the "double bubble" sign on x-ray. Surgical management involves bypassing the blocked portion of duodenum through procedures like duodenoduodenostomy. Complications can include anastomotic issues or problems from associated anomalies.
Complications of cholecystitis
This document summarizes the complications of acute and chronic cholecystitis. For acute cholecystitis, complications include perforation of the gallbladder fundus or neck, which can lead to fistula formation connecting the gallbladder to nearby structures. Other complications include peritonitis, abscesses, empyema, sepsis, and gangrenous gallbladder. Chronic cholecystitis complications include common bile duct obstruction, cholangitis, pancreatitis, and Mirizzi syndrome, where gallstones compress and damage the gallbladder and common bile duct walls.
Congenital hernia and hydrocele
A hernia is a protrusion of an organ through an opening, while a hydrocele is a fluid collection in the tunica vaginalis sac around the testes. During fetal development, the processus vaginalis allows the testes to descend through the inguinal canal. Normally this canal closes after birth, but if it remains patent it can lead to a hernia or hydrocele. Hernias appear as reducible inguinal swellings that increase with crying or coughing. Hydroceles cause scrotal swelling that varies with the day and is not reducible. Clinical diagnosis is sufficient, and hernias are usually repaired early to prevent complications while hydroceles may sometimes resolve on their own
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SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
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This document discusses rectal prolapse and various surgical treatments. It provides details on:
1) Types of rectal prolapse including full thickness, mucosal, and internal prolapse.
2) Common anatomical abnormalities that can cause rectal prolapse like a deep pouch of Douglas or lax muscles.
3) Investigations used to evaluate rectal prolapse like imaging, sigmoidoscopy, and manometry.
4) Goals of treatment include controlling the prolapse, restoring bowel function and continence, and preventing recurrence.
5) Numerous surgical procedures are described ranging from perineal to abdominal approaches, with recurrence rates varying from 0-38% depending on the
Meckel’s diverticulum
This document describes a case of a 12-year-old female who presented with abdominal pain and signs of peritonitis. She underwent an exploratory laparotomy which revealed a Meckel's diverticulum with gastric mucosa and a jejunal perforation. She had a complicated postoperative course requiring a second surgery. Meckel's diverticulum is a common congenital abnormality caused by incomplete vitelline duct obliteration. It can contain heterotopic gastric or pancreatic mucosa and commonly presents in children with GI bleeding. Surgical resection is often required for complications like perforation or obstruction.
Meckel diverticulum
Meckel diverticulum is a congenital abnormality caused by persistence of the omphalomesenteric duct, which normally disappears by gestational week 9. It occurs in about 2% of the population and is most common in children under age 2. Complications include bleeding from ulceration caused by ectopic gastric tissue, intestinal obstruction, and diverticulitis. Symptoms include painless rectal bleeding in infants and intestinal obstruction presenting as vomiting and abdominal distension in newborns. Diagnosis involves scans concentrating isotopes in ectopic gastric mucosa or x-rays showing dilated bowel loops. Surgical removal of the diverticulum is treatment for complications like bleeding or obstruction.
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Testicular Torsion
Testicular torsion refers to twisting of the spermatic cord and loss of blood supply to the testicle. It is a urological emergency as early diagnosis and treatment are needed to save the testicle. Ultrasound with Doppler is the primary imaging method and shows absent or decreased blood flow in the affected testicle compared to the normal side. Prompt surgical detorsion and orchioplexy are the definitive treatments.
Femoral Hernia
Femoral hernias occur when abdominal contents protrude through the femoral ring into the femoral canal. They are more common in elderly women and often present without a visible lump. Half of patients are unaware of the hernia prior to strangulation. Treatment involves surgical repair via open or laparoscopic surgery to reduce hernia contents and reinforce the femoral ring with sutures or mesh. Complications are higher if the hernia is incarcerated or strangulated at time of emergency surgery. With elective repair, prognosis is generally good with low recurrence rates.
Meckel’s diverticulum
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, occurring in approximately 2% of the population. It results from incomplete obliteration of the vitelline duct during fetal development. While most cases are asymptomatic, Meckel's diverticulum can cause complications like bleeding, diverticulitis, intestinal obstruction, and intussusception due to heterotopic gastric or pancreatic tissue. Diagnosis is often made through scans like a technetium-99m pertechnetate scan or CT scan. Treatment involves surgical resection of the diverticulum and adjacent bowel segment for symptomatic cases.
Colorectal surgery and stomas
Abdominal surgery and stomas are discussed, including:
- Common abdominal procedures for colorectal cancer like right/left hemicolectomy and anterior resection are described.
- Complications of surgery like anastomotic leaks and paralytic ileus are also covered.
- Stomas, specifically ileostomies and colostomies, are defined as ways to divert feces after removal of part of the colon and rectum. Differences between ileostomies and colostomies and potential complications are outlined.
Acute appendicitis
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Appendicitis
This document summarizes appendicitis, including the anatomy of the appendix, aetiology, clinical presentation, diagnosis, and treatment. Key points include:
- The appendix is a tubular structure located in the lower right abdomen that can become inflamed (appendicitis).
- Appendicitis is caused by obstruction of the appendix lumen, often by a fecolith. Common symptoms include abdominal pain that starts around the navel and moves lower.
- Diagnosis is usually clinical but can be supported by blood tests showing leukocytosis and imaging like CT scans. Treatment involves intravenous fluids, antibiotics, and an appendectomy to remove the appendix.
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This document discusses diverticular disease, specifically diverticulosis and acute diverticulitis. It covers the epidemiology, pathophysiology, clinical presentation, investigations including CT and barium enema, differential diagnosis, and Hinchey classification of diverticulitis severity. Diverticulosis is asymptomatic protrusions in the colon wall that become symptomatic as diverticulitis in 20% of cases from obstruction, inflammation, or perforation. Risk factors include low fiber diet and increased age. CT is the best imaging method to diagnose and stage diverticulitis.
Vitello intestine duct anomalies
This document discusses Vitello-intestinal duct anomalies including Meckel's diverticulum. Meckel's diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2% of the population. It can cause hemorrhage, intestinal obstruction, or diverticulitis. Investigations like USG, CT, and 99m Tc scans can help detect Meckel's diverticulum. Treatment involves resection of symptomatic diverticula with adjacent ileum, while asymptomatic cases may be resected or left alone.
Obstructed & stragulated hernia1
Strangulated inguinal hernias occur when herniated tissue becomes trapped within the hernia sac, cutting off blood flow. This can lead to tissue death. Symptoms include swelling, pain, and signs of bowel obstruction. Diagnosis is usually made through surgical exploration, which may involve bowel resection. While tension-free mesh repairs have been successfully used in strangulated hernias, non-mesh techniques are generally preferred due to the risk of mesh infection in contaminated fields. Proper surgical technique and mesh choice can help reduce infection risks for tension-free repairs in strangulated hernias.
duodenal atresia
This document provides an overview of duodenal atresia, including its definition, epidemiology, etiology, clinical features, diagnosis, management, complications, and differential diagnosis. Duodenal atresia is a congenital absence or closure of part of the duodenum due to defective fusion during development. It commonly presents after birth with vomiting, jaundice, and abdominal distension. Diagnosis is typically made through imaging findings like the "double bubble" sign on x-ray. Surgical management involves bypassing the blocked portion of duodenum through procedures like duodenoduodenostomy. Complications can include anastomotic issues or problems from associated anomalies.
Complications of cholecystitis
This document summarizes the complications of acute and chronic cholecystitis. For acute cholecystitis, complications include perforation of the gallbladder fundus or neck, which can lead to fistula formation connecting the gallbladder to nearby structures. Other complications include peritonitis, abscesses, empyema, sepsis, and gangrenous gallbladder. Chronic cholecystitis complications include common bile duct obstruction, cholangitis, pancreatitis, and Mirizzi syndrome, where gallstones compress and damage the gallbladder and common bile duct walls.
Congenital hernia and hydrocele
A hernia is a protrusion of an organ through an opening, while a hydrocele is a fluid collection in the tunica vaginalis sac around the testes. During fetal development, the processus vaginalis allows the testes to descend through the inguinal canal. Normally this canal closes after birth, but if it remains patent it can lead to a hernia or hydrocele. Hernias appear as reducible inguinal swellings that increase with crying or coughing. Hydroceles cause scrotal swelling that varies with the day and is not reducible. Clinical diagnosis is sufficient, and hernias are usually repaired early to prevent complications while hydroceles may sometimes resolve on their own
Sigmoid volvulus/ Generalised abdominal pain
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Rectal prolapse
This document discusses rectal prolapse and various surgical treatments. It provides details on:
1) Types of rectal prolapse including full thickness, mucosal, and internal prolapse.
2) Common anatomical abnormalities that can cause rectal prolapse like a deep pouch of Douglas or lax muscles.
3) Investigations used to evaluate rectal prolapse like imaging, sigmoidoscopy, and manometry.
4) Goals of treatment include controlling the prolapse, restoring bowel function and continence, and preventing recurrence.
5) Numerous surgical procedures are described ranging from perineal to abdominal approaches, with recurrence rates varying from 0-38% depending on the
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This document describes a case of a 12-year-old female who presented with abdominal pain and signs of peritonitis. She underwent an exploratory laparotomy which revealed a Meckel's diverticulum with gastric mucosa and a jejunal perforation. She had a complicated postoperative course requiring a second surgery. Meckel's diverticulum is a common congenital abnormality caused by incomplete vitelline duct obliteration. It can contain heterotopic gastric or pancreatic mucosa and commonly presents in children with GI bleeding. Surgical resection is often required for complications like perforation or obstruction.
Meckel diverticulum
Meckel diverticulum is a congenital abnormality caused by persistence of the omphalomesenteric duct, which normally disappears by gestational week 9. It occurs in about 2% of the population and is most common in children under age 2. Complications include bleeding from ulceration caused by ectopic gastric tissue, intestinal obstruction, and diverticulitis. Symptoms include painless rectal bleeding in infants and intestinal obstruction presenting as vomiting and abdominal distension in newborns. Diagnosis involves scans concentrating isotopes in ectopic gastric mucosa or x-rays showing dilated bowel loops. Surgical removal of the diverticulum is treatment for complications like bleeding or obstruction.
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A 2-year old boy presented with rectal bleeding and abdominal pain. Initial investigations showed anemia. Ultrasound was unremarkable but a Meckel's scan showed evidence of heterotopic gastric mucosa in the abdomen, indicating Meckel's diverticulum. During laparotomy, Meckel's diverticulum was found and resected along with reduction of two intussusceptions. Meckel's diverticulum is a remnant of the embryonic yolk sac that fails to obliterate, located on the ileum. It most commonly presents in children under 2 years old with rectal bleeding. Surgical resection is usually required for symptomatic cases.
Meckel’s diverticulum
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in approximately 2% of the population. It results from the incomplete obliteration of the vitelline duct during embryonic development. While most cases are asymptomatic, complications can include bleeding, intestinal obstruction, or diverticulitis. Symptomatic cases often present with painless rectal bleeding in children or intestinal obstruction in adults. Surgical resection is the treatment for symptomatic diverticula, while the management of asymptomatic cases remains controversial.
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Proceso inflamatorio generalizado o localizado de la
membrana peritoneal (secundaria a una irritacion
química, invasión bacteriana, necrosis local o
de una contusión directa). De cualquiera etiologia, y con extensión o intensidad indeterminada que producen exudación peritoneal ... CONTINUA
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Dear Viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on Meckel’s diverticulum. This is a great imitator because of its varied ways of presentation. It can present as bleeding per rectum, intestinal obstruction, pain abdomen and fecal umbilical discharge. I have discussed the epidemiology, etiology, embryology, clinical features, investigations, differential diagnosis and treatment of Meckel’s diverticulum in this video. Hope you will enjoy the video. You can watch the video in the following links:
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Mekel’s diverticulum
- 1. Meckel’s Diverticulum Ranjit Kumar Makaju
- 2. • It is the congenital diverticulum arising from the antimesenteric border of terminal ileum • During the eighth week of gestation, the omphalomesenteric (vitelline) duct normally undergoes obliteration • Failure or incomplete obliteration of vitelline duct results in some congenital abnormalities, the most common of which is Meckel's diverticulum.
- 4. • Sometimes this diverticulum can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut
- 5. • Most common congenital abnormality of the gastrointestinal tract • Contains all three layers of bowel with independent blood supply • Often contain heterotropic tissue- gastric, occasionally pancreatic • Sometime Meckel’s Diverticulum is found in an inguinal or femoral sac – Littre’s hernia
- 6. Rule of 2’s • 2% of the population • Usually found 2 feet proximal to the ileocecal valve • About 2 inches long • 2 times more common in males than females • Symptomatic mostly before 2 years of age • In adult patients it symptomatic in only about 2%
- 7. Clinical presentations • Majority of Meckel’s diverticuli are clinically silent Symptoms in order of frequencies— a) Severe haemorrhage b) Intussuception c) Meckel’s Diverticulitis d) Chronic peptic ulceration e) Intestinal obstruction
- 8. Pathophysiology • Severe Hemorrhage -painless per rectal bleeding, maroon colored Hemorrhage may be caused by: • Ectopic gastric or pancreatic mucosa: When diverticulum contains embryonic remnants of mucosa of other tissue types. • Secretion of gastric acid or alkaline pancreatic juice from the ectopic mucosa leads to ulceration in the adjacent ileal mucosa i.e. peptic or pancreatic ulcer • Perforation and bleeding from ulcer
- 9. • Meckel’s Diverticulitis Inflammation of the diverticulum can mimic symptoms of appendicitis Diverticulitis results from--- -Peptic ulceration resulting from ectopic gastric mucosa of the diverticulum -Following perforation by trauma or ingested food residue -Luminal obstruction due to tumors, foreign body, causing stasis or bacterial infection
- 10. • During perforation, the symptoms may resemble those of a perforated duodenal ulcer • Whether perforated or not, urgent surgery is required • In non perforated cases, an inflamed diverticulum should be sought as soon as it has been demonstrated that the appendix and fallopian tubes are not at fault
- 11. • Intestinal obstruction Causes— • Volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus • Entrapment of intestine by a mesodiverticular band • Intussusception with the diverticulum acting as a lead point • Stricture secondary to chronic diverticulitis • Tumors e.g. Carcinoid, adenocarcinoma, GIST arising in the diverticulum
- 13. Diagonosis • A technetium-99m (99mTc) pertechnetate scan, also called Meckel scan. positive only when the diverticulum contains associated ectopic gastric mucosa that is capable of uptake of the tracer • Laparoscopy • Enteroclysis/ small bowel enema under fluoroscopy • CT scan • Angiography
- 14. Indications of surgery • When the base is narrow, and lengthy diverticulum • Presence of adhesions or band which may precipitate obstruction, intussusception or volvulus • Symptomatic patients or presence of complications • If it is found in children below 2 years
- 15. Management • Meckelian Diverticulectomy: Meckel’s diverticulum with the broad base should not be amputated and invaginated A linear stapler device may be used. If induration of base, hetrotropic gastric tissue extending to adjacent ileum is present then- short segment of ileum is resected and end to end anastomosis is done restoring the continuity
- 18. Thank you
Editor's Notes
- the narrowed connection between the intraembryonic gut and the yolk sac
- As the vitelline duct is made up of pluripotent cell lining, Meckel’s diverticulum may harbor abnormal tissues, containing embryonic remnants of other tissue types.
- Inflammation of this Meckel's diverticulum may mimic appendicitis. Therefore during appendectomy, ileum should be checked for the presence of Meckel's diverticulum
- it can be attached to the umbilical region by the vitelline ligament, The mesodiverticular band is an embryologic remnant of the vitelline circulation
- Radionuclide scans (99mTc-pertechnetate) can be helpful in the diagnosis of Meckel's diverticulum; this test is, however, positive only when the diverticulum contains associated ectopic gastric mucosa that is capable of uptake of the tracer Enteroclysis is associated with an accuracy of 75%, but usually is not applicable during acute presentations of complications related to Meckel's diverticula Angiography can localize the site of bleeding during acute hemorrhage related to Meckel's diverticula