Meckel's Diverticulum: Causes, Symptoms, Risk Factors, Diagnosis, Differential Diagnosis, Treatment and Complications

A Meckel's diverticulum is a protrusion or bulge in the lower part of the small intestine. The defect is congenital (present at birth). Meckel's diverticulum is the most prevalent congenital malformation in the gastrointestinal tract. It affects 2% to 3% of the overall population.

Early in pregnancy, a fetus develops a Meckel's diverticulum. The vitelline duct also known as the omphalomesenteric duct , which connects the growing fetus with the yolk sac, is frequently incorporated into the fetus by the seventh week of pregnancy. When the vitelline duct is not entirely absorbed, a Meckel's diverticulum arises.

A Meckel's diverticulum may contain stomach and pancreatic cells. Stomach cells have the capacity to release acid, which can cause ulcers and bleeding.

What Are The Causes Of Meckel's Diverticulum?

Meckel diverticulum develops when the omphalomesenteric duct, which connects the developing embryo's yolk sac to its stomach, is largely damaged. The placenta provides nutrition as the baby grows. In the seventh week of pregnancy, the duct and intestine separate.

Failure of the duct to partially or completely split and involute can result in an omphalomesenteric cyst, an omphalomesenteric fistula that drains via the umbilicus, or a fibrous band from the diverticulum to the umbilicus that can obstruct the duct. In the absence of any additional attachment, it grows into a Meckel diverticulum.

Conveniently, a Meckel diverticulum has been described as following the "rule of 2s". It affects 2% of newborns and is the most prevalent congenital GI abnormality.It is typically 2 inches long and situated in the ileum around 2 feet away from the ileocecal valve. Men experience it twice as frequently.

It may contain either pancreatic or gastric tissue. Because it has every layer of the small intestinal wall, it is a real diverticulum. Ectopic tissue can occasionally be found inside the diverticulum's walls. The ectopic tissue's embryonic origin is a mystery. According to estimates, the diverticulum in 15% of patients will contain ectopic tissue.

What Are The Symptoms Of Meckel's Diverticulum?

Meckel's diverticulum symptoms can manifest as late as adulthood but typically present during the first year of life.

Here are several signs:

• Bleeding from the stomach or intestines, which is visible in the feces.
• Soreness and cramping in the abdomen.
• The belly button area is tender.
• A blockage that prevents the intestines' contents from flowing through the bowels is called a bowel obstruction. It may also result in nausea, vomiting, diarrhea, bloating, and constipation.
• The intestinal wall swelling condition known as diverticulitis.
• Children under the age of five typically experience bleeding, which is brought on by ulcers that form in the small intestine as a result of the diverticulum secreting stomach acid. In adults and older children, bowel blockage is more common.

What Are The Risk Factors For  Meckel's diverticulum?

Diverticulitis can happen at any age, but it most frequently affects older children. Although rare, tumors are a rare symptom of Meckel's diverticulum and can mostly be found in adults.

You should consult your pediatrician or other healthcare professional right away if your child exhibits any of the aforementioned symptoms.

How Is  Meckel's Diverticulum Diagnosed?

Meckel's diverticulum can be challenging to diagnose. Many of the symptoms, including nausea, stomach discomfort, and soreness, might be present in a number of different diseases.

Your child's doctor may order specific tests if they believe the collection of symptoms points to Meckel's diverticulum. These incorporate:

• Technetium scan: This examination is a scan. Injections of radioactive technetium are administered to patients. A specialized camera can identify this material, which is taken up by stomach cells in the diverticulum.
• Colonoscopy: In this test, a small, flexible tube with a camera on the end is introduced into the colon and rectum to check for blockages and the source of bleeding.
• Wireless capsule endoscopy: During this examination, the patient ingests a tiny camera that can look for small intestine bleeding. When your child is sleeping, a drug that your child can't swallow can be given intravenously.

What Is The Differential Diagnosis Of Meckel's Diverticulum?

Any cause of GI bleeding is included in the wide-ranging differential diagnosis. Children rarely experience severe GI bleeding. Children who eat spinach, bismuth, or iron may mistake their stools for hematochezia. The stool will test negative according to a hemoccult test. 

Rectal bleeding in babies can frequently be brought on by milk protein allergy, swallowed maternal blood from bleeding nipples, intussusception, and anal fissures. In neonates and premature newborns, necrotizing enterocolitis should be considered. Colitis, gastroenteritis, HSP, HUS, intussusception, inflammatory bowel disease, and vascular malformation are additional prevalent conditions that result in rectal bleeding in older children.

What Is The Treatment Of Meckel’s Diverticulum?

Meckel's diverticulum is common in adults, although men never experience any symptoms. It isn't until after surgery or tests for another condition that they find out they have the condition. Meckel's diverticulum doesn't typically need to be treated in this situation.

In the event that bleeding occurs, diverticulum removal surgery may be advised. In this treatment, the Meckel's diverticulum and surrounding small intestine are excised, and the ends of the remaining intestines are stitched together.

Open abdominal surgery or laparoscopic procedures (where the Meckel's diverticulum is repaired through a second small incision after a narrow tube with a camera is placed through one small incision) can be used to do this. Taking into account your child's symptoms, age, and general health, your doctor can advise you on the best course of action.

What Are The Complications Of Meckel's Diverticulum?

Rectal bleeding that causes anemia is the most frequent Meckel diverticulum problem in children. A small bowel blockage is the adult problem that occurs most frequently. The diverticulum may serve as the lead point in an intussusception in which the omphalomesenteric band, an internal hernia, a volvulus around the remnants of the vitelline duct, or another condition. Diverticulitis with perforation and peritonitis (Meckel diverticulitis) can occur when the diverticulum becomes inflamed.

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