Internal Medicine

Meckel's diverticulum

Synonyms

Synonyms

Meckel's diverticulum, diverticulum ilei

Definition / introduction

At a Meckel's diverticulum is it a Protuberance (Diverticulum) of Ileum (Ileum) or des Jejunum (Jejunum). This protuberance comes from the embryonic development and provides one Holdover (Relic) des Yolk ducts (Omphaloenteric duct) represent.

Of the Yolk duct is the embryonic Connection between the yolk sac and the intestinal tube and usually (physiologically) regresses in the womb (more precisely in the 6th embryonic week). As a rule, Meckel's diverticulum is around in the last 30-60cm of the small intestine.

causes

The reason for the development or persistence of Meckel's diverticulum lies in one poor regression of that applied in embryonic development Yolk ducts (Omphaloenteric duct).

diagnosis

In a laparoscopy, the abdominal cavity or organs are viewed from the inside with an endoscope.

Since only about 2% of the affected patients complain due to a Meckel's diverticulum, this intestinal protuberance is usually the case random in an open abdominal surgery (laparatomy) or a Laparoscopy (Laparoscopy) found.

However, if there are unclear complaints in the abdominal area, a Meckel's diverticulum should always be ruled out during open abdominal surgery.

Another important method for diagnosing Meckel's diverticulum is the Scintigraphy in this procedure will be radioactive substances (in this case sodium pertechnetate) introduced into the body, which is in the displaced (ectopic) To accumulate gastric mucosa in the area of Meckel's diverticulum and thus represent the intestinal protuberance.

Other imaging techniques like that CT or MRI are not groundbreaking and are rarely used if a Meckel's diverticulum is suspected. An MRI according to Sellink in particular can diagnose a Meckel's diverticulum. Here, an MRI is performed after oral contrast agent administration.
This becomes visible through the contrast medium uptake of the diverticulum.

Frequency distribution

At about 1.5-2% of the population a Meckel's diverticulum can be found. About 60% of patients are Infants under 2 years of age, in which Boys about twice as often are affected like girls.

Symptoms

One complication of Meckel's diverticulum is bowel obstruction (ileus), which causes sudden abdominal pain.

Usually, Meckel's diverticulum does not cause any symptoms. At about 2 % however, the sufferer may experience symptoms similar like appendicitis (appendicitis) occur. The complaints are caused by a inflammation in the area of Meckel's diverticulum due to pent-up intestinal contents, which are a breeding ground for bacteria and represents other germs. The symptoms range from fever, nausea and Vomit to strong ones Pain in the right half of the abdomen.

At about 30-50% of patients can be found in the area of Meckel's diverticulum instead of the normally occurring small intestinal mucosa Gastric mucosa be detected. Because the lining of the stomach has glands that emit acid to the inside of the stomach digestion to stimulate and fight germs, acid can now also develop on the gastric mucosa in the area of Meckel's diverticulum. Consequently, the intestinal lining becomes aggressive through the Stomach acid attacked and the development of intestinal mucosal defects (Ulcers) with bleeding, intestinal perforations (Perforations) and Inflammation of the peritoneum (Peritonitis) is favored. In the worst case, due to the rupture of the intestine and the spread of intestinal germs in the normally sterile abdomen, a so-called "Acute abdomen"Arise in which there is severe pain, fever and a reduced general condition comes. This can ultimately cause the germs to spread throughout the body via the blood (sepsis) and one shock to lead.

Another complication that can arise with a Meckel's diverticulum is the so-called Intussusception, in which there is invaginations of the intestinal wall in the area of the Meckeldivertikels. The consequences are a disruption of the blood supply to the corresponding section of the intestine and water retention (Edema) into the intestinal wall. Symptoms in children arise from perfect health and are equivalent to those of one Intestinal obstruction (Ileus): sudden severe abdominal pain, Vomit, paleness, high-pitched cries of the babies, bloody, slimy stool and cylindrical hardening of the intestine. In adults, these symptoms usually develop slowly over a longer period of time and finally culminate in a partial or complete intestinal obstruction (ileus).

In addition, a Intestinal obstruction (Ileus) also arise from the fact that the The intestine is pinched between Meckel's diverticulum and the navel by a cord of connective tissue becomes (so-called Bridenileus). The complaints are characterized by violent, cramping abdominal pain (Colic) and other more unspecific symptoms such as Vomit, Stool retention, diarrhea or a strong one General condition deterioration.

therapy

It is not clear whether an oerative removal of Meckel's diverticulum is absolutely necessary, but one is on the safe side with its removal.

The treatment of Meckel's diverticulum lies in the operative removal the intestinal wall sac (Resection). This should be done both in the event of complaints and if an incidental finding occurs during another abdominal operation. Although the opinions of doctors differ when it comes to the question of whether removal is necessary if there is no symptoms, it is clear that inflammation, bleeding and other complaints can be caused by a Meckel's diverticulum and that removal of the diverticulum is safe Side is.

As a further therapy option, there is the possibility of reducing the bleeding or inflammation complications caused by the Acid formation within the dislocated stomach lining in the area of Meckel's diverticulum can arise with the ingestion of so-called Proton pump inhibitors (PPI) to fight.

prophylaxis

In order not to overlook undiscovered diverticula and thus not to be responsible for possible complications that can arise from a Meckel's diverticulum every abdominal surgery the corresponding intestinal area is searched for a possible Meckel's diverticulum.

forecast

A Meckel's diverticulum usually has one good prognosis. However, depending on the course and complications that occur, this can get significantly worse. For example, if the diverticulum is not recognized in time and Complications intervened, it can lead to life-threatening clinical pictures such as one Blood poisoning (sepsis) come.