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  • Meckel’s Diverticulum

    Definition

    Meckel’s diverticulum is the most common problem that occurs in the digestive system. This condition happens when a pouch of tissue forms on the wall of the lower part of your small intestine (also known as your bowel).
    It is a congenital defect, meaning that you are born with it.
    Meckel’s diverticulum is a rather common condition, occurring in 1 out of every 50 people. However, it is often difficult to diagnose. Some people with Meckel’s diverticulum never have any symptoms. Others may have symptoms that are mistaken for other disorders such as appendicitis (an inflammation of the appendix) or a peptic ulcer (sore on the stomach lining).
    Meckel’s Diverticulum
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    Causes

    The pouch is believed to be the remains of your umbilical cord and intestines when you were a fetus in your mother’s womb. Usually, these parts are reabsorbed back into your body before birth, but if you have Meckel’s diverticulum, your body did not reabsorb this tissue.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chances of developing Meckel’s diverticulum. If you have any of these risk factors, tell your doctor:
    • Gender—Meckel’s diverticula occur equally in both men and women; however, men are more likely than women to experience complications.
    • Age—Complications from Meckel’s diverticula can occur at any age; however, they are more likely to occur in infants and children.

    Symptoms

    Although many people have Meckel’s diverticulum, only half experience any problems. The problems differ depending on your age. Most who develop symptoms are under the age of 10.
    In infants and children, the most common complication is bleeding in the intestines, which may or may not be visible in the stool. Invisible bleeding may be found on repeated stool sample tests. Persistent bleeding can eventually lead to iron deficiency anemia , which may be the first sign of the problem.
    Another complication occurs when a diverticulum becomes infected and inflamed, a condition known as Meckel's diverticulitis. The symptoms and signs are essentially indistinguishable from acute appendicitis and require prompt medical attention.
    If you have any of these symptoms, do not assume it is due to Meckel’s diverticulum. These symptoms may be caused by other, less serious or more serious health conditions. If you experience any one of them, see your physician.

    Diagnosis

    Meckel’s diverticulum is rarely diagnosed in the absence of complications like bleeding. Fecal occult blood testing (also known as a stool guaiac testing) can be used to detect the presence of hidden (occult) blood in the stool. Your doctor may also order a blood test to check for low hematocrit or hemoglobin (which would indicate anemia ). Neither of these tests, though, can determine the source of bleeding.
    If your doctor suspects bleeding from a Meckel’s diverticulum, he or she may order a technetium-99m pertechnetate scan (also called a Meckel scan). To perform this test, technetium-99m pertechnetate, a radioactive material, is injected into a vein in your arm. In the presence of Meckel’s diverticulum (particularly one that is actively bleeding), the radioactive material will be detected using a special camera positioned outside the body.
    Sometimes, a small bowel series can find Meckel’s diverticulum. Barium is a liquid used to coat the inside of your digestive tract so it becomes visible during an x-ray. After swallowing a quantity of barium, a series of x-rays may show the barium enter the diverticulum as it passes through the small intestine.
    If the diagnosis cannot be made by other means, your doctor may perform a laparoscopy . In this procedure, the contents of your abdomen can be examined through a laparoscope—a long, thin tube with a camera lens attached that is inserted through a tiny incision in the abdominal wall. If Meckel’s diverticulum is found, the laparoscope can be used to remove it (see below).

    Treatment

    If you are experiencing complications, such as bleeding, your doctor will likely recommend surgical removal of your Meckel’s diverticulum. In many cases, the surgery can be performed via a laparoscopy. Once the diverticulum is identified, your doctor can remove it by inserting surgical instruments through other similarly sized incisions.
    If the condition is discovered incidentally and is not giving you any trouble, some surgeons recommend prophylactic removal, surgical removal to prevent future complications.

    Prevention

    There is nothing that you can do to prevent developing Meckel’s diverticulum. It is a congenital defect, meaning you are born with it.

    RESOURCES

    American Family Physician http://www.aafp.org/online/en/home.html/

    National Institute of Diabetes and Digestive Disorders http://www.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Association of Gastroenterology http://www.cag-acg.org/

    North American Society for Pediatric Gastroenterology http://www.naspghan.org/

    References

    Cullen JJ, Kelly KA, Moir CR, et al. Surgical management of Meckel’s diverticulum. An epidemiologic population-based study. Ann Surg . 1995; 222:568-569.

    DynaMed Editorial Team. Meckel diverticulum. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 30, 2009. Accessed November 10, 2010.

    Lin S, Suhocki PV, Ludwig KA, et al. Gastrointestinal bleeding in adult patients with Meckel’s diverticulum: The role of technetium 99m pertechnetate scan. South Med J . 2002;95:1338-1341.

    Martin JP, Connor PD, Charles K. Meckel’s diverticulum. Am Fam Physician . 2000; 16:1037.

    Meckel’s diverticulum: patient information. Am Fam Physician . 2000;16:1044.

    Meckel’s diverticulum: review and management. Am Fam Physician . 2001;64:2000.

    Merck Manual. Meckel’s diverticulum. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/section19/chapter268/268d.jsp . Accessed August 16, 2005.

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