Definition

Meckel's diverticulum is a congenital anomaly characterized by the presence of an outwardly protruding sac in the distal portion of the small intestine. This sac is the residual portion of the umbilical cord. Meckel's diverticulum is a common congenital abnormality of the gastrointestinal tract. The prevalence of Meckel's diverticulum is estimated to be around 2-3% among the general population. This disease typically develops during the embryonic period, specifically between the fifth and seventh weeks of gestation, and can only be detected postnatally.

Despite its frequent occurrence, this condition rarely manifests symptoms. Numerous individuals are unaware they have had Meckel's diverticulum for their lifetimes. Although Meckel's diverticulum can manifest in males and females, the risk of complications is two to three times greater in males. Ulcers or ulcers of the small intestine may develop in certain infants, leading to the manifestation of bleeding and inflammation. In addition, obstruction in the small intestine is also possible.

Causes

Meckel's diverticulum manifests during the early stage of fetal development throughout pregnancy. After seven weeks of gestation, the fetus typically absorbs the vitelline duct, which connects the fetus to the yolk sac. Meckel's diverticulum may develop if the neonate fails to fully digest the vitelline duct. The average length of Meckel's diverticulum is 5 centimeters (2 inches).

Meckel's diverticulum is composed of cells from the stomach and pancreas. The production of stomach acid by gastric cells has the potential to induce ulceration, leading to gradual hemorrhage within the gastrointestinal tract. Symptoms may ensue if this occurs. Anemia or a deficiency of red blood cells may develop in individuals with Meckel's diverticulum if the hemorrhage persists untreated.

Risk factor

No information is available regarding risk factors for Meckel's diverticulum. No familial or genetic factors contribute to the development of this disease. However, compared to adults, infants and adolescents are at a greater risk of developing complications. Most symptomatic instances, exceeding 50%, manifest in children below two. With age, the risk of complications diminishes. Most of the time, Meckel's diverticulum is seen along with other birth defects, such as anorectal malformations (where the anus and rectum do not grow properly), esophageal atresia (where the esophagus does not grow at all), omphalocele (where organs stick out of the stomach), Crohn's disease, and neurological and cardiovascular defects.

Symptoms

The symptoms of Meckel's diverticulum typically manifest within the first year of life; however, they can develop throughout adulthood. The following symptoms are included:

• Gastrointestinal bleeding (visible in the patient's stool or feces). The color of children's excrement often ranges from bright red (35%) to dark red (40%), and in some cases, it might seem black like tar (7%).
• Nausea and vomiting
• Abdominal pain
• Navel pain
• The term "obstructive ileus" describes an obstruction in the digestive tract that prevents food from digesting. This can lead to gastrointestinal pain and, if prolonged, can end in a medical emergency.
• Diverticulitis refers to the inflammation of the intestinal wall.
• Pale due to anemia

Gastric acid secreted by cells in Meckel's diverticulum causes ulcer-induced bleeding or ulcers to develop in the small intestine, which are typical symptoms in children under five. At the onset, gastric acid will irritate the intestinal wall, resulting in minor lacerations and imperceptible hemorrhaging. The child may develop bloody stools if the laceration remains untreated and enlarges. These symptoms may manifest intermittently or not consistently during defecation.

Diagnosis

Diagnosing Meckel's diverticulum can be extremely challenging because its symptoms, such as vomiting, abdominal discomfort, and a sensation of warmth in the stomach, can also occur in other medical conditions. If your child exhibits symptoms suggestive of Meckel's diverticulum, the doctor will recommend a series of tests to establish a definitive diagnosis. These examinations may include:

• Complete blood count is performed to assess the presence of anemia or infection.
• Technetium scan is a diagnostic procedure that involves the injection of the radioactive chemical technetium (99 m) into the body for scanning purposes. The stomach cells comprising the diverticulum will assimilate this material, enabling its visualization during an x-ray scan.
• Colonoscopy is a diagnostic procedure in which a tube equipped with a camera is inserted into the rectum or colon to visualize and identify obstructions or sources of bleeding.
• Wireless capsule endoscopy is a diagnostic procedure in which a small camera is ingested orally to visualize the origin of bleeding in the upper gastrointestinal system. If your child cannot ingest the capsule due to their early age, the doctor can administer anesthesia to the child.
• CT-scan imaging. During the CT scan, Meckel's diverticulum appears as an air-filled sac in the small intestine.

Management

A lot of people with Meckel's diverticulum remain asymptomatic. Meckel's diverticulum is frequently unintentionally identified in this demographic through an abdominal examination or surgical procedure. With this condition, additional treatment is not required.

If bleeding occurs, symptomatic patients may require diverticulum removal surgery. Each end will be sutured after removing Meckel's diverticulum and surrounding small intestine. This can be done laparoscopically or openly. By putting a short tube-shaped camera around the diverticulum, laparoscopy makes multiple small stomach skin incisions. Considering your child's symptoms, age, and medical condition, your doctor will choose the appropriate surgery. The doctor will prescribe iron if bleeding causes anemia.

Complications

Meckel's diverticulum has a positive prognosis. Patients can achieve full recovery following surgery. Nevertheless, other potential difficulties may develop, such as:

• Hemorrhaging resulting from untreated ulcers in the small intestine. Hemorrhaging can lead to the development of anemia and perhaps result in shock.
• An obstruction is present due to the diverticulum's cause of scar tissue. In the case of Meckel's diverticulum, the presence of food and stomach acid in the diverticulum sac can impede the normal flow of food through the small intestine.
• Peritonitis occurs when there is a perforation or injury to the small intestine.
• Intussusception is a medical disorder characterized by the telescoping or invagination of one segment of the intestine into another.
• Carcinoid tumors with a slow rate of growth.

Prevention

Prevention of Meckel's diverticulum is impossible; however, early detection can prevent complications. If you or your child exhibits the aforementioned symptoms, seek medical attention at the nearest healthcare facility for further evaluation. The symptoms of Meckel's diverticulum are nonspecific and may manifest in various digestive disorders. Hence, further examination must be conducted to validate the diagnosis.

When to see a doctor?

If your child exhibits symptoms of diverticulum, such as abdominal pain and bloody feces, it is essential to seek medical evaluation at the nearest healthcare center promptly.

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