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Meckel Diverticulum: A Review
- 1. Meckel Diverticulum Ms. Anna Brown Shri Venkateshwara University Gajraula.UP
- 2. Introduction • Meckel diverticulum is a remnant of the fetal omphalomessentric duct that connected the yolk Sac with a primitive midgut during fetal life. • Normally, this is structure, is obliterated by the seven to eight weeks of gestation when the placenta replace the yolk sac as a source of nutrition for the fetus. • Failure of obliteration may result in omphalomesenteric fistula (a fibrous band, connecting the small intestine to umbilicus, known as Meckel diverticulum).
- 3. • Meckel diverticulum is true diverticulum because it arises from antimesenteric border of the small intestine and all layer of the intestinal wall are present • The diverticulum is usually found within 100 cm (40 inches) of ileocecal valve, and average 1 to 10, cm in length. Incedence • Meckel diverticulum is the most common congenital malformation of GI. • It is present in 1% to 3% of population. • It is twice as common in male as in females and • Complications are several times more frequent in males. • Most symptomatic case are seen in childhood.
- 4. Pathophysiology • The symptomatic, complication of meckel diverticulum are caused by: • bleeding obstruction or inflammation. • Gastric mucosa is common ectopic tissue found in meckel diverticulum • Bleeding, which is most common problem. In children is caused by peptic ulcer or perforation because of the unbuffered acidic secretion • Several mechanism may cause obstruction. • Intussusception may be led by the diverticulum. • Obstruction may also be caused by entanglement of his small intestine around the fibrous cord • Trapping of a loop of the small intestine under the band • Incarceration within a hernia Sac or volvulus of the intestinal segment containing the diverticulum. • Diverticulitis at this may occur when peptic ulceration or obstruction lead to inflammation.
- 5. Clinical Manifestation • Abdominal pain Similar to appendicitis May be vague and recurrent • Bloody Stools Bright or dark red with mucus (“currant jelly”stool) In infants, bleeding may be accompanied by pain • Sometimes Severe anemia shock
- 6. Diagnostic Evaluation • Physical examination. • Radiographic studies. • The sign-in symptom reflects the pathological process as the example intestinal obstruction. • Acute diverticulitis present the same clinical picture as acute appendicitis, although the pain may vague and recurrent. • In the paediatric population bleeding, most frequently appear as dark red or “currant jelly” stool and is frequently severe enough to require transfusion. • Abdominal radiograph, barium enema and arteriography, have generally been unsuccessful as a to diagnosis. • Specific nuclear scintigraphic study, which detect the presence of gastric mucosa is the most sensitive and specific non-invasive test for Michael diverticulum with accuracy of 90%. • Bloody studies are usually part of general laboratory workup to rule out the bleeding disorder and to evaluate the severity of the anemia.
- 7. Therapeutic management • The standard treatment is surgical removal of the diverticulum. • When severe Haemorrhage, increase the surgical risk medical intervention to correct hypovolemic shock such as blood replacement IV fluid oxygen may be necessary. • In diverticulitis, antibiotic maybe use preoperatively to control infection. • If intestinal obstruction has occurred, appropriate preoperative measures are used to reverse electrolyte imbalance and prevent abdominal distension PROGNOSIS. • If Meckel diverticulum is diagnosed and treated early full recovery is likely. • The mortality rate of untreated Meckel diverticulum has been reported to range from 2.5% to 15 percent. COMPLICATION • The serious complication of Meckel diverticulum may include GI Hemorrhage and bowel obstruction.
- 8. Nursing Management • Since the onset is usually rapid, psychological support. parallel that for other conditions such as appendicitis. It is important to remember that the massive intestinal bleeding is often traumatic to both and child and parents and may significant affect their emotional relation to hospitalization and surgery specific preoperative consideration. • When intestinal bleeding is present include: Frequent monitoring of Vital sign and blood pressure for shock. Keeping the child on bed rest. Recording the approximate amount of blood loss in a stool in the absence of Frank haemorrhage , the nurse test the stool for a occult blood.