The Meckel diverticulum is a blind protuberance of the intestine that occurs when the embryonic yolk duct does not regress sufficiently. In most cases, the phenomenon remains asymptomatic for life and does not require further treatment in this case. Only in the case of inflammatory processes based on the diverticulum are interventions required for treatment, which mainly correspond to removal of the diverticulum.
What is Meckel’s diverticulum?
When the embryonic seedling folds, the so-called omphaloenteric duct develops. The omphaloenteric duct is also known as the yolk duct. It is an embryonic structure that attaches the embryonic yolk sac to the intestinal tube. In the sixth week of pregnancy the yolk duct is reduced and obliterated. See AbbreviationFinder for abbreviations related to Meckel Diverticulum.
With a frequency of around three percent, part of the yolk duct remains and becomes a blind-ending sac of the intestine. This bulge is the so-called Meckel diverticulum. The phenomenon is named after the German anatomist Johann F. Meckel, who first documented it in the 19th century.
Secondary diseases can arise from Meckel’s diverticulum, above all inflammatory Meckel’s diverticulitis. In the majority of all cases, however, the minimal remnant of the embryonic vitelline duct remains completely asymptomatic. Meckel’s diverticulum is of clinical importance almost exclusively as a differential diagnosis to acute appendicitis.
Causes
The Meckel diverticulum is the consequence of a reduced involution of the embryonic yolk duct. The phenomenon is therefore a symptom of an embryonic developmental disorder. People with trisomy 21, the so-called Down syndrome, are particularly frequently affected by Meckel’s diverticulum.
Presumably, exogenous factors play an important role in the retention of the embryonic yolk duct. In many cases, however, the Meckel diverticulum cannot be traced back to a specific external influence. The connection with superordinate mutations such as trisomy 21 is not necessarily the cause of the phenomenon. This means that the diverticulum can also be completely isolated and does not necessarily have to be associated with other malformations or other developmental disorders.
Symptoms, Ailments & Signs
Meckel’s diverticulum is a sac of the ileus that lies about 30 to 50 centimeters proximal to the ileocecal valve in infants. In adults, the distance increases to around 60 to 100 centimeters as the intestines grow. As a rule, no symptoms are associated with Meckel’s diverticulum.
Discomfort occurs only when ectopic stomach or pancreatic tissue is contained within the diverticulum. With this phenomenon, inflammation with possible perforation often occurs. In this case, there can also be an ulcer formation with bleeding, since the gastric mucosa is scattered. If there is an opening between the small intestine and the diverticula, intestinal contents often enter the diverticula.
With the accumulation of intestinal contents in the Meckel diverticulum, the structure can become bacterially inflamed. The symptoms of such inflammation are similar to the symptoms of acute appendicitis. In addition to fever, nausea and severe abdominal pain on the right side occur.
Diagnosis & disease progression
In most cases, the diagnosis of Meckel’s diverticulum is an incidental finding. The phenomenon is usually discovered during laparotomy. In many cases, a targeted search is made for a planned appendix operation for reasons of differential diagnosis. Many people with Meckel’s diverticulum do not find out throughout their lives that they were born with the diverticulum.
The reason for this is the asymptomatic characteristic of Meckel’s diverticulum. In exceptional cases, the diagnosis is made immediately after birth. A palpable finding can give rise to an initial suspicion of the Meckel diverticulum, which can be clarified using imaging.
In patients with diagnosed trisomy 21, the presence of the diverticulum is obvious. Against this background, infants with a diagnosed Down syndrome are usually examined in detail for the phenomenon. The prognosis for people with Meckel’s diverticulum is extremely favorable, as the phenomenon usually remains symptom-free.
Complications
The Meckel diverticulum does not always lead to symptoms or complications. For this reason, it is not always necessary to deal with this complaint. However, this can lead to bleeding in the stomach or to problems with the gastric mucosa, which can limit the patient’s quality of life.
This leads to inflammation and infections in the stomach and intestines, so that treatment by a doctor is necessary in any case. It is not uncommon for the Meckel diverticulum to inflame the appendix, so that it has to be removed. There is also a high fever and vomiting.
Furthermore, the patients suffer from severe pain in the abdomen and stomach. In the worst case, an intestinal perforation occurs, which can also be fatal. This complaint is treated by means of a surgical procedure, which is usually not associated with any particular complications.
Most complaints can be limited relatively well. Life expectancy is not reduced either. After the operation, those affected are usually still dependent on taking antibiotics to prevent further inflammation or infections.
When should you go to the doctor?
If abnormalities and peculiarities occur in the area of the intestine, a doctor is needed. If there are irregular bowel movements, diarrhea, constipation or pain, a doctor should be consulted. Changes in the intestinal mucosa increase the risk of infection. If the person concerned repeatedly suffers from fever, inflammatory diseases or internal irritation, a comprehensive health assessment should be carried out on the person concerned. The cause of the symptoms can be determined in medical tests and a corresponding treatment plan is drawn up. A general feeling of illness, reduced performance, abdominal pain and nausea are signs of a health problem. A doctor’s visit is necessary if the symptoms persist for a long time or increase in intensity.
Blood in the stool and bleeding from the anus should be seen by a doctor. If itching or open wounds develop, it is advisable to consult a doctor. If there are disturbances while sitting or if the person concerned experiences discomfort when moving, a doctor’s visit is advisable. A doctor should be consulted in the event of sleep disorders, emotional problems, sensory disorders or exhaustion. If the symptoms lead to a reduced food intake and thus to a strong weight loss, a doctor is needed. Problems with digestion, hypersensitivity to certain foods and increased tiredness should be clarified by a doctor.
Treatment & Therapy
Meckel’s diverticula usually do not cause any symptoms. As long as the phenomenon remains entirely asymptomatic, targeted treatment is not required. If an opening between the diverticula and the small bowel has been documented, treatment may be indicated.
In most cases, however, treatment is only initiated when inflammation occurs due to pent-up intestinal contents. Therapy may also be required if the diverticulum contains corpus-type gastric mucosa or pancreatic tissue. Because these cells produce acids, ulcers or bleeding may occur.
In extreme cases, this results in a breakthrough that can lead to peritonitis. Surgery is the only sensible way to treat a Meckel’s diverticulum. Since operations are always associated with certain risks for the patient, the benefits and risks of the operation must be weighed against each other before the operation.
This consideration means that the Meckel diverticulum is usually only removed when secondary diseases have occurred as a result of the protrusion. During the operation, the surgeon severs the vascular supply of the Meckel’s diverticulum. After this blood flow is blocked, the diverticulum is removed at its base.
This creates an opening in the intestine, which the surgeon sews across. If the diverticulum is exceptionally large, a segmental resection is performed instead of the operation described. Part of the diverticulum is removed. As soon as inflammation has occurred due to the diverticulum, the inflammatory process is usually brought to subside as far as possible before the operation.
Outlook & Forecast
Normally, the Meckel diverticulum completely regresses on its own. Therefore, in most patients, spontaneous healing occurs due to the natural developmental process of the embryo. As early as the sixth week of pregnancy, the yolk duct regresses without the intervention of doctors or the support of medication. Irregularities and abnormalities occur in less than 3 percent of newborns. In the further course of growth, there is often an increased occurrence of inflammation or problems in the gastrointestinal tract. Pain in the epigastric region or the development of an acute condition in the intestines may occur. The prognosis for these people is therefore worse.
If the failure of the Meckel diverticulum to regress goes unnoticed, an unfavorable course of the disease can lead to an emergency situation. The intestine can rupture and lead to a life-threatening condition. Without intensive medical care and the fastest possible care, the affected person will die prematurely.
In most cases, however, due to the changed and weakened health situation, it is noticed in good time that the regression has not taken place in the abdomen. In these patients, a surgical procedure takes place, which is routine and does not lead to any special abnormalities under optimal conditions. After the wound has healed, the patient can be discharged from the treatment free of symptoms. A recurrence of the health irregularities is not to be expected.
Prevention
The Meckel diverticulum develops on the basis of an embryonic maldevelopment. Therefore, the phenomenon can only be prevented to the extent that embryonic development disorders can be prevented.
Aftercare
Aftercare for diverticula in the intestine (diverticulosis) is carried out with the internist or gastroenterologist, sometimes in cooperation with the family doctor. Immediately after the therapy, it is important to eat a bland diet that does not put additional strain on the patient’s intestines. In the event of bleeding or similar unusual events, the doctor treating you should be consulted.
The diet is coordinated with the doctor, but nutritionists or dieticians can also give valuable advice in this context. In many cases, a high-fiber diet combined with a sufficient amount of drinking is the optimal combination. Fruits and vegetables are advisable. On the other hand, those affected should avoid flatulent or spicy foods and alcohol in order to supplement the treatment with targeted aftercare.
Diverticula can be promoted in their formation by strong straining and constipation. Ideally, therefore, the stool should be kept soft and voluminous. If this is not achieved with a purely high-fiber diet, psyllium products are often helpful.
Especially in the context of aftercare, however, it is important to discuss the intake with the treating physicians in advance. The colonoscopy is aftercare and prevention at the same time. Your cycle is also determined by the doctor. It detects at an early stage whether new diverticula are developing again and can thus enable early treatment.
You can do that yourself
In many cases, a Meckel’s diverticulum does not cause any symptoms and therefore does not require any specific treatment. The most important self-help measure that those affected can take is therefore to pay attention to conspicuous physical symptoms and have them clarified.
If the course is severe, for example if an opening forms between the diverticulum and the small intestine, prompt treatment by a doctor is required. Acute symptoms such as nausea and abdominal pain can be alleviated with the help of home remedies. For example, warm pads or cooling are recommended for abdominal pain that typically occurs on one side, depending on which method relieves the pain. In the case of nausea, essential oils or gentle sedatives from the pharmacy can also provide relief. However, a medical examination is necessary in any case.
Rest and bed rest are indicated after an operation. The wound must be treated according to the doctor’s instructions in order to avoid wound healing disorders and other complications. At the same time, it is advisable to initially refrain from sports and physical exercise in general in order to avoid tearing the seam. In the first few weeks, regular check-ups in the doctor’s office are indicated.