Meckel's diverticulum history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
The presentation of Meckel's diverticulum is usually asymptomatic. The hallmark feature in symptomatic patients is the occurrence of painless lower gastrointestinal bleeding. Other symptoms of Meckel's diverticulum arise in complicated cases with features of intestinal obstruction, intussusception, volvulus and perforation. The age of presentation for approximately half of all patients is less than 10 years of age. Patients may also develop symptoms of diverticular inflammation (ie, Meckel's diverticulitis) which has a presentation similar to acute appendicitis.
History and Symptoms
The most common presenting symptom in patients is painless rectal bleeding, followed by less common symptoms of intestinal obstruction, volvulus and intussusception in complicated cases. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis.[1][2][3][4]
Common Symptoms
- Meckel's diverticulum is usually asymptomatic and is found incidentally on abdominal imaging or surgical exploration performed for a presumptive diagnosis such as acute cholecystitis (exploratory laparotomy, laparoscopy).
- The age of presentation for approximately half of all patients is less than 10 years of age.
Common symptoms of Meckel's diverticulum include:
- Lower gastrointestinal bleeding:[5]
- Mechanism: presence of ectopic gastric mucosa leads to acid secretion within the diverticulum and ulceration of the small bowel[6][3]
- Site: Downstream or adjacent to the diverticulum and not within it
- May be acute or chronic and insidious
- May be a massive bleed
- Usually painless
- More common in children
- In children: presents as maroon or dark red stools
- In adults: presents as melena as transit time through the colon is increased
- Acute abdominal complaints such as pain in the abdomen may be seen in complicated cases, mimicking the presentation of acute appendicitis
Less Common Symptoms
Less common symptoms of Meckel's diverticulum arise in complicated cases:[1][3][7][8][9][10]
- Symptoms of intussusception, particularly recurrent or atypical intussusception commonly seen in children:
- Pain: crampy abdominal pain with or without rectal bleeding
- Inconsolable crying
- Drawing up of the legs toward the abdomen[11]
- Vomiting usually after the first episode, initially non-bilious but may convert to bilious as obstruction progresses
- Bloody stool or occult blood[12]
- Current jelly stools (mixture of mucus and blood)
- Intermittent pain free intervals in between episodes of pain[7]
- Symptoms of bowel obstruction, more common in adults:
- Colicky abdominal pain (cramping and intermittent) in nature, with spasms lasting a few minutes
- Vomiting
- Nausea
- Constipation
- Symptoms of diverticular inflammation (ie, Meckel's diverticulitis): may present with features similar to acute appendicitis[13][2][14][15]
- Alternating diarrhea and constipation
- Painful abdominal cramps
- Chills or fever
- Symptoms of perforation:[16]
- Severe abdominal pain intensified by movement
- Chills
- Fever
- Nausea
- Vomiting
References
- ↑ 1.0 1.1 Sagar J, Kumar V, Shah DK (2006). "Meckel's diverticulum: a systematic review". J R Soc Med. 99 (10): 501–5. doi:10.1258/jrsm.99.10.501. PMC 1592061. PMID 17021300.
- ↑ 2.0 2.1 Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR (2005). "Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002)". Ann. Surg. 241 (3): 529–33. PMC 1356994. PMID 15729078.
- ↑ 3.0 3.1 3.2 Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D (2006). "Complications of Meckel's diverticula in adults". Can J Surg. 49 (5): 353–7. PMC 3207587. PMID 17152574.
- ↑ Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi K (1992). "Complications and diagnosis of Meckel's diverticulum in 776 patients". Am. J. Surg. 164 (4): 382–3. PMID 1415948.
- ↑ St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H (1991). "Meckel's diverticulum in children: a 20-year review". J. Pediatr. Surg. 26 (11): 1289–92. PMID 1812259.
- ↑ Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, Biassoni L (2013). "Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years". Pediatr. Surg. Int. 29 (5): 511–7. doi:10.1007/s00383-013-3270-3. PMID 23417523.
- ↑ 7.0 7.1 West KW, Stephens B, Vane DW, Grosfeld JL (1987). "Intussusception: current management in infants and children". Surgery. 102 (4): 704–10. PMID 3660243.
- ↑ Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL (1997). "Stool appearance in intussusception: assessing the value of the term "currant jelly"". Am J Emerg Med. 15 (3): 293–8. PMID 9148991.
- ↑ Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL (2001). "Meckel's diverticulum". J. Am. Coll. Surg. 192 (5): 658–62. PMID 11333103.
- ↑ Arnold JF, Pellicane JV (1997). "Meckel's diverticulum: a ten-year experience". Am Surg. 63 (4): 354–5. PMID 9124758.
- ↑ Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B (2012). "Intussusception: clinical presentations and imaging characteristics". Pediatr Emerg Care. 28 (9): 842–4. doi:10.1097/PEC.0b013e318267a75e. PMID 22929138.
- ↑ Losek JD, Fiete RL (1991). "Intussusception and the diagnostic value of testing stool for occult blood". Am J Emerg Med. 9 (1): 1–3. PMID 1985640.
- ↑ Ueberrueck T, Meyer L, Koch A, Hinkel M, Kube R, Gastinger I (2005). "The significance of Meckel's diverticulum in appendicitis--a retrospective analysis of 233 cases". World J Surg. 29 (4): 455–8. doi:10.1007/s00268-004-7615-x. PMID 15776296.
- ↑ Ymaguchi M, Takeuchi S, Awazu S (1978). "Meckel's diverticulum. Investigation of 600 patients in Japanese literature". Am. J. Surg. 136 (2): 247–9. PMID 308325.
- ↑ Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK (2004). "Meckel diverticulum: ten-year experience in adults". South. Med. J. 97 (11): 1038–41. doi:10.1097/01.SMJ.0000125222.90696.03. PMID 15586591.
- ↑ "Intestinal Perforation Clinical Presentation: History, Physical Examination".