Meckel's diverticulum natural history, complications and prognosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Meckel's diverticulum}}
{{Meckel's diverticulum}}
{{CMG}}
{{CMG}} {{AE}} {{Cherry}}


==Overview==
==Overview==
Intestinal torsions around the intestinal stalk may also occur, leading to obstruction, [[ischemia]], and [[necrosis]].
Meckel's diverticulum is mostly seen in male children (mostly <2 years of age). One fourth of untreated cases of Meckel's diverticulum may develop complications such as [[Bowel obstruction|intestinal obstruction]], [[Bleeding|hemorrhage]], [[diverticulitis]], bowel [[ischemia]], and [[necrosis]]. [[Bleeding|Hemorrhage]] is the most common complication in patients with [[Meckel's diverticulum]]. [[Bleeding]] in patients may be minimal, recurrent or massive and [[shock]]-producing. The rate of [[bleeding]] is assessed based on quantity of [[blood]] lost in the [[Human feces|stools]], appearance of the material passing through the [[rectum]] and [[Hemodynamics|hemodynamic]] state of the patient. Depending on the extent of the [[symptom]] progression at the time of diagnosis, the [[prognosis]] may vary. However, the [[prognosis]] is generally regarded as excellent in cases where [[symptomatic]] Meckel's diverticulum is treated in a timely manner. Complete [[Healing|recovery]] may be expected with [[surgery]] in majority of the cases.
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].


OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.  
*The symptoms of [[Meckel's diverticulum]] usually develop in children, and start with painless [[lower gastrointestinal bleeding]].<ref name="urlMeckels Diverticulum | Cleveland Clinic">{{cite web |url=https://my.clevelandclinic.org/health/diseases/14738-meckels-diverticulum |title=Meckel's Diverticulum &#124; Cleveland Clinic |format= |work= |accessdate=}}</ref>
*The symptoms of (disease name) typically develop ___ years after exposure to ___.  
*If left untreated, 25% of patients with [[Meckel's diverticulum]] may progress to develop [[Bleeding|hemorrhage]], [[Ulcer|ulceration]], [[Gastrointestinal perforation|bowel perforation]], [[diverticulitis]], [[peritonitis]] and [[Bowel obstruction|small bowel obstruction]].<ref name="pmid17152574" />
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].


===Complications===
===Complications===
*Common complications of [[Meckel's diverticulum]] include:
*Common complications of [[Meckel's diverticulum]] include:<ref name="pmid17152574">{{cite journal |vauthors=Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D |title=Complications of Meckel's diverticula in adults |journal=Can J Surg |volume=49 |issue=5 |pages=353–7 |year=2006 |pmid=17152574 |pmc=3207587 |doi= |url=}}</ref><ref name="pmid7944666">{{cite journal |vauthors=Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ |title=Surgical management of Meckel's diverticulum. An epidemiologic, population-based study |journal=Ann. Surg. |volume=220 |issue=4 |pages=564–8; discussion 568–9 |year=1994 |pmid=7944666 |pmc=1234434 |doi= |url=}}</ref><ref name="pmid29078157">{{cite journal |vauthors=Hong J, Park SB |title=A case of retroperitoneal abscess: A rare complication of Meckel's diverticulum |journal=Int J Surg Case Rep |volume=41 |issue= |pages=150–153 |year=2017 |pmid=29078157 |doi=10.1016/j.ijscr.2017.10.012 |url=}}</ref><ref name="pmid28698005">{{cite journal |vauthors=Lequet J, Menahem B, Alves A, Fohlen A, Mulliri A |title=Meckel's diverticulum in the adult |journal=J Visc Surg |volume=154 |issue=4 |pages=253–259 |year=2017 |pmid=28698005 |doi=10.1016/j.jviscsurg.2017.06.006 |url=}}</ref><ref name="pmid28473039">{{cite journal |vauthors=Cotter TG, Buckley NS, Loftus CG |title=Approach to the Patient With Hematochezia |journal=Mayo Clin. Proc. |volume=92 |issue=5 |pages=797–804 |year=2017 |pmid=28473039 |doi=10.1016/j.mayocp.2016.12.021 |url=}}</ref><ref name="pmid28154669">{{cite journal |vauthors=Rosat A, Pérez E, Oaknin HH, Mendiz J, Hernández G, Barrera M |title=Spontaneous hemoperitoneum caused by meckel's diverticulum in an elder patient |journal=Pan Afr Med J |volume=24 |issue= |pages=314 |year=2016 |pmid=28154669 |pmc=5267917 |doi=10.11604/pamj.2016.24.314.10384 |url=}}</ref><ref name="pmid28051045">{{cite journal |vauthors=Rattan KN, Singh J, Dalal P, Rattan A |title=Meckel's diverticulum in children: Our 12-year experience |journal=Afr J Paediatr Surg |volume=13 |issue=4 |pages=170–174 |year=2016 |pmid=28051045 |pmc=5154221 |doi=10.4103/0189-6725.194671 |url=}}</ref><ref name="pmid27492813">{{cite journal |vauthors=Choi SY, Hong SS, Park HJ, Lee HK, Shin HC, Choi GC |title=The many faces of Meckel's diverticulum and its complications |journal=J Med Imaging Radiat Oncol |volume=61 |issue=2 |pages=225–231 |year=2017 |pmid=27492813 |doi=10.1111/1754-9485.12505 |url=}}</ref><ref name="pmid27483571">{{cite journal |vauthors=Chabowski M, Szymanska-Chabowska A, Dorobisz T, Janczak D, Jelen M, Janczak D |title=A massive bleeding from a gastrointestinal stromal tumor of a Meckel's diverticulum |journal=Srp Arh Celok Lek |volume=144 |issue=3-4 |pages=219–21 |year=2016 |pmid=27483571 |doi= |url=}}</ref><ref name="pmid26932405">{{cite journal |vauthors=Srisajjakul S, Prapaisilp P, Bangchokdee S |title=Many faces of Meckel's diverticulum and its complications |journal=Jpn J Radiol |volume=34 |issue=5 |pages=313–20 |year=2016 |pmid=26932405 |doi=10.1007/s11604-016-0530-x |url=}}</ref><ref name="pmid26884080">{{cite journal |vauthors=Alfa-Wali M, Wardle S, Nizar S, Bloom IT |title=Atypical presentation of a Meckel's diverticulum |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=26884080 |doi=10.1136/bcr-2016-214464 |url=}}</ref><ref name="pmid19661646">{{cite journal |vauthors=Komlatsè AN, Komla G, Komla A, Azanledji BM, Abossisso SK, Hubert T |title=Meckel's diverticulum strangulated in an umbilical hernia |journal=Afr J Paediatr Surg |volume=6 |issue=2 |pages=118–9 |year=2009 |pmid=19661646 |doi=10.4103/0189-6725.54779 |url=}}</ref>
**[[Bleeding|Hemorrhage]]
**[[Bleeding|Hemorrhage]]
**[[Perforation]] of the [[Intestine|bowel]]
**[[Perforation]] of the [[Intestine|bowel]]
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* Presentation:  
* Presentation:  
** Patients present with the following symptoms:
** Patients present with the following symptoms:<ref name="pmid27126093">{{cite journal |vauthors=Pattni V, Wright K, Marden P, Terlevich A |title=Meckel's diverticulum in an adult: an obscure presentation of gastrointestinal bleeding |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27126093 |doi=10.1136/bcr-2015-213852 |url=}}</ref>
*** Passage of bright red [[blood]] in the stools
*** Passage of bright red [[blood]] in the stools
*** May or may not be associated with:
*** May or may not be associated with:
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**** Appearance of the material passing through the [[rectum]]  
**** Appearance of the material passing through the [[rectum]]  
**** [[Hemodynamics|Hemodynamic]] state
**** [[Hemodynamics|Hemodynamic]] state
*** Characteristics of [[Bleeding|hemorrhage]] based on the appearance of [[Human feces|stools]] include the following:  
*** Characteristics of [[Bleeding|hemorrhage]] based on the appearance of [[Human feces|stools]] include the following:<ref name="pmid25540213">{{cite journal |vauthors=Anwar MO, Ahmed HI, Al Hindi S, Al Omran Y |title=Meckel's diverticulum with intussusception in a 5-year-old patient with Down's syndrome |journal=BMJ Case Rep |volume=2014 |issue= |pages= |year=2014 |pmid=25540213 |pmc=4281549 |doi=10.1136/bcr-2014-207431 |url=}}</ref><ref name="pmid25337720">{{cite journal |vauthors=Holcomb CN, Hawn MT |title=Occult gastrointestinal bleeding |journal=JAMA Surg |volume=149 |issue=12 |pages=1335–6 |year=2014 |pmid=25337720 |doi=10.1001/jamasurg.2014.109 |url=}}</ref>
**** Brisk [[Bleeding|hemorrhage]]: bright red blood in the [[Human feces|stools]]  
**** Brisk [[Bleeding|hemorrhage]]: bright red blood in the [[Human feces|stools]]  
**** Minor [[Upper gastrointestinal bleeding|upper GI bleeding]], associated with delayed [[Intestine|intestinal]] transit causing alteration of [[blood]]: [[Melena|Tarry stools]]  
**** Minor [[Upper gastrointestinal bleeding|upper GI bleeding]], associated with delayed [[Intestine|intestinal]] transit causing alteration of [[blood]]: [[Melena|Tarry stools]]  
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** Brisk [[Bleeding|hemorrhage]] may present as bright red blood in the [[Human feces|stools]]  
** Brisk [[Bleeding|hemorrhage]] may present as bright red blood in the [[Human feces|stools]]  
** Minor [[Upper gastrointestinal bleeding|upper GI]] [[bleeding]], associated with delayed [[Intestine|intestinal]] transit causing alteration of [[blood]] may present as [[Melena|tarry stools]]  
** Minor [[Upper gastrointestinal bleeding|upper GI]] [[bleeding]], associated with delayed [[Intestine|intestinal]] transit causing alteration of [[blood]] may present as [[Melena|tarry stools]]  
** [[Intussusception]] may present as currant jelly [[Human feces|stools]] with copious amounts of [[mucus]] due to bowel ischemia  
** [[Intussusception]] may present as currant jelly [[Human feces|stools]] with copious amounts of [[mucus]] due to [[Intestine|bowel]] [[ischemia]]
** [[Fissure]]-in-ano may present with [[blood]]-streaked [[Human feces|stools]]  
** [[Fissure]]-in-ano may present with [[blood]]-streaked [[Human feces|stools]]  
* [[Ectopia|Ectopic]] [[gastric mucosa]] is found in about half of all cases of [[Meckel's diverticulum|Meckel's diverticula]]; and three fourths of all the cases of [[bleeding]] [[Meckel's diverticulum|Meckel's diverticulae]].
* [[Ectopia|Ectopic]] [[gastric mucosa]] is found in about half of all cases of [[Meckel's diverticulum|Meckel's diverticula]]; and three fourths of all the cases of [[bleeding]] [[Meckel's diverticulum|Meckel's diverticulae]].
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** [[Colon (anatomy)|Colorectal]] region
** [[Colon (anatomy)|Colorectal]] region


=== Perforation ===
==== Intestinal obstruction ====
* [[Perforation]] may present as:  
* Presentation:<ref name="pmid27251525">{{cite journal |vauthors=Basani L, Aepala R, Reddy BM |title=Congenital diaphragmatic hernia, Meckel's diverticulum and malrotation in a 3-month-old infant |journal=Afr J Paediatr Surg |volume=13 |issue=1 |pages=47–9 |year=2016 |pmid=27251525 |pmc=4955462 |doi=10.4103/0189-6725.181708 |url=}}</ref><ref name="pmid26310428">{{cite journal |vauthors=Kunitsu T, Koshida S, Tanaka K, Nakahara S, Yanagi T, Maruo Y, Takeuchi Y, Kubota Y |title=Neonatal Meckel diverticulum: Obstruction due to a short mesodiverticular band |journal=Pediatr Int |volume=57 |issue=5 |pages=1007–9 |year=2015 |pmid=26310428 |doi=10.1111/ped.12694 |url=}}</ref><ref name="pmid25970960">{{cite journal |vauthors=Bălălău C, Bacalbaşa N, Motofei I, Popa F, Voiculescu S, Scăunaşu RV |title=Meckel's diverticulum--a rare cause of intestinal obstruction in adults |journal=Rev Med Chir Soc Med Nat Iasi |volume=119 |issue=1 |pages=162–5 |year=2015 |pmid=25970960 |doi= |url=}}</ref>
** Acute [[abdomen]]
** Erect [[Chest X-ray|CXR]]: Air under the [[Thoracic diaphragm|diaphragm]]
 
=== Intestinal obstruction ===
* Presentation:
** [[Abdominal pain]]   
** [[Abdominal pain]]   
** [[Nausea and vomiting|Vomiting]]   
** [[Nausea and vomiting|Vomiting]]   
** [[Constipation|Obstipation]]  
** [[Constipation|Obstipation]]  
* In case of [[intussusception]], patient may also present with:  
* In case of [[intussusception]], patient may also present with:<ref name="pmid27179156">{{cite journal |vauthors=Kim KH, Kang KA, Lim JH, Lee KG, Kwon TJ |title=Inverted Meckel diverticulum as a lead point of small bowel intussusception: misinterpreting case as a lipoma |journal=Clin Imaging |volume=40 |issue=5 |pages=840–2 |year=2016 |pmid=27179156 |doi=10.1016/j.clinimag.2016.03.009 |url=}}</ref>
** palpable lump in the lower [[abdomen]]   
** Palpable lump in the lower [[abdomen]]   
** currant jelly [[Human feces|stools]]  
** Currant jelly [[Human feces|stools]]  
* [[Radiography]] of the [[abdomen]] may indicate:
* [[Radiography]] of the [[abdomen]] may indicate:
** [[Ileus]]   
** [[Ileus]]   
** Stepladder air-fluid levels, as seen in dynamic [[Bowel obstruction|intestinal obstruction]]  
** Stepladder air-fluid levels, as seen in dynamic [[Bowel obstruction|intestinal obstruction]]  
* Observed in one fourth of patients with symptomatic [[Meckel's diverticulum]]  
* Observed in one fourth of patients with symptomatic [[Meckel's diverticulum]]  
* Various mechanisms of [[Bowel obstruction|intestinal obstruction]] occur with [[Meckel's diverticulum]]:
* Various mechanisms of [[Bowel obstruction|intestinal obstruction]] occur with [[Meckel's diverticulum]]:<ref name="pmid28229080">{{cite journal |vauthors=Luu AM, Meurer K, Herzog T, Uhl W, Tannapfel A, Braumann C |title=Small Bowel Obstruction due to a Giant Meckel's Diverticulum |journal=Visc Med |volume=32 |issue=6 |pages=434–436 |year=2016 |pmid=28229080 |pmc=5290431 |doi=10.1159/000450589 |url=}}</ref><ref name="pmid27588829">{{cite journal |vauthors=Fiegel H, Gfroerer S, Rolle U |title=Systematic review shows that pathological lead points are important and frequent in intussusception and are not limited to infants |journal=Acta Paediatr. |volume=105 |issue=11 |pages=1275–1279 |year=2016 |pmid=27588829 |doi=10.1111/apa.13567 |url=}}</ref>
** [[Volvulus]]: The [[Vitelline duct|omphalomesenteric duct]] may be attached to the wall of the [[abdomen]] by a fibrotic band, and [[volvulus]] of the [[Small intestine|small bowel]] around the band may occur.  
** [[Volvulus]]: The [[Vitelline duct|omphalomesenteric duct]] may be attached to the wall of the [[abdomen]] by a fibrotic band, and [[volvulus]] of the [[Small intestine|small bowel]] around the band may occur.  
** [[Intussusception]]: An [[intussusception]] is a blockage in the [[Intestine|intestines]] caused by folding of the [[Intestine|intestines]]. The lead point of the [[intussusception]] may be:
** [[Intussusception]]: An [[intussusception]] is a blockage in the [[Intestine|intestines]] caused by folding of the [[Intestine|intestines]]. The lead point of the [[intussusception]] may be:
*** [[Diverticulum]]   
*** [[Diverticulum]]   
*** [[Tumor]] arising in the wall of the [[diverticulum]]  
*** [[Tumor]] arising in the wall of the [[diverticulum]]  
** Littre hernia: The incarceration of a [[Meckel's diverticulum]] in an [[inguinal hernia]] is called a Littré hernia.  
** Littre hernia: The incarceration of a [[Meckel's diverticulum]] in an [[inguinal hernia]] is called a Littré hernia.<ref name="pmid27464282">{{cite journal |vauthors=Clasen K, Kalinski T, Meissner C, Bruns CJ, Meyer F |title=[77-year-old man with rare Littré's hernia] |language=German |journal=Dtsch. Med. Wochenschr. |volume=141 |issue=15 |pages=1099–101 |year=2016 |pmid=27464282 |doi=10.1055/s-0041-109109 |url=}}</ref><ref name="pmid25323188">{{cite journal |vauthors=Qin D, Liu G, Wang Z |title=Littre's hernia in a paediatric patient |journal=Afr J Paediatr Surg |volume=11 |issue=4 |pages=351–3 |year=2014 |pmid=25323188 |doi=10.4103/0189-6725.143168 |url=}}</ref>
==== Perforation ====
* [[Perforation]] may present as:<ref name="pmid27507693">{{cite journal |vauthors=Ahmed Z, Chhabra S, Kankaria J, Jenaw RK |title=Meckel's diverticular perforation presenting as acute abdomen in the second trimester of pregnancy |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27507693 |doi=10.1136/bcr-2016-216643 |url=}}</ref><ref name="pmid26175810">{{cite journal |vauthors=Farah RH, Avala P, Khaiz D, Bensardi F, Elhattabi K, Lefriyekh R, Berrada S, Fadil A, Zerouali NO |title=Spontaneous perforation of Meckel's diverticulum: a case report and review of literature |journal=Pan Afr Med J |volume=20 |issue= |pages=319 |year=2015 |pmid=26175810 |pmc=4491457 |doi=10.11604/pamj.2015.20.319.5980 |url=}}</ref>
** Acute [[abdomen]]
** Erect [[Chest X-ray|CXR]]: Air under the [[Thoracic diaphragm|diaphragm]]
 
==== Neoplasm ====
* [[Neoplasm|Neoplasms]] are found in approximately 4-5% of complicated [[Meckel's diverticulum]] cases.
* Types of [[Tumor|tumors]]:<ref name="pmid17373755">{{cite journal |vauthors=Karadeniz Cakmak G, Emre AU, Tascilar O, Bektaş S, Uçan BH, Irkorucu O, Karakaya K, Ustundag Y, Comert M |title=Lipoma within inverted Meckel's diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage: a case report and review of literature |journal=World J. Gastroenterol. |volume=13 |issue=7 |pages=1141–3 |year=2007 |pmid=17373755 |pmc=4146883 |doi= |url=}}</ref><ref name="pmid21135700">{{cite journal |vauthors=Thirunavukarasu P, Sathaiah M, Sukumar S, Bartels CJ, Zeh H, Lee KK, Bartlett DL |title=Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management |journal=Ann. Surg. |volume=253 |issue=2 |pages=223–30 |year=2011 |pmid=21135700 |pmc=4129548 |doi=10.1097/SLA.0b013e3181ef488d |url=}}</ref><ref name="pmid27995004">{{cite journal |vauthors=Zhou B, Lai H, Lin Y, Mo X |title=Omphalomesenteric duct remnant adenocarcinoma in adults: a case study |journal=Springerplus |volume=5 |issue=1 |pages=2027 |year=2016 |pmid=27995004 |pmc=5126029 |doi=10.1186/s40064-016-3713-0 |url=}}</ref><ref name="pmid26936384">{{cite journal |vauthors=Metwally IH, Elalfy AF, Awny S, Megahed N |title=Meckel's diverticulum complicated with gastro-intestinal stromal tumor: Case report |journal=J Egypt Natl Canc Inst |volume=28 |issue=2 |pages=123–7 |year=2016 |pmid=26936384 |doi=10.1016/j.jnci.2016.02.002 |url=}}</ref>
** [[Leiomyoma]] is the one that is most frequently found
** [[Leiomyosarcoma]]
** [[Fibroma]]
** [[Ectopia|Ectopic]] [[Adenocarcinoma|gastric adenocarcinoma]]
** [[Lipoma]]
** [[Zollinger-Ellison syndrome|Gastrinomas]]
** [[Angioma]]
** [[Carcinoid syndrome|Carcinoid tumor]]
 
==== Umbilical anomalies ====
* Occurs in up to 10% of patients and consist of the following:<ref name="pmid19661646">{{cite journal |vauthors=Komlatsè AN, Komla G, Komla A, Azanledji BM, Abossisso SK, Hubert T |title=Meckel's diverticulum strangulated in an umbilical hernia |journal=Afr J Paediatr Surg |volume=6 |issue=2 |pages=118–9 |year=2009 |pmid=19661646 |doi=10.4103/0189-6725.54779 |url=}}</ref>
** [[Cyst|Cysts]]
** [[Sinus|Sinuses]]
** [[Fistula|Fistulas]]
** Fibrous bands between the [[Navel|umbilicus]] and the [[diverticulum]]
* Presentation:
** Chronic discharging [[umbilical]] [[sinus]] superimposed by:
*** [[Infection]]
*** [[Excoriation]] of periumbilical [[skin]]
** [[Patient]] may have a history of:<ref name="pmid26955478">{{cite journal |vauthors=Yıldız İ, Koca YS, Barut İ |title=An unusual case of intraabdominal abscess and acute abdomen caused by axial torsion of a Meckel's diverticulum |journal=Ann Med Surg (Lond) |volume=6 |issue= |pages=74–6 |year=2016 |pmid=26955478 |pmc=4761698 |doi=10.1016/j.amsu.2016.01.082 |url=}}</ref>
*** Abdominal-wall [[abscess]] formation
*** Recurrent [[infection]]
*** [[Sinus]] healing
*** On examination, [[Gastrointestinal tract|intestinal mucosa]] may be identified over the [[skin]]
*** [[Cannula|Cannulation]] and [[Injection (medicine)|injection]] with [[Contrast|radiographic contrast]] may help in the delineation of the entire [[tract]] and aids in surgery
** Treatment:
*** [[Surgery]]
*** Exploratory [[laparotomy]]
*** In case a fibrous band is found at [[laparotomy]], it should be excised because of the risk of [[volvulus]] and internal [[Hernia|herniation]].
==== Diverticulitis ====
==== Diverticulitis ====
*occurs in approximately 10-20% of patients with symptomatic [[Meckel's diverticulum]]
[[File:Itisrgif.gif|500px|right|thumb|Meckel's diverticulitis <br> Source: Wikimedia commons <ref name="urlFile:Meckels Diverticulum AFIP.jpg - Wikimedia Commons">{{cite web |url=https://commons.wikimedia.org/wiki/File:Meckel%27s_Diverticulum_AFIP.jpg |title=File:Meckel's Diverticulum AFIP.jpg - Wikimedia Commons |format= |work= |accessdate=}}</ref>]]
 
*Occurs in approximately 10-20% of patients with symptomatic [[Meckel's diverticulum]]
*seen in the elderly population  
*Seen in the elderly population  
* Presentation:  
* Presentation:<ref name="pmid27146826">{{cite journal |vauthors=Marwah S, Singla P, Marwah N, Gupta S, Singh VP |title=Ileal stricture following Meckel's diverticulitis: a rare cause of intestinal obstruction |journal=Clin J Gastroenterol |volume=9 |issue=3 |pages=118–23 |year=2016 |pmid=27146826 |doi=10.1007/s12328-016-0647-6 |url=}}</ref><ref name="pmid25892011">{{cite journal |vauthors=Hamilton CM, Arnason T |title=Ileitis associated with Meckel's diverticulum |journal=Histopathology |volume=67 |issue=6 |pages=783–91 |year=2015 |pmid=25892011 |doi=10.1111/his.12717 |url=}}</ref>
** intermittent, crampy [[abdominal pain]]  
** Intermittent, crampy [[abdominal pain]]  
** [[tenderness]] in the periumbilical area
** [[Tenderness]] in the periumbilical area


* Mechanism:  
* Mechanism:  
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*** Secondary [[infection]]  
*** Secondary [[infection]]  
*** [[Adhesion (medicine)|Adhesions]] may develop due to [[diverticular]] [[inflammation]] causing [[Symptom|symptoms]] of [[Bowel obstruction|intestinal obstruction]]
*** [[Adhesion (medicine)|Adhesions]] may develop due to [[diverticular]] [[inflammation]] causing [[Symptom|symptoms]] of [[Bowel obstruction|intestinal obstruction]]
*** [[Peritonitis]]: [[perforation]] of the [[Inflammation|inflamed]] [[diverticulum]] may lead to inflammation of the peritoneum, which is a thin tissue that lines the inside of the abdomen. 
*** [[Peritonitis]]: [[perforation]] of the [[Inflammation|inflamed]] [[diverticulum]] may lead to [[inflammation]] of the [[peritoneum]], which is a thin [[Tissue (biology)|tissue]] that lines the inside of the [[abdomen]]. 


Umbilical anomalies
==== Other complications  ====
Occur in up to 10% of patients and consist of the following:
* Other complications in [[Meckel's diverticulum]] include:<ref name="pmid27345602">{{cite journal |vauthors=Gasparella M, Marzaro M, Ferro M, Benetton C, Ghirardo V, Zanatta C, Zoppellaro F |title=Meckel's diverticulum and bowel obstruction due to phytobezoar: a case report |journal=Pediatr Med Chir |volume=38 |issue=2 |pages=117 |year=2016 |pmid=27345602 |doi=10.4081/pmc.2016.117 |url=}}</ref><ref name="pmid26040824">{{cite journal |vauthors=Lo T, Sagar J, Trickett J |title=A rare presentation of complication arising from Meckel's diverticulum in the form of diverticulotransverse colonic fistula in an adult |journal=BMJ Case Rep |volume=2015 |issue= |pages= |year=2015 |pmid=26040824 |pmc=4460404 |doi=10.1136/bcr-2013-203330 |url=}}</ref><ref name="pmid25309093">{{cite journal |vauthors=Wu SY, Ho MH, Hsu SD |title=Meckel's diverticulum incarcerated in a transmesocolic internal hernia |journal=World J. Gastroenterol. |volume=20 |issue=37 |pages=13615–9 |year=2014 |pmid=25309093 |pmc=4188914 |doi=10.3748/wjg.v20.i37.13615 |url=}}</ref>
Fistulas
** Vesicodiverticular [[Fistula|fistulas]]
Sinuses
** Phytobezoar formation
Cysts
** Stone formation
fibrous bands between the diverticulum and the umbilicus
** [[Diverticulum]] within a [[Meckel's diverticulum]]: formation of 'daughter" [[Diverticular|diverticula]]
Presentation:
* Complications occur frequently in:
Chronic discharging umbilical sinus superimposed by infection or excoriation of periumbilical skin.
** Children  
Pt may have a history of:
** Infants
recurrent infection
** Males
sinus healing
abdominal-wall abscess formation
intestinal mucosa may be identified on the skin
Cannulation and injection with radiographic contrast help to delineate the entire tract and aid in planning a surgical approach for cure.  
Treatment:surgical
A discharging sinus should be approached surgically with a view toward correction. Exploratory laparotomy may be required.
When found at laparotomy, a fibrous band should be excised because of the risk of internal herniation and volvulus.  
Neoplasm
found in approximately 4-5% of complicated Meckel diverticulum cases.  
Types of tumors:
Leiomyoma is the one that is most frequently found
Leiomyosarcoma
Carcinoid tumor
gastrinomas
Fibroma
Ectopic gastric adenocarcinoma
Lipoma
Angioma
Other complications
Other complications in Meckel diverticulum include:
vesicodiverticular fistulas,
"daughter" diverticula (formation of a diverticulum within a Meckel diverticulum)
formation of stones
phytobezoar  formation in the Meckel diverticulum.
Children and infants are at the highest risk for complications, and for some reason, complications occur more often in males than females.


===Prognosis===
===Prognosis===
Line 150: Line 148:
*Complete [[Healing|recovery]] may be expected with [[surgery]].<ref name="pmid20871204">{{cite journal |vauthors=Yagnik VD, Yagnik BD |title=Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated? |journal=Saudi J Gastroenterol |volume=16 |issue=4 |pages=306 |year=2010 |pmid=20871204 |pmc=2995107 |doi=10.4103/1319-3767.70626 |url=}}</ref>
*Complete [[Healing|recovery]] may be expected with [[surgery]].<ref name="pmid20871204">{{cite journal |vauthors=Yagnik VD, Yagnik BD |title=Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated? |journal=Saudi J Gastroenterol |volume=16 |issue=4 |pages=306 |year=2010 |pmid=20871204 |pmc=2995107 |doi=10.4103/1319-3767.70626 |url=}}</ref>
*The risk of developing complications in the postoperative period is 2-7%, the most common complication being [[bowel obstruction]].<ref name="pmid18216533">{{cite journal |vauthors=Zani A, Eaton S, Rees CM, Pierro A |title=Incidentally detected Meckel diverticulum: to resect or not to resect? |journal=Ann. Surg. |volume=247 |issue=2 |pages=276–81 |year=2008 |pmid=18216533 |doi=10.1097/SLA.0b013e31815aaaf8 |url=}}</ref>  
*The risk of developing complications in the postoperative period is 2-7%, the most common complication being [[bowel obstruction]].<ref name="pmid18216533">{{cite journal |vauthors=Zani A, Eaton S, Rees CM, Pierro A |title=Incidentally detected Meckel diverticulum: to resect or not to resect? |journal=Ann. Surg. |volume=247 |issue=2 |pages=276–81 |year=2008 |pmid=18216533 |doi=10.1097/SLA.0b013e31815aaaf8 |url=}}</ref>  
*The risk of developing complications such as [[perforation]], [[inflammation]], [[bleeding]] and [[obstruction]] in asymptomatic patients with Meckel diverticulum is 4-6.4%.<ref name="pmid7944666">{{cite journal |vauthors=Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ |title=Surgical management of Meckel's diverticulum. An epidemiologic, population-based study |journal=Ann. Surg. |volume=220 |issue=4 |pages=564–8; discussion 568–9 |year=1994 |pmid=7944666 |pmc=1234434 |doi= |url=}}</ref>
*The risk of developing complications such as [[perforation]], [[inflammation]], [[bleeding]] and [[obstruction]] in asymptomatic patients with Meckel's diverticulum is 4-6.4%.<ref name="pmid7944666">{{cite journal |vauthors=Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ |title=Surgical management of Meckel's diverticulum. An epidemiologic, population-based study |journal=Ann. Surg. |volume=220 |issue=4 |pages=564–8; discussion 568–9 |year=1994 |pmid=7944666 |pmc=1234434 |doi= |url=}}</ref>
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 19:54, 8 January 2018

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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

Meckel's diverticulum is mostly seen in male children (mostly <2 years of age). One fourth of untreated cases of Meckel's diverticulum may develop complications such as intestinal obstruction, hemorrhage, diverticulitis, bowel ischemia, and necrosis. Hemorrhage is the most common complication in patients with Meckel's diverticulum. Bleeding in patients may be minimal, recurrent or massive and shock-producing. The rate of bleeding is assessed based on quantity of blood lost in the stools, appearance of the material passing through the rectum and hemodynamic state of the patient. Depending on the extent of the symptom progression at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent in cases where symptomatic Meckel's diverticulum is treated in a timely manner. Complete recovery may be expected with surgery in majority of the cases.

Natural History, Complications, and Prognosis

Natural History

Complications

Hemorrhage

  • Most common complication in patients with Meckel diverticulum
  • Accounts for one fourth of all complications
  • More commonly seen in:
    • Children younger than 2 years
    • Male sex

Intestinal obstruction

Perforation

Neoplasm

Umbilical anomalies

Diverticulitis

Meckel's diverticulitis
Source: Wikimedia commons [32]

Other complications

Prognosis

Prognosis of patients with Meckel's diverticulum is as follows: [38]

References

  1. ↑ "Meckel's Diverticulum | Cleveland Clinic".
  2. ↑ 2.0 2.1 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.
  3. ↑ 3.0 3.1 Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ (1994). "Surgical management of Meckel's diverticulum. An epidemiologic, population-based study". Ann. Surg. 220 (4): 564–8, discussion 568–9. PMC 1234434. PMID 7944666.
  4. ↑ Hong J, Park SB (2017). "A case of retroperitoneal abscess: A rare complication of Meckel's diverticulum". Int J Surg Case Rep. 41: 150–153. doi:10.1016/j.ijscr.2017.10.012. PMID 29078157.
  5. ↑ Lequet J, Menahem B, Alves A, Fohlen A, Mulliri A (2017). "Meckel's diverticulum in the adult". J Visc Surg. 154 (4): 253–259. doi:10.1016/j.jviscsurg.2017.06.006. PMID 28698005.
  6. ↑ Cotter TG, Buckley NS, Loftus CG (2017). "Approach to the Patient With Hematochezia". Mayo Clin. Proc. 92 (5): 797–804. doi:10.1016/j.mayocp.2016.12.021. PMID 28473039.
  7. ↑ Rosat A, Pérez E, Oaknin HH, Mendiz J, Hernández G, Barrera M (2016). "Spontaneous hemoperitoneum caused by meckel's diverticulum in an elder patient". Pan Afr Med J. 24: 314. doi:10.11604/pamj.2016.24.314.10384. PMC 5267917. PMID 28154669.
  8. ↑ Rattan KN, Singh J, Dalal P, Rattan A (2016). "Meckel's diverticulum in children: Our 12-year experience". Afr J Paediatr Surg. 13 (4): 170–174. doi:10.4103/0189-6725.194671. PMC 5154221. PMID 28051045.
  9. ↑ Choi SY, Hong SS, Park HJ, Lee HK, Shin HC, Choi GC (2017). "The many faces of Meckel's diverticulum and its complications". J Med Imaging Radiat Oncol. 61 (2): 225–231. doi:10.1111/1754-9485.12505. PMID 27492813.
  10. ↑ Chabowski M, Szymanska-Chabowska A, Dorobisz T, Janczak D, Jelen M, Janczak D (2016). "A massive bleeding from a gastrointestinal stromal tumor of a Meckel's diverticulum". Srp Arh Celok Lek. 144 (3–4): 219–21. PMID 27483571.
  11. ↑ Srisajjakul S, Prapaisilp P, Bangchokdee S (2016). "Many faces of Meckel's diverticulum and its complications". Jpn J Radiol. 34 (5): 313–20. doi:10.1007/s11604-016-0530-x. PMID 26932405.
  12. ↑ Alfa-Wali M, Wardle S, Nizar S, Bloom IT (2016). "Atypical presentation of a Meckel's diverticulum". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-214464. PMID 26884080.
  13. ↑ 13.0 13.1 Komlatsè AN, Komla G, Komla A, Azanledji BM, Abossisso SK, Hubert T (2009). "Meckel's diverticulum strangulated in an umbilical hernia". Afr J Paediatr Surg. 6 (2): 118–9. doi:10.4103/0189-6725.54779. PMID 19661646.
  14. ↑ Pattni V, Wright K, Marden P, Terlevich A (2016). "Meckel's diverticulum in an adult: an obscure presentation of gastrointestinal bleeding". BMJ Case Rep. 2016. doi:10.1136/bcr-2015-213852. PMID 27126093.
  15. ↑ Anwar MO, Ahmed HI, Al Hindi S, Al Omran Y (2014). "Meckel's diverticulum with intussusception in a 5-year-old patient with Down's syndrome". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-207431. PMC 4281549. PMID 25540213.
  16. ↑ Holcomb CN, Hawn MT (2014). "Occult gastrointestinal bleeding". JAMA Surg. 149 (12): 1335–6. doi:10.1001/jamasurg.2014.109. PMID 25337720.
  17. ↑ Basani L, Aepala R, Reddy BM (2016). "Congenital diaphragmatic hernia, Meckel's diverticulum and malrotation in a 3-month-old infant". Afr J Paediatr Surg. 13 (1): 47–9. doi:10.4103/0189-6725.181708. PMC 4955462. PMID 27251525.
  18. ↑ Kunitsu T, Koshida S, Tanaka K, Nakahara S, Yanagi T, Maruo Y, Takeuchi Y, Kubota Y (2015). "Neonatal Meckel diverticulum: Obstruction due to a short mesodiverticular band". Pediatr Int. 57 (5): 1007–9. doi:10.1111/ped.12694. PMID 26310428.
  19. ↑ Bălălău C, Bacalbaşa N, Motofei I, Popa F, Voiculescu S, Scăunaşu RV (2015). "Meckel's diverticulum--a rare cause of intestinal obstruction in adults". Rev Med Chir Soc Med Nat Iasi. 119 (1): 162–5. PMID 25970960.
  20. ↑ Kim KH, Kang KA, Lim JH, Lee KG, Kwon TJ (2016). "Inverted Meckel diverticulum as a lead point of small bowel intussusception: misinterpreting case as a lipoma". Clin Imaging. 40 (5): 840–2. doi:10.1016/j.clinimag.2016.03.009. PMID 27179156.
  21. ↑ Luu AM, Meurer K, Herzog T, Uhl W, Tannapfel A, Braumann C (2016). "Small Bowel Obstruction due to a Giant Meckel's Diverticulum". Visc Med. 32 (6): 434–436. doi:10.1159/000450589. PMC 5290431. PMID 28229080.
  22. ↑ Fiegel H, Gfroerer S, Rolle U (2016). "Systematic review shows that pathological lead points are important and frequent in intussusception and are not limited to infants". Acta Paediatr. 105 (11): 1275–1279. doi:10.1111/apa.13567. PMID 27588829.
  23. ↑ Clasen K, Kalinski T, Meissner C, Bruns CJ, Meyer F (2016). "[77-year-old man with rare Littré's hernia]". Dtsch. Med. Wochenschr. (in German). 141 (15): 1099–101. doi:10.1055/s-0041-109109. PMID 27464282.
  24. ↑ Qin D, Liu G, Wang Z (2014). "Littre's hernia in a paediatric patient". Afr J Paediatr Surg. 11 (4): 351–3. doi:10.4103/0189-6725.143168. PMID 25323188.
  25. ↑ Ahmed Z, Chhabra S, Kankaria J, Jenaw RK (2016). "Meckel's diverticular perforation presenting as acute abdomen in the second trimester of pregnancy". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-216643. PMID 27507693.
  26. ↑ Farah RH, Avala P, Khaiz D, Bensardi F, Elhattabi K, Lefriyekh R, Berrada S, Fadil A, Zerouali NO (2015). "Spontaneous perforation of Meckel's diverticulum: a case report and review of literature". Pan Afr Med J. 20: 319. doi:10.11604/pamj.2015.20.319.5980. PMC 4491457. PMID 26175810.
  27. ↑ Karadeniz Cakmak G, Emre AU, Tascilar O, Bektaş S, Uçan BH, Irkorucu O, Karakaya K, Ustundag Y, Comert M (2007). "Lipoma within inverted Meckel's diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage: a case report and review of literature". World J. Gastroenterol. 13 (7): 1141–3. PMC 4146883. PMID 17373755.
  28. ↑ Thirunavukarasu P, Sathaiah M, Sukumar S, Bartels CJ, Zeh H, Lee KK, Bartlett DL (2011). "Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management". Ann. Surg. 253 (2): 223–30. doi:10.1097/SLA.0b013e3181ef488d. PMC 4129548. PMID 21135700.
  29. ↑ Zhou B, Lai H, Lin Y, Mo X (2016). "Omphalomesenteric duct remnant adenocarcinoma in adults: a case study". Springerplus. 5 (1): 2027. doi:10.1186/s40064-016-3713-0. PMC 5126029. PMID 27995004.
  30. ↑ Metwally IH, Elalfy AF, Awny S, Megahed N (2016). "Meckel's diverticulum complicated with gastro-intestinal stromal tumor: Case report". J Egypt Natl Canc Inst. 28 (2): 123–7. doi:10.1016/j.jnci.2016.02.002. PMID 26936384.
  31. ↑ Yıldız İ, Koca YS, Barut İ (2016). "An unusual case of intraabdominal abscess and acute abdomen caused by axial torsion of a Meckel's diverticulum". Ann Med Surg (Lond). 6: 74–6. doi:10.1016/j.amsu.2016.01.082. PMC 4761698. PMID 26955478.
  32. ↑ "File:Meckel's Diverticulum AFIP.jpg - Wikimedia Commons".
  33. ↑ Marwah S, Singla P, Marwah N, Gupta S, Singh VP (2016). "Ileal stricture following Meckel's diverticulitis: a rare cause of intestinal obstruction". Clin J Gastroenterol. 9 (3): 118–23. doi:10.1007/s12328-016-0647-6. PMID 27146826.
  34. ↑ Hamilton CM, Arnason T (2015). "Ileitis associated with Meckel's diverticulum". Histopathology. 67 (6): 783–91. doi:10.1111/his.12717. PMID 25892011.
  35. ↑ Gasparella M, Marzaro M, Ferro M, Benetton C, Ghirardo V, Zanatta C, Zoppellaro F (2016). "Meckel's diverticulum and bowel obstruction due to phytobezoar: a case report". Pediatr Med Chir. 38 (2): 117. doi:10.4081/pmc.2016.117. PMID 27345602.
  36. ↑ Lo T, Sagar J, Trickett J (2015). "A rare presentation of complication arising from Meckel's diverticulum in the form of diverticulotransverse colonic fistula in an adult". BMJ Case Rep. 2015. doi:10.1136/bcr-2013-203330. PMC 4460404. PMID 26040824.
  37. ↑ Wu SY, Ho MH, Hsu SD (2014). "Meckel's diverticulum incarcerated in a transmesocolic internal hernia". World J. Gastroenterol. 20 (37): 13615–9. doi:10.3748/wjg.v20.i37.13615. PMC 4188914. PMID 25309093.
  38. ↑ "Meckel diverticulum Prognosis - Epocrates Online".
  39. ↑ Yagnik VD, Yagnik BD (2010). "Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated?". Saudi J Gastroenterol. 16 (4): 306. doi:10.4103/1319-3767.70626. PMC 2995107. PMID 20871204.
  40. ↑ Zani A, Eaton S, Rees CM, Pierro A (2008). "Incidentally detected Meckel diverticulum: to resect or not to resect?". Ann. Surg. 247 (2): 276–81. doi:10.1097/SLA.0b013e31815aaaf8. PMID 18216533.

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