Definition of Diverticulum
A blind pouch that is continuous with lumen of a hollow viscus(gut or urinary bladder)
- Persistent patency of the proximal part of the vitellointestinal duct.
- lt is the most common cause of bleed per rectum in childhood
Incidence(Rule of 2)
(Most prevalent congenital anomaly of the GIT)
- 2% of people are affected.
- 2% of affected people may have complicati
- 2 times more common in males than females.
- 2 feet (60 cm) from ileocaecaljunction.
- 2 inches long.
- its true diverticulum which consist of all layers of the bowel and has seperate blood supply from the superior mesentric artery
- it project from antemesenteric boarder
- it may contain ectopic tissues(gastric,duodenal,pancreatic or colonic tissues in 20% of cases)
- its may be asymtomatic
- may present with complications
- most frequent manifestation is bleeding
1-Intestinal obstruction(the commonest)
may be due to
- Sometimes the diverticulum contains ectopic gastric epithelium This leads to formation of peptic ulcer on the neighboring epithelium.
- The ulcer is liable to Perforation →Bleeding→ melena or blood per rectum according to the amount of bleeding.
Clinical Picture :
- Usually a child 8-10 years old.
- Abdominal pain (around the umbilicus because it is a part of Midgut) following meals
- Picture of acute peritonitis if the ulcer perforates.
- Clinical picture similar to that of acute appendicitis.
- At operation, the appendix is found normal (it is the only way to differentiate between acute appendicitis and Meckel's diverticulitis).
- It is more danqerous than acute appendicitis due to:
- Easier perforation due to its thin wall.
- More difficult localization due to its central position & mobility of the small intestine
- its hernia in which its content is Meckel's diverticulum
- May strangulate causing strangulation without obstruction.
- Perforated peptic ulcer.
1-Barium meals follow through: may show a diverticulum.
2-Superior mesenteric angiography: extravasation.
3-Tc99 Scan + gamma camera: safer than arteriography can demonstrate gastric mucosa.
4-Angiography: extravasation: weeping meckel's (active blood, 0.5ml / min)
- Wedge resection of the ileum and closure of the defect transversely or segmental resection is indicated.
2-Silent cases and accidentally discovered at laprotomy:
- indications of resection(if complication is likely)
1-Narrow mouthed (diverticulitis is likely)
2-The wall of the diverticulum is thickened (contains ectopi gastric tissue)→ (peptic ulcer is likely).
3-Attached band of adhesions→(intestinal obstruction is likely)
4-Young adults and children→(different complications are likely)
- If not we can leave it