meckel’s diverticulectomy

Meckel’s diverticulum is the most common congenital abnormality of the small intestine that results from incomplete closure of the vitelline (omphalo-mesenteric) duct. This true diverticulum is approximately 2 ft from the ileocecal valve commonly found on the anti-mesenteric border of the ileum, is benign and in majority of cases asymptomatic. 

RULE OF 2- It is 2 inches long, 2feet from IC junction, 2cm in diameter, 2types of heterotopic mucosa, 2times common in males and found in 2% of population

PATHOLOGY

  • Meckels is a true diverticulum with all the layers of bowel wall
  • ¾ times meckels are free from the abdominal wall
  • Gastric mucosa is the most common heterotopic mucosa seen in meckels 
  • Incidence of mucosal bleeding is as high as 80%
  • A litters hernia is one containing meckels diverticulum in it

CLINICAL PRESENTATION

  • Symptomatic in young patients, common in less than 2yrs of age
  • Patients may present with hemorrhage, intestinal obstruction, intussusceptions, diverticulitis
  • Malignancy common in elderly

RADIOLOGY

  • Technetium -99m pertecnate radionuclide scan is used
  • Accuracy can be improve by giving pentagastrin which stimulates gastric mucosa
  • Angiography- is usually negative unless the bleeding rate is greater than 0.5ml/min
  • Wireless capsule endoscopy has also been used

PRESENTATION

  • BLEEDING- 

                –  Meckels diverticulum accounts for 50% of all the lower gastro-intestinal bleedings

                – The colour of stool is bright red, maroon.

                – Younger patients are anaemic

                -episodic painless bleeding is the most common presenting scenario

  • OBSTRUCTION-
  • Meckels can cause small bowel obstruction via intussusception, volvulus, vitelline bands, incarcerated littre hernia
  • Patients can present with pain abdomen, vomiting, bloody stools, palpable abdominal mass
  • Volvulus can result from a omphalodiverticular fibrous band or a vascular vitelline remanant, which provides a fixation point for the bowel to twist around
  • Meso-diverticular intestinal remanants can create internal hernia
  • MANAGEMENT-
  • Treatment of symptomatic meckels is resection followed by primary anastomosis.
  • Can be done by open or laparoscopic assisted approach
MECKEL’S DIVERTICULUM DELIVERED THROUGH THE UMBILICAL WOUND LAP GUIDED

Minimising scars in children

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