Meckel's diverticulum

The Meckel 's diverticulum ( " Meckel diverticulum " diverticulum ilium ) - named after the German anatomist Johann Friedrich Meckel ( 1781-1833 ) - is a protrusion of the jejunum ( jejunum ) or ileum (ileum ), the a remnant of the embryonic Dottergangs ( vitelline duct, illustrating the connection of the yolk sac ).

In human newborn diverticulum about 30-50 cm, 60-90 cm in adults prior to entry of the small intestine ( ileum) in the cecum is ( separated by the ileocecal valve ), in which the side facing away from the mesenteric intestinal wall located.

Frequency

Depending on the angle, the frequency is specified differently. According to pediatric section studies it is found in 1.5 % of cases; Surgeons see it more often with 3.2 to 4.5 % when eg looking at an appendectomy after. Particularly common is a Meckel 's diverticulum in people with a form of trisomy 21 (Down syndrome) before.

Medical importance

Usually make Meckel 's diverticulum no complaints. Is the Dottergang but partially open, bowel contents can get in and result in impoundment inflammation. The symptoms then hardly differ from acute appendicitis: fever, nausea and severe right-sided abdominal pain. Surgery is the only meaningful therapy in such acute cases.

In about 30-50 % of cases, the diverticulum can instead of the usual small intestinal mucosa and gastric mucosa - mostly from Corpus type - or rare (about 5 %) of cells in the pancreas. The acid forming such cells can cause ulcers and bleeding. The ulcers are usually located at the Divertikelbasis. Rarely there may be a breakthrough and peritonitis ( perforative ) come.

The cause of bleeding in the digestive tract, the Meckel 's diverticulum is rarely responsible to make: 3-5% of the bleeding comes from the small intestine, 30 % of which from a Meckel 's diverticulum. If you suspect an ectopic ulcer diagnosis, especially in children can be secured by the sodium technetium-99m pertechnetate scintigraphy, since the isotope used accumulates in the gastric mucosa in particular.

Rarely, the diverticulum can vorstülpen as invagination into the lumen of the ileum or the colon.

Stay between Meckel 's diverticulum and navel a connective tissue strand consist - usually will dissolve with the regression of the Dottergangs -, this may be the cause of postoperative obstruction. If this strand completely open, it is called a " persistent vitelline duct "; closes the other hand, the internal open string both navel and gut approach is called a " yolk duct cyst ".

During the operation the independent vascular supply of the diverticulum is prohibited in the rule and located at the base ( resected ). The resulting opening of the bowel is sutured transversely. For very large diverticula a segmental resection may be necessary.

Diagnosis

In general, a Meckel 's diverticulum is discovered accidentally during a laparoscopy or laparotomy, as it is usually clinically silent behaves. Due to the often existing ectopic gastric mucosa, it can be best demonstrated by scintigraphy with sodium pertechnetate ( Na99mTcO4 ). If a negative result, if no acute abdomen is present, a contrast agent enema be performed. A promising method seems to be the push endoscopy. Computed tomography and abdominal ultrasound are not helpful.

Legal issues

If a Meckel 's diverticulum randomly befundet ( gynecological, biliary or laparoscopy appendectomy ), so this finding must be documented. If a short time after the survey findings, a complication of this diverticulum a, a malpractice were in the past, especially in the U.S., surgeons assumed and brought this action for damages. If the surgeon but the diverticulum resected and doing a complication occurs, they can be interpreted at its expense ( unilateral action with adverse consequences for the patient ) and it does not have to be paid by the patient, as no other agreement has been made. A solution to this dilemma is further.