Meckel's diverticulectomy





Definition

Meckel's diverticulectomy is a surgical procedure that isolates and removes an abnormal diverticulum (Meckel's diverticulum) or pouch, as well as surrounding tissue, in the lining of the small intestine. It is performed to remove an obstruction, adhesions, infection, or inflammation.


Purpose

Meckel's diverticulum is an intestinal diverticulum (pouch) that results from the inability of the vitteline (umbilical) duct to close at five weeks of embryonic development. The vitteline duct is lined with layers of intestinal tissue containing cells that can develop into many different forms, called pluripotent cells. Meckel's diverticulum is a benign congenital condition that has no symptoms for some people, and develops complications in others.

Ninety percent of diverticula are close to the ileocecal valve in the upper intestine, and tissue made up predominantly of gastric and pancreatic cells is thought to cause chemical changes in the mucosa, or lining of the intestines.

The most common cells found in the mucosa of diverticula are gastric cells (present in 50% of all Meckel's diverticulum cases). The highly acidic secretions of gastric tissue may cause the early symptoms of Meckel's diverticulum. The alkaline secretions of pancreatic tissue are also thought to be a source of diverticula inflammation in a small number—about 5%—of cases.

Inflammation of the diverticula or infection of the intestines around the diverticula results in a condition known as diverticulitis, which may be treated with antibiotics . However, when it is acute and causes obstructions and bleeding, surgery is the treatment of choice.


Demographics

Meckel's diverticulum is present in approximately 2% of the population. It is the most commonly encountered congenital anomaly of the small intestine. Although the abnormality occurs in both sexes, men have

During Meckel's diverticulectomy, the abdomen is opened above the area of the diverticulum, which is exposed along with the bowel (A). The diverticulum is clamped off at the base, and then cut off (B). Two layers of stitches are used to repair the bowel (C and D). (Illustration by GGS Inc.)
During Meckel's diverticulectomy, the abdomen is opened above the area of the diverticulum, which is exposed along with the bowel (A). The diverticulum is clamped off at the base, and then cut off (B). Two layers of stitches are used to repair the bowel (C and D). (
Illustration by GGS Inc.
)
more frequent complications with the condition and are more often diagnosed with it. One 15-year study set the complication risk of the abnormality at 4.2%. A recent 10-year study done retrospectively reported an even age distribution for complications of the diverticulum. Malignancy is found in only 0.5–4.9% of patients with complications of Meckell's diverticulum.


Description

Open surgery of the intestines is indicated in acute cases. In the surgery, the intestinal segment containing the diverticulum, usually the ileum or upper intestines, is removed. After the diverticulum is removed, the healthy portions of the intestine are joined together. Some debate exists about whether surgery for asymptomatic Meckel's diverticulum found incidentally is recommended. Some researchers have shown that preventive removal of the diverticulum is less risky than surgical complications, and point to the fact that 6.4% of patients with Meckel's diverticulum develop complications of the condition over their lifetime.

Depending on the surgeon's decision, the operation may be minimal, isolating and then removing the pouch containing the inflammation, or it may be more extensive. In the latter cases, surrounding tissue is removed due to the presence of pervasive inflammation, obstruction, or incarceration in an inguinal hernia (Littre's hernia). Removing additional tissue is done to prevent recurrences. Recent studies have demonstrated the feasibility of laparoscopic, or minimally invasive diverticulectomy, utilizing small incisions and video imagery via tiny cameras. No long-term studies of this procedure have been conducted.

Surgery is performed under general anesthetic. The small intestine is isolated and the diverticulum is removed, sometimes with a small segment of the intestines. Operative techniques are used to conjoin the end sections of the intestines that have been severed. Some surgeons prefer to perform two surgeries, and do not join together the intestinal sections until some healing of the segments has occurred. In this case, a stoma, or temporary outlet for tubal connection to the intestines, is created in the wall of the abdomen where an external appliance, called an ostomy, can receive waste until the intestinal sections are rejoined.


Diagnosis/Preparation

The vast majority of Meckel's diverticulum diagnoses are incidental, that is, discovered during barium studies, abdominal surgery for other conditions, or autopsy. The most common symptom of the condition is intestinal bleeding, which occurs in 25–50% of patients who have complications. Hemorrhage is the most significant symptom in children two years old and younger. Intestinal obstructions are common, resulting from complications of the tissue surrounding the diverticula. Symptomatic Meckel's diverticulum has symptoms similar to appendicitis. Lower abdominable pain or diverculitits accounts for 10–20% of cases, and requires careful diagnosis to distinguish it from appendicitis. Left untreated, diverticulitis can lead to perforation of the intestine and peritonitis.

Patients who have diverticulitis symptoms, such as acute abdominal pain are given various imaging tests, including a CT scan, colonoscopy , or a sigmoidoscopy (view of the lower colon through a tiny video instrument placed in the rectum). For children, a special chemical diagnostic test of sodium Tc-pertechnetate, a radioisotope that reacts to the mucosa in the diverticulum, allows inflammation or infection to be viewed radiographically. In adult patients, barium studies may help with diagnosis. When acute hemorrhaging is present, MR imaging of blood vessels is an effective diagnostic tool.

If surgery is indicated for Meckel's diverticulum, an enema is given (unless contraindicated by complications) to completely clear the bowel and avoid infection during surgery.

Aftercare

Intestinal surgery is a serious procedure, and recovery may take two weeks. The number of postoperative days spent in the hospital depends on the extent of the diverticulum surgery and complications of the condition prior to surgery. Barring complications, patients usually stay in the hospital for about one week. Immediately after surgery, the patient is observed carefully, and given intravenous fluids and antibiotics. Surgical catheters, or stents, are removed over the next two days, with food by mouth offered once bowel sounds are heard.


Risks

Intestinal surgery has the surgical complications associated with any open surgery. These include lung and heart complications, as well as reactions to medications, bleeding, and infection.


Normal results

The usual results of this surgery are an end to obstruction, pain, and infection. Highly successful results include the return of bowel function and daily activities.


Morbidity and mortality rates

Patients with complications of Meckel's diverticulum have a 10–12% incidence of early postoperative complications such as an intestinal leak, a suture line leak or intra-abdominal abscess. Later complications occur in about 7% of patients, and include bowel obstructions and intestinal adhesions. The reported mortality rate for surgery on patients with symptomatic diverticulum is 2–5%. With asymptomatic patients who undergo incidental diverticulectomy, both early and late complications occur in 2% of cases, and the mortality rate is 1%.


Alternatives

Diverticulitis is routinely treated with a change in diet that includes increasing bulk with high-fiber foods and bulk additives like Metamucil. Recurrent attacks, perforation, tissue adhesions, or infections are initially treated with antibiotics, a liquid diet, and bed rest. If medical treatment does not clear the complications, emergency surgery may be required.


Resources

BOOKS

Townsend, Courtney M. "Diverticular Disease" In Sabiston Textbook of Surgery 16th ed. W. B. Saunders Company, 2001.

PERIODICALS

"Laparoscopy-assisted Resection of Complicated Meckel's Diverticulum in Adults." Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 12(3) (June 1, 2000): 190-4.

"Meckel's Diverticulum." American Family Physician 61(4) (February 15, 2000).


ORGANIZATIONS

International Foundation for Functional Gastrointestinal Disorders (IFFGD).P.O. Box 170864, Milwaukee, WI 53217-8076. (888) 964-2001 or (414) 964-1799. fax: (414) 964-7176. http://www.iffgd.org .

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, Maryland 20892-3570. http://www.niddk.nih.gov .


OTHER

"Meckel's diverticulectomy." MedlinePlus http://www.nlm.nih/medlineplus.gov .


Nancy McKenzie, Ph.D.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Surgery takes place in a hospital setting by a physician with advanced training in surgery and gastrointestinal surgery. If the surgery is minimally invasive, requiring only small incisions, it may be performed in an outpatient surgical area of the hospital.

QUESTIONS TO ASK THE DOCTOR


  • Is this surgery necessary or can changing the diet and medical treatment be just as effective?
  • Because this surgery was on an emergency basis, how extensive was the surgery and how much of the intestine was removed?

User Contributions:

Krzysiek
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Jan 19, 2008 @ 1:13 pm
Hi, i had surgery of Meckeli's diverticulum about 6 months ago, before surgery i had a big pain in stomach, and emesis, about eight on day, when i arrived to hospital, doctors maked test of blood, in the result i exceed limit of leucocyt's about 22 thousands, on the firstly doctor's think that it may was inflammation of peritoneum, but on the surgery they affirmed that is meckeli's diverticulum, inflammation of peritoneum with abcess intraabdominal, and they cut appendix. I spent in hospital 8 days, i have drainage in abdominal, after surgery i had big pain in abomen, as i left hospital in home i don't walk because you can't, after one month i feelt better, my surgery was very complication, about 2 months after surgery i had a problem of heart(increased blood-presure, headchache, and problems with stomach,gastric)After operation i must keep diet, eliminated products which have glutens. Today i feel good but sometimes i have problem with gastric(bloat,diarrhoea)and pain in place where i have cut.
Jodie
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Feb 4, 2009 @ 12:00 am
HI I am 23 years old and I just found out that I had Meckel's Diverticulum. This article is very helpful.
a123
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Apr 13, 2009 @ 3:15 pm
I had Meckel's Diverticulum and at age 30. Due to severe stomach pain, I had emergency surgery where they removed part of my small intestine. I was in the hospital for 9 days and my recovery took about 3 weeks with a strict diet. My only major side-effect was that my stomach was upset daily for about 4-5 months but it has now subsided. Now, a year later I just found out I am severly anemic and am curious as to whether or not this surgery is causing my body to not absorb iron. I'd be curious to know if anyone else having this surgery also is anemic.
dolores
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Nov 22, 2009 @ 3:03 am
Dolores, check on line forfoods without glutens. Also check what foods provide/assist in acidic production and the alkoline effect of the surgery is the minimum 50 charcater limit of this comment field.
But I am glad i did so I can remember to look more info.
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Mar 7, 2011 @ 6:18 pm
I had Meckel`s Diverticulum at age 59 which was removed in emergency op,i to suffer from gastric upsets,stomach bloating etc now and again.
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Apr 5, 2011 @ 9:21 pm
I am a 45 year old male.I had Meckel's Diverticulum surgery March 18, 2011,I was admitted into the hospital with severe pains on march 13, 2011.I was 1st treated for the obstruction for the 1st 4 days & the found out I needed the surgery.I was released on March 22. 10 days in the hospital.I was seen by my surgeon a week after going home from the hospital still not feeling well but everything seemed fine,3 days later I had a fever of 103. My wife immediately called the Dr. who met us in the office the incision had gotten infected,the Dr. then squeezed & reopened my incision & put a drain.The drain then had to be removed 2 days later, went back to the Dr. today & he put another drain in & said to remove it in 2 more days> I am on antibiotics also twice a day. The best is when I had the surgery,I asked another Dr. who had seen me in the hospital when can I go back to work.he said not for at least 2 week,I wish.I am down 20 pnd & am not even close to 50% back to normal.Tonight going to the Dr. was pretty rough cleaning the incision inside & out it hurt like a @$@%^. When is this nightmare going to end?
Kelly
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Aug 28, 2011 @ 11:23 pm
I am 41 years old and had emergency surgery just over 5 weeks ago while I was on holidays in the UK. Since the surgery I have steadily felt better. Over the last week (after returning to work) I have been experiencing periodic sharp piercing pains on my right side near the incision (internal). Will this pass?
michele
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May 7, 2012 @ 8:08 am
I was first diagnosed with Meckels at age 34. It took ten years of pain and testing before finding a doc who performed exploratory surgery and "fixed" the condition. I have had five surgeries since, and at age 59, am currently exhibiting pain again. I cannot eat anything fibrous like fruit and veggies without eating something like bread with them. The problem is that scar tissue forms after surgery causing a restriction at the site of operation. I am weary of this condition, but guess it beats the alternative. Wish someone could actually fix once and for all this problem of reaccuring scarafication.
Ken Kelsey
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May 16, 2012 @ 6:18 pm
I am 71yrs 10 mths I was unable to eat normaly lost two kgs in two weeks admitted to hospital diagnosed with meckels Diverticulum had 2 hr corrective surgery.was unable to pass wind for 13 days hence in pain most of the time pain relief taken continually.Finaly bowels moved day 14 unable have food until day 16 soup & liquids only in hospital for 21 days lost 8 klg .Home now gained 3 klg able to walk 800 mtrs twice daily progressing well.
Reena
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Jul 9, 2012 @ 11:11 am
my boy friend diagnosed with meckel diverticulum. would like to ask suggestion, is the surgery could cure the condition.
Stephanie
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Jul 14, 2012 @ 2:02 am
My mom had the disease, she had emergency surgery. She is now loosing blood internally, what is causing this.
James Sutton
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Sep 27, 2012 @ 5:17 pm
Hey, I'm 17 and I was admitted to hospital 3 weeks ago today with severe stomach pains. The doctors initially thought that I had appendicitis so sent me up to surgery to have my appendix out. But it was only when i was actually having surgery that they found that my appendix was fine and that I had a Meckel's Diverticulum which had perforated and was leaking out toxins and blood into my body - which nearly killed me. So that turned what thought would be a 30 minute operation into a 6 and a half hour But thankfully they removed the Meckel and drained all fluids out from my body. However, I was one of the rare ones as they did it via Key-hole surgery (even though it wasn't the normal method of procedure). I was in hospital for about a week recovering and then had a further 2 weeks off. It didn't come at the best of times as the day i was admitted had been my first day back at sixth form. I think my case might be linked because In January this year i had to have major emergency surgery for testicular torsion (which i missed a month of sixth form for) and then at Easter i was diagnosed with severe Glandular fever & Tonsillitis & Hepatitis B. Possibly because my immune system has been so weak this could have caused My Meckel's Diverticulum. Recovery is going well but still fairly weak :)
Anne Marie
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Oct 7, 2012 @ 3:15 pm
Following four years of being anaemic and diagnosed with hyper gastric aneamia - i finally had the meckels removed and small bowel resection on 8.9.12.
I just wondered if anyone else had problems with an extremely upset stomach in the mornings, i am unable to leave the house until mid day each day! my job is both demanding and challenging and i am definately not fit enough at the moment. i normall swim three times a week, but have avoided this and find that short brisk walks in the fresh air help.
Yehualashet
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Dec 31, 2012 @ 12:00 am
I need full lecture note of Meckel's diverticulitis, because I am 3rd year public health student in one of our country university.
Debra
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Jan 17, 2013 @ 6:06 am
Meckel's is a congenital birth defect. Only 2% of the population have it. Aren't we the lucky ones? (insert sarcasm)
I had mine removed in my late 20's. Now, twenty years post surgery I have suffered with painful abdominal cramps and diarrhea for many years. I've also had acid reflux since surgery. I take proton pump inhibitor meds to control the GERD. I suspect I now suffer from Crohn's disease which I am not sure if related to having the meckel's diverticulum or not. Off to the GI doctor soon to diagnose current symptoms.
Dawn
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Jan 25, 2013 @ 6:18 pm
I had meckel's two years ago. I had bleeding , obstruction , and I lost 60 pounds in 3 months because the fibrous cords were wrapping around my intestines blocking any food from going down. Every time I ate it would come back up whether it was liquid or solids. I had the colon resection surgery and I have been fine ever since( crossing my fingers). My doctor framed my pathology report and put it in his office because it is so rare and he had not had a patient with it. Being a female and 27 yrs old he was shocked that that's what it was. Going into surgery I was told I had two tumors in my intestine and didn't know if it was cancer or not. Coming out of surgery I was extremely relieved it wasn't cancer and the meckel's was taken out with no complications. :)
Sara
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Aug 30, 2013 @ 6:06 am
Hi I was just wondering if anyone has had the meckel's scan with a negative result but had surgery and they found it. My 3 year old has been having all the. Symptoms but the scan showed nothing so they now what to do a laparoscopy to see if it is there!! Sorry need some help as we've been dealing with this for nearly a year now and I need some answers thank you.
Cheryl
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Sep 29, 2013 @ 6:18 pm
I had mekels and a tumor taken out about 6 weeks ago, I'm 53 yrs old. I recovered well but have continually had a pain in my right side, can't sleep but on 1 side. I hv to take so many laxative that I will never be the same. Sometimes it feels like my ribs are expanding.

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