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Condition: Meckel’s Diverticulum
Overview (“What is it?”)
- A Meckel’s Diverticulum (MD) is a condition where there is a congenital (baby was born with it) extension of the small intestine. It is a remnant of a normal structure (vitelline duct) that is present in all babies as they develop inside their mothers. This structure usually disappears completely before the baby is born.
- Meckel’s Diverticula affects about 2% of the population, but most of the time, they do not cause symptoms.
- Meckel’s Diverticula are also known as ‘the great mimickers’ because they can masquerade as many other problems.
Signs and Symptoms (“What symptoms will my child have?”)
- Symptoms arising from Meckel’s Diverticulum can vary. They can present at any age.
- Bleeding: Some MD possess stomach tissue within it. Stomach tissue makes acid causing an ulcer which can bleed or result in a hole (perforation). The amount of bleeding from MD can be pretty massive. There is frankly bloody stools without associated abdominal pain. If the blood loss is severe, there may be sleepiness or shock.
- Infection: MD can be infected. The pain is usually in the lower abdomen. There may be fever.
- Obstruction: MD and its attachments can be a focal point for intestine to twist around. Nausea and vomiting may be present.
- Perforation: A hole can result in a MD from an inflammatory process. Fever and abdominal pain may be seen.
Diagnosis (“What tests are done to find out what my child has?”)
- Labs and tests: Blood count (CBC) will be checked if the child has bleeding. In a vomiting child, levels of minerals (electrolytes) will be checked to see how bad the dehydration is.
- A Technetium 99m pertechnetate nuclear medicine scan can show whether someone has MD. In this test, a small amount of radioactive material is injected in the vein. It is taken up by MD if stomach tissue is present in MD. Occasionally, the nuclear scan does not perfectly visualize the gastric tissue.
- Tagged RBC scans may pinpoint the source of bleeding, but these require fairly rapid blood loss to be useful.
- Endoscopy: In this test, a flexible lighted telescope is placed in the mouth or the anus to look for sources of bleeding. Although endoscopy does not diagnose a MD, it looks for other sources of bleeding.
- In cases of belly pain, a plain X-ray of the belly may be performed first.
- A computed tomography (CT) scan of the belly may show if there is an infection or blockage.
Treatment (“What will be done to make my child better?”)
- Medicine: The initial treatment for patients with a bleeding MD is IV fluid resuscitation, and occasionally blood transfusion. If MD causes infection, perforation or obstruction, antibiotics are usually given.
- Surgery for MD consists of removing it. It may also require removing part of the small intestine next to it and drainage of infected fluid if perforation happened. Surgery can be done using an open or laparoscopic techniques.
- Open surgery: The operation is done using a large vertical cut on the abdomen.
- Laparoscopic surgery: Several small cuts (incisions) are made. Through one of the cuts, a video camera is placed. The surgery itself is done using small instruments placed through the other incisions. The usual number of incisions (cuts) for laparoscopic surgery vary from one (single port umbilical) to a few.
- Open and laparoscopic surgery take about the same amount of time to perform. One benefit of laparoscopy is that other abdominal structures can be examined using the video camera during surgery. Laparoscopy also has lower risks of wound infection.
- Preparation for surgery: Your child will be given fluids, antibiotics, pain medicine prior to surgery.
- Postoperative care
- Activity: Typically, the child is encouraged to walk around as soon as possible.
- Diet: Once function of the intestine returns (as evidenced by passing gas and stool), patients are started on liquids after their surgery then advanced to a general diet.
- Medicines: Your child may need any of the following:
- Antibiotics: To help prevent or treat an infection caused by bacteria.
- Anti-nausea medicine: To control vomiting (throwing up).
- Pain medicine: Pain medicine can include acetaminophen (Tylenol®), ibuprofen (Motrin®), or narcotics. These medicines can be given by vein or by mouth.
- Risks/Benefits: All abdominal surgeries have risks, including infection, bleeding and damage to nearby structures. Non-operative management is usually not an effective therapy for a bleeding Meckel’s Diverticula, as the likelihood of recurrent symptoms is very high.
Home Care (“What do I need to do once my child goes home?”)
- Diet: Your child may eat a normal diet after surgery.
- Activity: Your child should avoid strenuous activity and heavy lifting for the first 1-2 weeks after laparoscopic surgery, 4-6 weeks after open surgery.
- Wound care: Surgical incisions should be kept clean and dry for a few days after surgery. Most of the time, the stitches used in children are absorbable and do not require removal. Your surgeon will give you specific guidance regarding wound care, including when your child can shower or bathe.
- Medicines: Medicines for pain such as acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) or something stronger like a narcotic may be needed to help with pain for a few days after surgery. Stool softeners and laxatives are needed to help regular stooling after surgery, especially if narcotics are still needed for pain.
- What to call the doctor for: Call your doctor for worsening belly pain, fever, vomiting, diarrhea, problems with urination, or if the wounds are red or draining fluid.
- Follow-up care: Your child should follow-up with his or her surgeon 2-3 weeks after surgery to ensure proper post-operative healing.
Long-Term Outcomes (“Are there future conditions to worry about?”)
- Wound infection: Happens around 3% of the time. Infections may need only antibiotics or may require opening up of the wound depending on how bad the infection is.
- Small bowel obstruction: 3-5% risk in child’s lifetime.
Authors: Steven L. Lee, MD; Joshua Dale Rousch, MD
Editors: Patricia Lange, MD; Marjorie J. Arca, MD