Meckel's diverticulum – treatment of disease. Symptoms and prevention of diseases of Meckel's diverticulum

Meckel's diverticulum – What is this disease? Meckel diverticulum-congenital anomaly ileum, the resulting violations of obliteration yolk proximal duct.

Meckel diverticulum-causes

Meckel diverticulum is embryonic defect, t. it is. formed in the process of fetal development.

On 3-5 month of embryonic development normally happens obliteration (closing) yolk duct and its atrophy. In the case of incomplete obliteration and preservation of the bile duct at the time of the birth of the child formed Meckel diverticulum.

In most cases, Meckel diverticulum is formed in the lower third of the ileum at a distance 60-80 see on ileocekal'nogo (Ilio-slepokishechnogo) corner. Usually has a length of about diverticulum 3-4 cm, the form of a cone or cylinder, located on the opposite wall of the mesentery ileum.

Meckel diverticulum in children refers to true divertikulam, because its wall repeats the morphological structure of the wall of the ileum. However, the composition of the walls of the diverticulum is frequently found jektopirovannaja gastric mucosa, able to produce hydrochloric acid, or pancreatic tissue. The presence of glandular epithelium of stomach in jektopicheskogo divertikule Meckel in children causes ulceration its walls and gastrointestinal bleeding.

Meckel diverticulum in children is often combined with esophageal atresia, atresia, anus and rectum, omphalocele, Crohn's disease.

Symptoms Mekkeleva diverticulum

Uncomplicated Meckel diverticulum in children are asymptomatic and can be accidentally find when performing laparoscopy about another disease or never be recognized. Clinical manifestation of Meckel diverticulum in children is usually associated with the development of complications: intestinal bleeding, inflammation (diverticulitis), bowel obstruction (invaginations, stranguljacii), tumors.

Bleeding from peptic ulcer, as the most frequent complication of Meckel diverticulum in children, It may be acute, abundant or chronic, hidden. A sign of intestinal bleeding Meckel divertikule children serve tarry, black stools. Bleeding is accompanied by a general weakness, dizziness, taxikardiej, paleness, clinical and laboratory signs of post-hemorrhagic anemia. Unlike bleeding from esophageal varices or ulcers stomach and duodenal ulcers, When complicated Meckel divertikule children never vomit "coffee grounds".

The clinic of acute diverticulitis, complicating the Meckel diverticulum in children, resembles the symptoms of acute appendicitis. A child is defined abdominal pain (about belly button or in the right iliac region), nausea, elevated temperature. Inflammation and ulceration Meckel diverticulum in children can cause its free perforation in the abdomen with the development of peritonitis.

Ileus, due divertikulom Meckel in children, accompanied by nausea, vomiting, shvatkoobraznoj abdominal pain, increasing intoxication. Obstruction can be caused by invaginaciej, reabrupt loops of ileum around diverticulum, infringement of intestinal loops.

Sometimes children have infringement occurs in Meckel diverticulum inguinal or femoral bag gryzhevom hernia (hernia Liter). Pari infringement hernia occurs sharp pain, stress and nevpravljaemost' hernias ', the absence of symptom kashlevogo Jolt.

Rarely, than other complications, the children found the tumor Meckel diverticulum, as benign (hamartomas, fibroids, lipomas), and malignant (adenocarcinoma, carcinoid).

Meckel Diverticulum-Diagnostics

With a view to diagnose Meckel diverticulum in children conducted radiography of small intestine with barium suspension, scintigraphy, Ultrasound and CT SCAN of abdominal organs, laparoscopy.

Treatment of Mekkeleva diverticula

In respect of asymptomatic diverticula Meckel in children are divided. Some children's surgeons consider, that you should not delete the accidentally discovered during the operation, an unchanged diverticulum; others insist on compulsory deleting when enabling surgical situations.

Meckel diverticulum in children, complicated inflammation, perforation, bleeding, ileus, infringement, clearly requires emergency surgical intervention. In doing so, the child may be solved diverticulectomy of small intestine (divertikuljektomija) or segmental resection of small intestine with jenterojenteroanastomoza according to the type of end-to-end. Preferred in Pediatric Surgery endoscopic resection of small intestine.

The method of choice of treatment of diverticulitis in children serves as conservative medical therapy: infusion of antibiotics, injection of anti-inflammatory drugs. With the recurring nature of Meckel diverticulum in children, inflammation of diverticulum resection.

With the development of peritonitis, In addition to the small bowel resection, There is a need for drainage and sanitation of the abdominal cavity, appointment of massive antibiotic therapy, infusion and desintoksikatini therapy.

Meckel Diverticulum-Complications

Meckel diverticulum is dangerous their complications: bleeding, intestinal permeability, not, inflammation, perforation, infringement, neoplastic processes.

Prevention Mekkeleva diverticulum

Patient recommended permanent reception coarse wheat bran (gradually increasing the dose of 2-3 teaspoons to 3-9 tablespoons per day). The optimal dose is considered, providing regular Chair not less 1 times in two days.