- Genetic Factors: The condition develops during foetal growth due to incomplete obliteration of the vitelline duct. This process occurs between the fifth and seventh weeks of gestation.
- Age: Complications from Meckel’s diverticulum are more common in younger individuals, particularly children under two years old. These complications, such as intestinal obstruction, inflammation, or bleeding, become less frequent as individuals age, with many remaining asymptomatic throughout life.
- Gender: Males are about twice as likely as females to have complications from Meckel’s diverticulum. This suggests a biological or hormonal influence on the onset of symptoms or complications.
Meckel’s Diverticulum Treatment in Singapore
Meckel’s diverticulum is a small pouch in the intestinal wall that develops during foetal growth and is the most common congenital anomaly of the gastrointestinal tract. It forms when a portion of the vitelline duct (an embryonic structure connecting the developing gut to the yolk sac) fails to fully regress. This pouch is typically located in the small intestine, usually within 100 centimetres of the ileocecal valve, and may contain tissue resembling that of the stomach or pancreas.
Symptoms of Meckel’s Diverticulum
Individuals with Meckel’s diverticulum may experience various symptoms, though many cases remain asymptomatic. Symptoms may include:
- Gastrointestinal Bleeding: Painless rectal bleeding appears as bright red blood in stools or dark, tarry stools. This occurs due to ulceration of intestinal tissue by acid-producing stomach tissue in the diverticulum.
- Intestinal Obstruction: Abdominal pain and distention occur when the diverticulum causes bowel blockage. Vomiting and constipation may accompany these symptoms.
- Diverticulitis: Inflammation of the diverticulum leads to severe abdominal pain and fever. The pain typically centres around the naval area.
- Intussusception: The diverticulum can lead to a condition where one section of the bowel slides or folds into an adjacent section. This can cause severe abdominal pain, vomiting, and bloody stools.
Causes and Risk Factors
Several factors influence the development of Meckel’s diverticulum and the likelihood of complications. These include:
Diagnosis of Meckel’s Diverticulum
Meckel’s Scan
This specialised nuclear medicine test is used to detect stomach-like tissue within the diverticulum. A small amount of radioactive substance is injected into the bloodstream, which specifically accumulates in stomach tissue. This allows the abnormal tissue to be highlighted and clearly visible on imaging, making it an effective tool for diagnosis.
Laparoscopy
This is a minimally invasive surgical procedure where a small camera is inserted through tiny incisions in the abdomen, allowing direct visualisation of the diverticulum. This approach can also transition to treatment if the diverticulum is identified.
CT Scan and Ultrasound
These imaging techniques are commonly used to detect complications, such as inflammation or bowel obstruction. While they may indicate secondary signs of Meckel’s diverticulum, they rarely show the diverticulum itself directly.
Treatment Options
The approach to treating Meckel’s diverticulum depends on whether it causes symptoms and its presentation.
Non-Surgical Treatment
- Observation: Asymptomatic cases discovered incidentally, such as during imaging or surgery for unrelated reasons, may not require immediate treatment. Regular monitoring helps ensure any potential complications, such as bleeding or obstruction, are detected early.
- Medication: Proton pump inhibitors (PPIs) or antacids may be used to reduce gastric acid secretion in cases where ectopic gastric tissue in the diverticulum causes irritation or bleeding. Antibiotics are given when infections, such as diverticulitis or abscesses, are suspected or confirmed.
Surgical Treatment
- Diverticulectomy: This procedure involves the surgical removal of only the diverticulum while preserving the surrounding small intestine. It is suitable for cases where the diverticulum has a narrow base and the adjacent tissue appears healthy. This approach minimises the impact on intestinal function.
- Bowel Resection: In more severe cases, such as when the diverticulum is inflamed, perforated, or causing significant complications, a segment of the surrounding small intestine is removed along with the diverticulum. This ensures complete removal of affected tissue and prevents further complications, such as infection or obstruction.
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Prevention and Management
Prevention focuses on identifying risk factors and monitoring patients with known Meckel’s diverticulum. Regular medical check-ups help detect complications early. Patients who undergo surgical removal require follow-up visits to monitor recovery and prevent post-operative complications, with a General Surgeon overseeing post-surgical care to ensure optimal healing. Those with asymptomatic diverticula benefit from awareness of potential symptoms to seek prompt medical attention if complications develop.
Frequently Asked Questions
Can Meckel’s diverticulum develop later in life?
No, Meckel’s diverticulum is present from birth. However, symptoms can develop at any age, occurring more often in children under two due to a higher risk of complications like bleeding or obstruction.
How does Meckel’s diverticulum affect children differently from adults?
Children are more prone to complications like bleeding, caused by acid-producing stomach tissue, and obstruction from intussusception. Adults more commonly experience inflammation (diverticulitis) or secondary issues like perforation or adhesions.
Can Meckel’s diverticulum mimic appendicitis?
Yes, inflamed Meckel’s diverticulum can mimic appendicitis with symptoms such as abdominal pain, fever, nausea, and vomiting. Pain is often near the navel or lower right abdomen, making diagnosis challenging without imaging or surgery.
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