Difference between revisions of "Meckel's diverticulum natural history, complications and prognosis"

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* Various mechanisms of [[Bowel obstruction|intestinal obstruction]] occur with [[Meckel's diverticulum]]:
 
* Various mechanisms of [[Bowel obstruction|intestinal obstruction]] occur with [[Meckel's diverticulum]]:
 
** [[Volvulus]]: The [[Vitelline duct|omphalomesenteric duct]] may be attached to the wall of the [[abdomen]] by a fibrotic band, and [[volvulus]] of the [[Small intestine|small bowel]] around the band may occur.  
 
** [[Volvulus]]: The [[Vitelline duct|omphalomesenteric duct]] may be attached to the wall of the [[abdomen]] by a fibrotic band, and [[volvulus]] of the [[Small intestine|small bowel]] around the band may occur.  
** [[Intussusception]]: The lead point of the [[intussusception]] may be:
+
** [[Intussusception]]: An [[intussusception]] is a blockage in the [[Intestine|intestines]] caused by folding of the [[Intestine|intestines]]. The lead point of the [[intussusception]] may be:
 
*** [[Diverticulum]]   
 
*** [[Diverticulum]]   
 
*** [[Tumor]] arising in the wall of the [[diverticulum]]  
 
*** [[Tumor]] arising in the wall of the [[diverticulum]]  
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*** Secondary [[infection]]  
 
*** Secondary [[infection]]  
 
*** [[Adhesion (medicine)|Adhesions]] may develop due to [[diverticular]] [[inflammation]] causing [[Symptom|symptoms]] of [[Bowel obstruction|intestinal obstruction]]
 
*** [[Adhesion (medicine)|Adhesions]] may develop due to [[diverticular]] [[inflammation]] causing [[Symptom|symptoms]] of [[Bowel obstruction|intestinal obstruction]]
*** [[Peritonitis]]: [[perforation]] of the [[Inflammation|inflamed]] [[diverticulum]] may lead to it
+
*** [[Peritonitis]]: [[perforation]] of the [[Inflammation|inflamed]] [[diverticulum]] may lead to inflammation of the peritoneum, which is a thin tissue that lines the inside of the abdomen. 
  
 
==== Umbilical anomalies ====
 
==== Umbilical anomalies ====

Revision as of 18:20, 27 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Intestinal torsions around the intestinal stalk may also occur, leading to obstruction, ischemia, and necrosis. If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
  • The symptoms of (disease name) typically develop ___ years after exposure to ___.
  • If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Complications

Hemorrhage

  • Most common complication in patients with Meckel diverticulum
  • Accounts for one fourth of all complications
  • More commonly seen in:
    • Children younger than 2 years
    • Male sex

Perforation

Intestinal obstruction

Diverticulitis

Umbilical anomalies

These occur in up to 10% of patients and consist of fistulas, sinuses, cysts, and fibrous bands between the diverticulum and the umbilicus. A patient may present with a chronic discharging umbilical sinus superimposed by infection or excoriation of periumbilical skin. There may be a history of recurrent infection, sinus healing, or abdominal-wall abscess formation. When a fistula is present, intestinal mucosa may be identified on the skin. Cannulation and injection with radiographic contrast help to delineate the entire tract and aid in planning a surgical approach for cure. A discharging sinus should be approached surgically with a view toward correction. Exploratory laparotomy may be required. When found at laparotomy, a fibrous band should be excised because of the risk of internal herniation and volvulus.

Neoplasm

This is the pathology least commonly associated with Meckel diverticulum and is reported in approximately 4-5% of complicated Meckel diverticulum cases. Of the various types of tumors reported, leiomyoma is the one that is most frequently found, followed by leiomyosarcoma, carcinoid tumor, and fibroma. One case of ectopic gastric adenocarcinoma has been reported. Lipoma and angioma have also been found. [4, 5]

Other complications

Other reported complications in Meckel diverticulum are vesicodiverticular fistulas, "daughter" diverticula (formation of a diverticulum within a Meckel diverticulum), and formation of stones and phytobezoar in the Meckel diverticulum. Children and infants are at the highest risk for complications, and for some reason, complications occur more often in males than females. Due to this, males are more frequently diagnosed with Meckel’s Diverticulum than females.

The possible complications with Meckel’s Diverticulum include:

A blockage in the intestines caused by folding of the intestines (intussusception)

Abnormal and excessive bleeding arising within the diverticulum

Injury to the diverticulum may result in perforation of the bowel wall

Inflammation of the peritoneum, which is a thin tissue that lines the inside of the abdomen

Rarely, tumors can occur within a Meckel’s Diverticulum. The most common tumor includes carcinoid tumors and gastrinomas. These tumors arise from abnormal collection of neuroendocrine cells or gastrin hormone producing cells

Prognosis

Prognosis of patients with Meckel's diverticulum is as follows: [1]

References

  1. "Meckel diverticulum Prognosis - Epocrates Online".
  2. Yagnik VD, Yagnik BD (2010). "Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated?". Saudi J Gastroenterol. 16 (4): 306. doi:10.4103/1319-3767.70626. PMC 2995107. PMID 20871204.
  3. Zani A, Eaton S, Rees CM, Pierro A (2008). "Incidentally detected Meckel diverticulum: to resect or not to resect?". Ann. Surg. 247 (2): 276–81. doi:10.1097/SLA.0b013e31815aaaf8. PMID 18216533.
  4. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ (1994). "Surgical management of Meckel's diverticulum. An epidemiologic, population-based study". Ann. Surg. 220 (4): 564–8, discussion 568–9. PMC 1234434. PMID 7944666.

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