Meckels Diverticulum: Causes, Symptoms & Treatment

Meckel’s diverticulum is a blind protrusion of the intestine that occurs when there is insufficient regression of the embryonic yolk duct. In most cases, the phenomenon remains asymptomatic throughout life and, in this case, does not require further therapy. Only in the case of inflammatory processes based on the diverticulum are interventions necessary for treatment, which predominantly correspond to removal of the diverticulum.

What is Meckel’s diverticulum?

When the embryonic seedling folds, the so-called omphaloenteric duct is formed. The omphaloenteric duct is also known as the yolk duct. It is an embryonic structure that connects the embryonic yolk sac to the intestinal tube. By the sixth week of pregnancy, the yolk duct regresses and obliterates. With an incidence of about three percent, a portion of the yolk duct remains and becomes a blind-ended outpouching of the intestine. This outpouching is the so-called Meckel’s diverticulum. The phenomenon is named after the German anatomist Johann F. Meckel, who first documented it in the 19th century. Meckel’s diverticulum can give rise to secondary diseases, most notably inflammatory Meckel’s diverticulitis. In a majority of cases, however, the minimal remnant of the embryonic yolk duct remains completely asymptomatic. Meckel’s diverticulum has clinical significance almost exclusively as a differential diagnosis to acute appendicitis.

Causes

Meckel’s diverticulum is the consequence of decreased regression of the embryonic yolk duct. Thus, the phenomenon is a symptom of an embryonic developmental disorder. People with trisomy 21, the so-called Down syndrome, are particularly frequently affected by Meckel’s diverticulum. Presumably, exogenous factors play a significant role in the retention of the embryonic yolk duct. In many cases, however, Meckel’s diverticulum cannot be attributed to a specific external influence. Also the connection with superordinate mutations such as trisomy 21 is not necessarily causative for the phenomenon. Thus, the diverticulum can also be present in complete isolation and need not necessarily be associated with other malformations or other developmental disorders.

Symptoms, complaints, and signs

Meckel’s diverticulum is an outpouching of the ileus that is located about 30 to 50 centimeters proximal to the ileocecal valve in infants. In adults, the distance increases to about 60 to 100 centimeters due to visceral growth. In all cases, no symptoms are associated with Meckel’s diverticulum. Complaints occur only if the diverticulum contains ectopic gastric or pancreatic tissue. In this phenomenon, inflammation with possible perforation often occurs. In addition, ulceration with bleeding may occur in this case because the gastric mucosa is dispersed. If there is an opening between the small intestine and the diverticulum, in many cases intestinal contents enter the diverticulum. With the accumulation of intestinal contents in the Meckel’s diverticulum, the structure may become bacterially inflamed. The symptoms of such inflammation are similar to those of acute appendicitis. In addition to fever, nausea and right-sided severe abdominal pain occur.

Diagnosis and course of the disease

In most cases, the diagnosis of Meckel’s diverticulum is an incidental finding. Most often, the phenomenon is discovered during laparotomy. In many cases, it is specifically sought on the occasion of a planned appendectomy for differential diagnostic reasons. Many people with Meckel’s diverticulum do not learn throughout their lives that they were born with the diverticulum. The reason for this is the asymptomatic nature that is characteristic of Meckel’s diverticulum. In exceptional cases, the diagnosis is made immediately after birth. Palpatory findings may give rise to an initial suspicion of Meckel’s diverticulum, which can be clarified by imaging. In patients diagnosed with trisomy 21, the presence of the diverticulum is obvious. Infants diagnosed with Down syndrome are usually extensively screened for the phenomenon against this background. The prognosis for individuals with Meckel’s diverticulum is extremely favorable, as the phenomenon usually remains symptomless.

Complications

Meckel’s diverticulum does not cause discomfort or complications in every case. For this reason, treatment of this complaint is also not necessary in every case.However, this can lead to bleeding in the stomach or discomfort in the gastric mucosa, which can limit the patient’s quality of life. This leads to inflammation and infections in the stomach and intestines, so that treatment by a physician is necessary in any case. It is not uncommon for Meckel’s diverticulum to cause inflammation of the appendix, so that it must be removed. Likewise, there is severe fever and further vomiting. Furthermore, patients suffer from severe pain in the abdomen and stomach. In the worst case, there is a rupture of the intestine, which can also be fatal. This complaint is treated by surgical intervention, which is usually not associated with any particular complications. Most of the complaints can be relatively well limited by this. Life expectancy is also not reduced. After surgery, those affected are usually still dependent on taking antibiotics to prevent further inflammation or infection.

When should you see a doctor?

If abnormalities and peculiarities occur in the intestinal area, a doctor is needed. If there are irregularities in bowel movements, diarrhea, constipation or pain, a doctor should be consulted. Changes in the intestinal mucosa increase the risk of infection. If the affected person repeatedly suffers from fever, inflammatory disorders or internal irritability, a comprehensive health assessment should be performed on the affected person. Medical tests can determine the cause of the symptoms and an appropriate treatment plan will be established. A general feeling of illness, reduced performance, abdominal pain and nausea are signs of a health disorder. A visit to the doctor is necessary if the complaints persist over a longer period of time or increase in intensity. Blood in the stool and bleeding from the anus must be presented to a doctor. If itching or open sores develop, consultation with a doctor is recommended. If there are disturbances in sitting or if the affected person experiences discomfort when moving around, a visit to the doctor is recommended. If there are sleep disturbances, emotional problems, sensory disturbances or fatigue, a doctor should be consulted. If there is a decreased food intake due to the symptoms, resulting in severe weight loss, a doctor is needed. Problems with digestion, hypersensitivity to certain foods, and increased fatigue should be clarified by a physician.

Treatment and therapy

Meckel’s diverticulum usually does not cause any symptoms. As long as the phenomenon remains entirely asymptomatic, specific treatment is not necessary. If an opening between the diverticulum and the small bowel has been documented, treatment may be indicated. In most cases, however, treatment is not initiated until inflammation results from accumulated intestinal contents. Therapy may also be required if the diverticulum contains gastric mucosa of the corpus type or tissue of the pancreas. As these cells produce acids, ulcers or bleeding may occur. In extreme cases, this results in a perforation that can lead to peritonitis. To treat a Meckel’s diverticulum, surgery is the only sensible course of action. Since surgery is always associated with certain risks for the patient, the benefits and risks of the procedure must be weighed against each other before the operation. As a result of this weighing, the Meckel’s diverticulum is usually not removed until secondary diseases have occurred as a result of the protrusion. During surgery, the surgeon cuts the vascular supply to the Meckel’s diverticulum. After this blood supply is cut off, the diverticulum is removed at its base. This creates an opening on the intestine, which is sutured transversely by the surgeon. If the diverticulum is exceptionally large, a segmental resection is performed instead of the operation described above. In this case, parts of the diverticulum are removed. Once inflammation has occurred due to the diverticulum, the inflammatory process is usually allowed to subside as much as possible before surgery.

Outlook and prognosis

Normally, Meckel’s diverticulum completely regresses on its own. Therefore, most patients experience spontaneous healing due to the natural developmental process of the embryo. As early as the sixth week of pregnancy, the yolk duct regresses entirely without the intervention of physicians or the assistance of medications.Only less than 3 percent of newborns experience irregularities and abnormalities. Frequently, an increased incidence of inflammation or problems of the gastrointestinal tract becomes apparent as growth progresses. Pain in the stomach area or the development of an acute condition in the intestines may occur. The prognosis is therefore worse in these individuals. If the lack of regression of the Meckel’s diverticulum goes unnoticed, an emergency situation may develop if the disease progresses unfavorably. The bowel may rupture, leading to a life-threatening condition. Without intensive medical care as quickly as possible, the affected person will die prematurely. In most cases, however, due to the altered and weakened state of health, it is noticed in time that the regression has not occurred in the abdomen. In these patients, a surgical procedure, which is routine and under optimal conditions, does not lead to any particular abnormalities. After the wound healing, the patient can be discharged from the treatment as symptom-free. Recurrence of health irregularities is not expected.

Prevention

Meckel’s diverticulum arises on the basis of embryonic maldevelopment. Therefore, the phenomenon can be prevented only to the extent that embryonic developmental abnormalities can be prevented.

Follow-up

Follow-up care for diverticula in the intestine (diverticulosis) is performed with the internist or gastroenterologist, sometimes in cooperation with the family physician. Immediately after therapy, a gentle diet that does not put additional stress on the patient’s intestines is important. In case of bleeding or similar unusual events, consultation with the attending physician should be sought. The diet is coordinated with the physician, but nutritionists or dieticians can also provide valuable advice in this context. A diet rich in dietary fiber in conjunction with sufficient drinking are the optimal composition in many cases. Fruits and vegetables are advisable. On the other hand, those affected should tend to avoid flatulent or spicy foods as well as alcohol in order to supplement treatment with targeted aftercare. Diverticula can be promoted in their development by strong pressing and constipation. Therefore, the stool should ideally be kept soft and voluminous. If this cannot be achieved with a purely fiber-rich diet, psyllium products are often helpful. Particularly in the context of aftercare, however, it is important to discuss the use of psyllium products with the treating physicians in advance. Colonoscopy is both follow-up and preventive care. Its frequency is also determined by the physician. It detects early whether new diverticula are in the process of forming again and can thus enable early treatment.

What you can do yourself

In many cases, a Meckel’s diverticulum progresses without symptoms and therefore does not require specific treatment. The most important self-help measure that affected individuals can take is therefore to pay attention to noticeable physical symptoms and have them clarified. In the event of a severe course, for example if an opening forms between the diverticulum and the small intestine, rapid treatment by a physician is required. Acute symptoms such as nausea and abdominal pain can be alleviated with home remedies. For example, warm compresses or cooling are recommended for abdominal pain that typically occurs on one side, depending on which method relieves the pain. For nausea, essential oils or gentle sedatives from the pharmacy may also provide relief. However, medical clarification is necessary in any case. After an operation, rest and bed rest are indicated. The wound must be treated according to the instructions of the responsible physician in order to avoid wound healing disorders and other complications. Accompanying this, it is recommended to refrain from sports and physical exercise in general at first in order to avoid tearing of the suture. Regular check-ups in the doctor’s office are indicated during the first few weeks.