Diverticul Meckel in children: what is it?
- 17 Aug 17:30
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Meckel diverticulum refers to congenital pathologies. In most cases, this disease does not pose a serious health hazard, but the risk of an advancedvariant remains almost 5% of all cases detected. Given the fact that a small probability of severe consequences remains, a special survey and periodic monitoring of pathology development are necessary. The need for operative treatment can only be set by a specialist.
- 1 The essence of the pathology
- 2 The etiology of the disease
- 3 Symptomatic manifestations of
- 4 Methods of diagnosis
- 5 Methods of treatment
1 The essence of the pathology of
The term "diverticulum" means hernia, that is, the sacked bowel peptic ulcer in the weakest place as a result of exposurevarious factors. Meckel diverticulum is one of the varieties of this pathology when local bulging( sac) is formed on the ileum. The main cause of the disease is incomplete closure of the yolk bubble, through which the nutrition of the embryo was carried out. The diverticulum of Meckel in children is recognized as the most common violation of the innervated gastrointestinal tract.
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In essence, the defect considered is the so-called true diverticulum, since the walls of the bag retain all layers of the intestine itself. The average size of education is 6-7.5 cm, but in some cases there were defects with large sizes. The formation of a sack occurs in the womb during a period of 5-7 months of pregnancy, and it is localized most often at the end of the gut.
The pathology is recorded in almost 5% of all children, much more often in boys. Meckel diverticulum in children appears at the age of 8-9 years in almost half of all cases, and most of the previously unidentified diseases are established already at the age of 35 years. A part of the pathology was not detected at all because of the absence of severe symptoms.
Meckel's diverticulum is considered a rather insidious illness, although in most cases it does not cause complications. However, the lack of signs complicates early diagnosis in children, and problems nevertheless sometimes arise. In particular, more than 30% of all formations are coated with an epithelium of the glandular type that is capable of producing hydrochloric acid, and its concentration in the bag can lead to peptic ulcer disease, perforation of the intestine, and internal bleeding. Even more dangerous is the tightening of the diverticula scarring, which overlaps the intestinal lumen and can cause intestinal obstruction.
So, you should not rely on the anomaly's innocence. In order to exclude the smallest risk of complications in a child, diverticulum should be detected in the early stages, and its development should be kept under control. That is why the diagnosis of this disease is considered an important task of pediatric surgery.
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2 Etiology of the disease
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Within the maternal womb there is a gradual formation of organs and systems of the new human body. For this period, nature has created temporary channels for feeding one or another body, which after the development of the main lines become unnecessary and overgrown. In particular, at the stage of embryonic development to provide the formation of the intestine, the small intestine of the embryo is connected to the jaundice with the help of a temporary duct.
With normal development during the period of 4-5 months of pregnancy, this duct becomes unnecessary and dissolves, and the hole through which the nutrition is overgrown. Due to a number of reasons( to the end not studied), the process of eliminating the duct stops, and there are 2 variants of the pathology: the duct is completely preserved, leaving abnormal intestinal output to the anterior wall of the peritoneum, or only a part of the duct that is disconnected from the peritoneum but remainswithdrawal from the small intestine in the form of appendix. The latter version also becomes the diverticulum of Meckel.
Thus, the causes of the formation of the congenital defect are due to a violation of the resorption process of the yolk bubble. The formed appendix has the form of "blind" process in the ileum near its connection with the intestine. The shape of the appendix( sack) can be conical, cylindrical, kolbobraznaya, etc. Development of the Meckel diverticula is often associated with the presence of pathologies such as esophageal atresia, atresia of the anus and rectum, Crohn's disease.
3 Symptomatic manifestations of
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The manifestation of pathology depends on the form in which it is: complicated or uncomplicated. In the latter case, the dimensions are small protrusions, and the structure of the walls of the bag completely coincides with the stenosis structure. Such a diverticulum is no different from the gut itself, and therefore the symptoms may not manifest at all, and a person who has lived all his life with an intestinal defect does not even know his presence. Detection of such protrusion occurs, as a rule, accidentally during prophylactic examination or examination of the intestine on another occasion.
Another thing is complicated diverticulum. Symptoms of this kind of education are manifested depending on the type of complication and the signs that are provoked by pathology( bleeding, inflammatory reactions, tumor education, intestinal obstruction, etc.).Quite a frequent complication in childhood is an ulcer peptic type. A characteristic feature - a bleeding that has a sharp, intense or concealed, chronic character. Internal bleeding is manifested by the change in the color of fecal mass: almost black stool gritty. In addition, the following symptoms are manifested: general weakness, pallor of the skin, dizziness, tachycardia.
Often the exacerbation of the complicated Meckel diverticulum is confused with the attack of the appendicitis. In children there is a sharp pain syndrome in the area of the navel or in the iliac area to the right, nausea, high body temperature, elevated levels of leukocytes in the blood. This is how often the inflammatory process in the diverticula is detected. Such a process is very dangerous because it can lead to perforation of the intestine in the area of the sac with the further development of peritonitis.
A serious complication of the Meckel diverticulum is intestinal obstruction. This pathology manifests itself with an attack-like severe pain in the abdomen, nausea and vomiting. The signs of a general intoxication of an organism are growing rapidly. Intestinal obstruction can be provoked by such factors as: inactivation, distortion of the intestinal loop around the appendix, overlapping of the intestinal canal with scar tissue, and intestinal loop stinging.
Another variant of the complication is the pinching of the appendix in the development of the inguinal or femoral hernia. In this case, the following symptoms are manifested: acute pain syndrome, inability to correct hernial stiffness, problems with cough impulse. In rare cases, the complications of the diverticulum can be caused by tumorous formations. Most often there are benign formations - myoma, lipoma, hamartoma, but the presence of oncology - adenocarcinoma and carcinoid can not be ruled out. As a result of such a defeat - perforation of the intestine, internal bleeding, intestinal obstruction.
4 Diagnostic methods for
Diagnosis of Meckel diverticula is rather complicated, since the uncomplicated variant does not show the expressed symptoms, and the complication is similar to other pathologies. The primary diagnosis is based on laboratory methods: biochemical blood analysis and fecal analysis on the content of blood impurities. Ultrasonography of the peritoneum makes it possible to detect an inflammatory reaction, but it is not possible to determine the defect precisely. A more complete picture is manifested as a result of X-ray of the small intestine with a contrast effect. Hidden hemorrhages detect scintigraphy using an isotope. To differentiate the causes of bleeding a colonoscopy is performed.
In the case of intestinal obstruction risk, further studies are required. For these purposes, X-ray of the entire abdominal cavity, computer tomography is used. The difficulty in diagnosing is that some diverticulations are determined only with laparoscopy or laparotomy.
5 Treatment methods for
If the pathology occurs without symptoms, surgical treatment is generally not performed.
At times, children are treated with antibiotic infusions and anti-inflammatory drugs. At the same time, experts are of the opinion that even at this stage of the disease better surgical intervention to exclude the risk of complications.
In case of severe development of the disease, surgical intervention is required, especially when it comes to latent bleeding, perforation of the intestine and intestinal obstruction. Treatment can be done via diverticulectomy, ie, excision of the affected bowel, or segmental resection using enteroanthanthomas. Modern technologies are based on the endoscopic operation of the small intestine. When signs of peritonitis appear in addition to surgical treatment, drainage and sanitation of the abdominal cavity, antibiotic, infusion and detoxification therapy are provided.
Meckel diverticulum is a congenital intestinal defect, but you can live all your life without knowing about its presence. At the same time, in some cases, there are serious complications that can seriously undermine health. This pathology requires a serious approach.