This can be defined as a large sack formed by all layers of the intestine, located at the ileum, small intestine in the antimesenteric side and is presented by the continuing partial or total duct or conduit omphalomesenteric yolk.
DIFFERENT STYLES EMBRYOLOGICAL
- ileal diverticulum is a diverticulum as such, is a protrusion of all layers of the intestine, but not attached to anything or have any communication.
"When
through a fibrous cord is no communication with the navel.
-When a fistula through the umbilicus out the intestinal contents, in this way was a cyst, is obliterated by the distal cord and formed a cyst.
EPIDEMIOLOGY
- Named after a German anatomist who first described it in 1809.
- most common congenital abnormality of the digestive tract.
- are found in 1 to 2% of the population and go unnoticed.
- Most found in the antimesenteric border of ileum, about 50 to 60 cm from the ileocecal valve.
- The average size is 2 to 3 cm in length and 1 to 2 cm in diameter.
Meckel's diverticulum is a true diverticulum because it has all the layers of the intestine, also has a heterotopic mucosa, ie different from the intestine, which most commonly is achieved there is the gastric mucosa pancreas, is about 15 to 30% of cases, the colonic mucosa, jejunal and duodenal present but less frequently and mixed variants are very rare.
clinical presentation
- with intestinal bleeding, bloody stools, in 25% of cases, a product of peptic ulceration associated with heterotopic gastric mucosa and bleeding in the stomach certain chance when there are problems of hemorrhagic gastritis, if the area of \u200b\u200bthe diverticulum has gastric mucosa, it can fester and cause bleeding, blood is red, sparkling, importantly, does not affect the patient hemodynamically, no pain with bowel movements, signs of obstruction intestine, but each time he goes to the bathroom sparkling evacuated blood important.
- As a bowel obstruction in 30% of cases causing intussusception in children older than 2 years the head of intussusception may be a Meckel's diverticulum or intestinal volvulus caused by fibrous cord that connects it to the navel.
- infectious
- So, the diverticulum becomes inflamed, diverticulitis and generates a picture of surgical acute abdomen infection, which is often confused with acute appendicitis is abdominal pain and signs of peritoneal irritation, always surgery that takes a picture with abdominal pain and signs of peritoneal irritation and is a normal appendix, the ileum is removed systematically and reviewed 50 to 70 cm to verify that there is a picture of diverticulitis. The diagnosis in this case intraoperatively.
DIAGNOSIS
- clinical history, abdominal pain, in the case of diverticulitis is interpreted as appendicitis.
- physical examination, signs of peritoneal irritation in the lower right quadrant.
Laboratory Hematology leukocytosis reported. - If there is a bowel obstruction, will have the triad that is, vomiting, lack of bowel movements and abdominal distension, and in the operating room we have a bowel volvulus or intussusception; radiographically observed only fluid levels.
- If the diverticulum is presented in hemorrhagic and the patient is hemodynamically stable, no bloating, and there is suspicion of a diverticulum, scintigraphy should be performed [1] radioisotope are contrasts placed intravenously, it will color or mark the gastric mucosa, also marking the heterotopic mucosa found at the diverticulum.
SURGICAL
removal of the entire diverticulum if large or wedge excision of a small area because the pouch is really small. If the diverticulum is very large to do a bowel resection with termino-terminal anastomosis.
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