English

Abstract

BACKGROUND: Although Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract; it has varied presentations and often becomes a diagnostic challenge. PATIENTS AND METHODS: This was a retrospective study of all children who had underwent surgery for Meckel's Diverticulum in the department of Pediatric Surgery, S. Nijalingappa Medical college and H.S.K Hospital, Bagalkot between February 2009 and February2013. RESULT: A total of 17 patients (10male and 7 female) aged from 1month to 13 years with a diagnosis of Meckel's Diverticulum were evaluated and analyzed, looking at age, gender, clinical features, investigations, histopathological findings and surgical interventions. All patients were symptomatic and presented with various clinical features like intestinal obstruction(29.4%), perforated Meckel's Diverticulum(23.5%), diverticulitis(17%), intussusceptions(11.7%), patent vitellointestinal duct ( Meckel's prolapse) (11.7%), Littre's hernia(5.8%). All the cases were investigated and underwent surgical intervention Meckel's diverticulectomy/ resection anastomosis and were followed up. Most common post-operative complication was wound infection. CONCLUSION: A Preoperative diagnosis of complicated Meckel's Diverticulum may be challenging because of the overlapping clinical and imaging features of the other acute surgical and inflammatory conditions of the abdomen, hence it is necessary to maintain a high incidence of suspicious in the pediatric age group. INTRODUCTION: Meckel's diverticulum (MD) is one of the most common congenital abnormalities of the gastrointestinal tract, occurring in approximately 2% of the population. Nearly two centuries have passed since its first description by Johan Friederich Meckel. Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. 1 It contains all normal layers of the intestinal wall and, in approximately 50 percent of cases, contains tissue from other sites (ectopic tissue), 60-85% of which is gastric mucosa and 5-16% pancreatic tissue. 2 In the majority of cases, it is asymptomatic. However, it is prone to complications, especially in children, due to ectopic epithelial lining and various bands, reflective of its embryological development. Although the lifetime risk of a Meckel's diverticular complication varies from 4 to 34%, more than 50 to 60% of the patients who develop symptoms are younger than 2 years of age.3 Harper et al. suggested that a bleeding MD should be identifiable scintigraphically using 99mTc pertechnetate, since it is concentrated by gastric mucosa.4 The Tc99 Meckel's scan has a reported sensitivity of 81 to 90%.5 The purpose of this study was to review the various presentations of Meckel's diverticulum, to estimate the epidemiologic features and the extent of this clinical entity at our center and to review the detection techniques and treatment options.