MECKEL’S DIVERTICULUM

MECKELS DIVERTICULUM SURGERY NOIDA-DELHI

^{Meckel’s diverticulum is rare and accounts for only 2% of the general population.MECKELS DIVERTICULUM SURGERY is available in NOIDA-DELHI.}

^{An equal incidence is found in men and women. Meckel’s diverticulitis is one of the recognized complications of the condition and is clinically indistinguishable from appendicitis, except that the pain and tenderness typically localized at the periumbilical region. Diverticulitis may lead to perforation and peritonitis.}

^{A Meckel’s diverticulum is commonly discovered at operation. Resection of incidental Meckel’s found during laparotomy is controversial in children and adults. It is generally recommended that asymptomatic Meckel’s to be resected in children during laparotomy given an increased lifelong risk for complications . However, this approach remains debatable in adult patients. The argument was that the likelihood of Meckel’s diverticulum becoming symptomatic in an adult is 2% or less and that postoperative morbidity secondary to intestinal obstruction and infection from prophylactic resection confers no potential benefit in prevention of disease .}

^{On the other hand, treatment for a symptomatic (bleeding, inflamed) Meckel’s diverticulum should be prompt and referred for surgical intervention in all patients (children and adults) to relieve symptoms. The standard surgical approach is to perform a segmental (wedge or v-shaped diverticulectomy) resection of the narrow-based diverticulum or to perform a limited small bowel resection followed by primary end-to-end anastomosis if an inflamed or ulcerated diverticulum is encountered. Although gastrointestinal bleeding from a Meckel’s diverticulum is a rare complication, when encountered, a segmental small bowel resection followed by end-to-end ileoileostomy rather than simple diverticulectomy is preferred . Proton-pump inhibitor therapy should also be initiated on these patients. Transverse closure of the ileum with hand-sewn technique or using linear stapler across the base of the diverticulum is the ideal method to minimize the risk of subsequent stenosis.}

^{The long-term outcomes with laparoscopy approaches (including laparoscopic diverticulectomy and laparoscopic-assisted transumbilical Meckel’s diverticulectomy) are still lacking . However, many studies have reported that the laparoscopic management of the complicated Meckel’s diverticulum is safe, cost effective and efficient, fewer complications and shorter recovery period compared with conventional laparotomy.}

^{_The learning point of this clinical vignette is that Meckel’s diverticulitis is often clinically indistinguishable from appendicitis especially in adult patients. Computed tomography (CT) has become an invaluable tool for the evaluation of abdominal pain. CT scanning is useful in demonstrating acutely inflamed diverticula, typically identified as a blind pouch off the distal small intestine and associated with bowel wall thickening and in detecting the presence of enterocolic and enterovesical fistulas.}

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