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|Year : 1992 | Volume
| Issue : 1 | Page : 19-20
Meckel's diverticulum in children.
PC Das, PL Rao, K Radhakrishna
Department of Pediatric Surgery, Kasturba Medical College and Hospital, Manipal, India., India
P C Das
Department of Pediatric Surgery, Kasturba Medical College and Hospital, Manipal, India.
Source of Support: None, Conflict of Interest: None
Twenty one surgically documented cases of Meckel's diverticulum in children treated at Kasturba Hospital, Manipal since 1981 are reviewed. Of them, 14 presented with intestinal obstruction, 2 with pain abdomen, 2 with Littre's hernia and 2 were found incidentally. Only one patient presented with gastrointestinal bleeding. The clinical profile of these patients is analyzed.
Keywords: Child, Child, Preschool, Cross-Sectional Studies, Developing Countries, Female, Human, Incidence, India, epidemiology,Infant, Infant, Newborn, Male, Meckel′s Diverticulum, diagnosis,epidemiology,surgery,
|How to cite this article:|
Das P C, Rao P L, Radhakrishna K. Meckel's diverticulum in children. J Postgrad Med 1992;38:19-20
Meckel's diverticulum, a developmental anomaly with eccentric manifestations, has intrigued the clinicians for over three centuries. It is statedi that "Meckel's diverticulum is frequently suspected, often looked for and seldom found". We have analysed the clinical profile of this problem in children presenting to our centre.
The records of all children with Meckel's diverticulum seen in the department of Pediatric Surgery, Kasturba hospital, Manipal from June 1981 to Dec. 1989 reviewed. They were analysed with respect to their age and sex distribution, clinical presentation, treatment, morbidity and mortality
During the said period 21 children were found to have Meckel's diverticulum. The age and sex distribution of these children is shown in [Table - 1]. Three of them presented during neonatal period and more than 50% during infancy. The youngest child was 2 days old whereas the oldest was 13 years.
Sixteen children presented with features of intestinal obstruction/pain abdomen, two with Littre's hernia and in another two Meckel's diverticulum was found incidentally. Interestingly, only one child had gastrointestinal bleeding [Table - 2]. In each case, the diagnosis was established at surgery. Intestinal obstruction was seen in 12 cases - bands in 9, volvulus in 2 and intussusception in 1. Diverticulitis was seen in 1 child whereas 2 had perforation and one had torsion of the diverticulum with appendicitis. Two patients presented with Littre's hernia. The tip of the Meckel's diverticulum was adherent to the fundus of the hernial sac in both children with Littre's hernia.
Of the 19 children in which Meckel's diverticulum was the primary surgical disease, 10 required diverticulectomy and 9 had resection with end-to-end anastomosis of the bowel. In the 2 cases of incidental Meckel's diverticulum, diverticulectomy was carried out. Postoperative complications occurred in 2 cases; a pelvic abscess, which was drained successfully and a burst abdomen, which needed resuturing. There was no mortality.
Though the first recorded observation of an ileal diverticulurn has been attributed to Fabricius Hildamus in 1650, Littre reported its presence in a hernia in 1745, and Meckel first described its association with omphalomesenteric duct
In the reported series, 45% of patients with symptomatic Meekel's diverticulum were under 2 years of age. In our study it was 68.4%. Interestingly, 3 presented in the neonatal period; 2 with meconium peritonitis due to perforation of the diverticulum. In our series (M:F=4:1), a male preponderance is reported.
Though the frequency of specific complications varies, six series of 830 cases have revealed bleeding in 32%, intestinal obstruction in 35%, diverticulitis (with or with out perforation) in 22% and others in 11%-. In our study, out of 19 symptomatic patients, 63.1% presented with intestinal obstruction, 15.8% with diverticulitis with or without performation, 10.5% with Littre's hernia and 5.2% with lower gastrointestinal bleeding. Histological examination revealed extopic gastric mucosa in only 3 (15.8%) as against 75% reported in the literature. Probably this can explain the rarity of gastrointestinai bleeding in our series in 3 series of 182 cases, intussusception was the cause of intestinal obstruction in 47% and herniation, bands, kinks & volvulus in 53% (6). In our study, intestinal obstruction was due to Meckelís band in 9 (75%), intussusception in 1 (8.4%) and volvulus in 2(16.6%) of 12 cases. Although Littre's hernia refers to a Meckel's diverticulum incarcerated in an indirect inguinal hernial sac, Littre originally defined his hernia as a Meckel's diverticulum in a femoral hernial sac,. In most cases the diverticulum is adherent to the sac as in both our cases. Diverticulectomy was done in both. In the other 19 cases, diverticulectomy was done in 10 and resection anastomosis in 9. There was no mortality ; and morbidity was seen in 2(9.5%).
Our 21 cases of Meckel's diverticulum presented in a manner similar to earlier reports, except for the rarity of gastrointestinal bleeding and of ectopic gastric mucosa. The reason for the difference is not known.
We are grateful to the principal and the Medical Director of Kasturba Medical College and the Medical Superintendent of Kasturba Hospital, Manipal for allowing us to publish this paper. We acknowledge our thanks to our pediatric colleagues for referring some of theses cases, and to the computer department for their technical help.
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[Table - 1], [Table - 2]
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