MECKELS DIVERTICULUM
v GENERAL INFORMATION The small intestine starts at the stomach and ends in the right side of the lower abdomen, where it empties into the large bowel. About a foot and a half or so before the small intestine ends, it sometimes has a side pocket (called a diverticulum, and Meckels after the person who rst described it almost 200 years ago) (Fig. 1). The side pocket usually is about as big around as your thumb. It may not be much longer than the tip of your thumb, or it can be as long as your entire thumb. About one or two out of 100 people is born with a diverticulum. About half of such diverticula have a lining in them that is just like the lining found in the stomach. The diverticulum can become infected and irritate the tissue around it, with the following signs and symptoms: There is pain in the right side of the lower abdomen. There is distention of the abdomen. There is fever and an elevated white blood cell count. DIAGNOSIS The diagnosis can be suspected from the symptoms. However, making an exact diagnosis is not easy. Often, the diagnosis is made only when the abdomen is opened, because then it is obvious that something is happening inside the abdomen. Having you swallow barium and taking pictures of it as it travels through the small intestine sometimes will show the diverticulum. Other tests can be done with some success. q TREATMENT There is no need to open the abdomen to remove a Meckels diverticulum that is not causing symptoms. A Meckels diverticulum that produces symptoms however, should be removed. This requires an operation. PREOPERATIVE PREPARATION You will have an examination of your blood, urine, heart (EKG), and lungs (chest x-ray). Do not eat or drink anything for 8 hours before the operation. Shower as usual on the morning of the operation. You may be given medicine that will make you feel drowsy before you are brought to the operating room.
s OPERATION You will be asleep for the operation. The abdomen will be opened, the diverticulum removed, and the intestine put together again. You will not need a blood transfusion. The operation usually takes about 1 hour. POSTOPERATIVE CARE You will be taken to a recovery room and observed. When your blood pressure, pulse, and breathing are stable, you will be taken to a regular hospital room. You may have a thin, plastic tube in your nose. The tube will be removed as soon as your bowels start working. The evening after the operation you will be helped to sit up in bed and on the next day to get out of bed. Pain will be controlled with medicine. You should be able to go home in 3 to 4 days. As with any operation, complications are always possible. With this type of operation, complications can include leakage where the opened intestine was
Right colon
Meckels diverticulum
Small intestine Appendix Cecum
Figure 1. When a Meckels diverticulum does not produce symptoms and is found incidentally, the indication to remove it is inuenced by its length, the likelihood that it will cause a problem, the primary diagnosis causing the abdomen to be opened, and the local conditions present at the time.
COMMON SIGNS AND SYMPTOMS Most of the time, Meckels diverticulum does not produce any symptoms. Occasionally, however, it can cause trouble, as follows: The lining that is like the lining in the stomach can form an ulcer and bleed just as it can in the stomach. When this happens, blood is seen in the stool. Sometimes a diverticulum, especially a long one, can become twisted. This chokes off its blood supply and also blocks the intestine. The symptoms it produces can include the following: Abdominal cramps. Swelling of the abdomen. Possible peritonitis if a twisted diverticulum develops gangrene. The diverticulum can cause the part of the small intestine in which it is located to slip into the small intestine just ahead of it. This causes blockage of the intestine and the following conditions: There is abdominal cramping. The abdomen becomes distended with gas that cannot pass.
reconnected, bleeding, infection, bowel obstruction, and possibly others. Arrangements will be made for your medicine, follow-up ofce visit, and stitch removal. & HOME CARE You may walk about as you wish, even climb stairs. Your diet can be as before the operation. You may shower as you wish, with any dressings on or off. There may be narrow strips of tape across the incision. Its all right if they get wet; they will be removed in the doctors ofce. After you dry yourself, replace any dressings with clean, dry ones.
Driving a car with an automatic shift is not too demanding, but if you suddenly have to slam on the brakes or twist to turn the steering wheel, you may strain the sutures or tear something. During your follow-up visit, lets discuss when you can resume driving. You may resume sexual activity whenever you choose. You may return to work when you feel up to it, but lets rst talk about it during one of your follow-up visits.
CALL OUR OFFICE IF
The incision becomes red or swollen, or there is drainage from it. You develop a temperature higher than 100F. You have any questions.
