Intestinal obstruction caused by Meckel’s diverticulum in children

Abstract

Meckel’s diverticulum is the most common variant of anomalies of incomplete obliteration of the yolk duct. Among the various malformations of the digestive tract, which can cause intestinal obstruction, Meckel’s diverticulum ranks first and is 1.7%. Purpose – to generalize the results of treatment of children with intestinal obstruction caused by Meckel’s diverticulum. Materials and methods. The experience of treating 183 children with Meckel’s diverticulum and related pathology is summarized. The main complications of Meckel’s diverticulum were intestinal obstruction, bleeding from a peptic ulcer, diverticulitis. In 100 children, the diverticulum was asymptomatic and was an accidental finding during surgery on the abdominal organs for other pathologies. Results. Intestinal obstruction caused by Meckel’s diverticulum accounted for 20.8% of all cases and 45.7% of all diverticulum-related complications. Strangulative intestinal obstruction was diagnosed in 18 patients: in 16 Meckel’s diverticulum caused internal compression, in 1 – torsion of the loops of the small intestine around the fixed diverticulum, in 1 – nodulation. In 5 observations, Meckel’s diverticulum caused the phenomenon of partial intestinal obstruction. Intussusception was detected in 15 children (small intestinal in 6 cases and ileocecal in 9). Clinical cases demonstrating the difficulties in diagnosing intesti nal intussusception caused by Meckel’s diverticulum in older children and small bowel entrapment in the mesodiverticular ligament are presented. A method of subserous diverticulectomy and one-step decompression of the small intestine was proposed. Conclusions. Meckel’s diverticulum should be considered as a probable cause of acute intestinal obstruction in children older than 2 years and who have not previously undergone surgery on the abdominal organs. In the surgical treatment of pathology caused by Meckel’s diverticulum, it is possible to use one-time decompression of the small intestine by diverticulotomy and subserous removal of the diverticulum. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Meckel’s diverticulum, intestinal obstruction, children.