Meckel's diverticulum history and symptoms: Difference between revisions

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==Overview==
==Overview==
Approximately 98% of people afflicted with Meckel's diverticulum are [[asymptomatic]]. If symptoms do occur, they typically appear before the age of two.
The presentation of Meckel's diverticulum is usually [[asymptomatic]]. The hallmark feature in [[symptomatic]] patients is the occurrence of painless [[lower gastrointestinal bleeding]]. Other symptoms of Meckel's diverticulum arise in complicated cases with features of [[Bowel obstruction|intestinal obstruction]], [[intussusception]], [[volvulus]] and [[perforation]]. The age of presentation for approximately half of all [[Patient|patients]] is less than 10 years of age. Patients may also develop symptoms of [[diverticular]] inflammation (ie, Meckel's [[diverticulitis]]) which has a presentation similar to [[Appendicitis|acute appendicitis]].  
 
The majority of patients with [disease name] are asymptomatic.
 
OR
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
==History and Symptoms==
==History and Symptoms==


The most common presenting symptom is painless [[rectal bleeding]], followed by [[intestinal obstruction]], [[volvulus]] and [[intussusception (medical disorder)|intussusception]]. Occasionally, Meckel's diverticulitis may present with all the features of [[acute appendicitis]]. Also, severe pain in the upper abdomen is experienced by the patient along with bloating of the stomach region. At times, the symptoms are so painful such that they may cause sleepless nights with extreme pain in the abdominal area.
The most common presenting symptom in patients is painless [[rectal bleeding]], followed by less common symptoms of [[intestinal obstruction]], [[volvulus]] and [[intussusception (medical disorder)|intussusception]] in complicated cases. Occasionally, Meckel's [[diverticulitis]] may present with all the features of [[acute appendicitis]].<ref name="pmid17021300">{{cite journal |vauthors=Sagar J, Kumar V, Shah DK |title=Meckel's diverticulum: a systematic review |journal=J R Soc Med |volume=99 |issue=10 |pages=501–5 |year=2006 |pmid=17021300 |pmc=1592061 |doi=10.1258/jrsm.99.10.501 |url=}}</ref><ref name="pmid15729078">{{cite journal |vauthors=Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR |title=Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002) |journal=Ann. Surg. |volume=241 |issue=3 |pages=529–33 |year=2005 |pmid=15729078 |pmc=1356994 |doi= |url=}}</ref><ref name="pmid17152574">{{cite journal |vauthors=Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D |title=Complications of Meckel's diverticula in adults |journal=Can J Surg |volume=49 |issue=5 |pages=353–7 |year=2006 |pmid=17152574 |pmc=3207587 |doi= |url=}}</ref><ref name="pmid1415948">{{cite journal |vauthors=Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi K |title=Complications and diagnosis of Meckel's diverticulum in 776 patients |journal=Am. J. Surg. |volume=164 |issue=4 |pages=382–3 |year=1992 |pmid=1415948 |doi= |url=}}</ref>
 
*The majority of patients with [disease name] are asymptomatic.
OR
*The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
*Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. 
===History===
Patients with [disease name]] may have a positive history of:
*[History finding 1]
*[History finding 2]
*[History finding 3]
===Common Symptoms===
===Common Symptoms===
* Meckel's diverticulum is usually [[asymptomatic]] and is found incidentally on [[Abdomen|abdominal]] [[imaging]] or surgical exploration performed for a presumptive diagnosis such as [[acute cholecystitis]] (exploratory [[laparotomy]], laproscopy).
* Meckel's diverticulum is usually [[asymptomatic]] and is found incidentally on [[Abdomen|abdominal]] [[imaging]] or surgical exploration performed for a presumptive diagnosis such as [[acute cholecystitis]] (exploratory [[laparotomy]], laparoscopy).
* The age of presentation for approximately half of all [[Patient|patients]] is less than 10 years of age.
* The age of presentation for approximately half of all [[Patient|patients]] is less than 10 years of age.
Common symptoms of Meckel's diverticulum include:
Common symptoms of Meckel's diverticulum include:
*[[Lower gastrointestinal bleeding]]:
*[[Lower gastrointestinal bleeding]]:<ref name="pmid1812259">{{cite journal |vauthors=St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H |title=Meckel's diverticulum in children: a 20-year review |journal=J. Pediatr. Surg. |volume=26 |issue=11 |pages=1289–92 |year=1991 |pmid=1812259 |doi= |url=}}</ref>
**[[Mechanism (biology)|Mechanism]]: presence of [[Ectopia|ectopic]] [[gastric mucosa]] leads to [[acid]] [[secretion]] within the [[diverticulum]] and [[Ulcer|ulceration]] of the [[Small intestine|small bowel]]
**[[Mechanism (biology)|Mechanism]]: presence of [[Ectopia|ectopic]] [[gastric mucosa]] leads to [[acid]] [[secretion]] within the [[diverticulum]] and [[Ulcer|ulceration]] of the [[Small intestine|small bowel]]<ref name="pmid23417523">{{cite journal |vauthors=Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, Biassoni L |title=Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years |journal=Pediatr. Surg. Int. |volume=29 |issue=5 |pages=511–7 |year=2013 |pmid=23417523 |doi=10.1007/s00383-013-3270-3 |url=}}</ref><ref name="pmid17152574">{{cite journal |vauthors=Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D |title=Complications of Meckel's diverticula in adults |journal=Can J Surg |volume=49 |issue=5 |pages=353–7 |year=2006 |pmid=17152574 |pmc=3207587 |doi= |url=}}</ref>
**Site: Downstream or adjacent to the [[diverticulum]] and not within it
**Site: Downstream or adjacent to the [[diverticulum]] and not within it
**May be acute or chronic and insidious  
**May be acute or [[Chronic (medical)|chronic]] and insidious  
**May be a massive [[Bleeding|bleed]]
**May be a massive [[Bleeding|bleed]]
**Usually painless
**Usually painless
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===Less Common Symptoms===
===Less Common Symptoms===
Less common [[Symptom|symptoms]] of Meckel's diverticulum arise in complicated cases:<ref name="pmid3660243" /><ref name="pmid9148991">{{cite journal |vauthors=Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly" |journal=Am J Emerg Med |volume=15 |issue=3 |pages=293–8 |year=1997 |pmid=9148991 |doi= |url=}}</ref>  
Less common [[Symptom|symptoms]] of Meckel's diverticulum arise in complicated cases:<ref name="pmid17021300" /><ref name="pmid17152574" /><ref name="pmid3660243" /><ref name="pmid9148991">{{cite journal |vauthors=Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly" |journal=Am J Emerg Med |volume=15 |issue=3 |pages=293–8 |year=1997 |pmid=9148991 |doi= |url=}}</ref><ref name="pmid11333103">{{cite journal |vauthors=Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL |title=Meckel's diverticulum |journal=J. Am. Coll. Surg. |volume=192 |issue=5 |pages=658–62 |year=2001 |pmid=11333103 |doi= |url=}}</ref><ref name="pmid9124758">{{cite journal |vauthors=Arnold JF, Pellicane JV |title=Meckel's diverticulum: a ten-year experience |journal=Am Surg |volume=63 |issue=4 |pages=354–5 |year=1997 |pmid=9124758 |doi= |url=}}</ref>  
*Symptoms of [[intussusception]], particularly recurrent or atypical [[intussusception]] commonly seen in children:
*Symptoms of [[intussusception]], particularly recurrent or atypical [[intussusception]] commonly seen in children:
** Pain: crampy [[abdominal pain]] with or without [[rectal]] [[bleeding]]  
** [[Pain]]: crampy [[abdominal pain]] with or without [[rectal]] [[bleeding]]  
** Inconsolable crying  
** Inconsolable crying  
** Drawing up of the legs toward the [[abdomen]]<ref name="pmid22929138">{{cite journal |vauthors=Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B |title=Intussusception: clinical presentations and imaging characteristics |journal=Pediatr Emerg Care |volume=28 |issue=9 |pages=842–4 |year=2012 |pmid=22929138 |doi=10.1097/PEC.0b013e318267a75e |url=}}</ref>  
** Drawing up of the legs toward the [[abdomen]]<ref name="pmid22929138">{{cite journal |vauthors=Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B |title=Intussusception: clinical presentations and imaging characteristics |journal=Pediatr Emerg Care |volume=28 |issue=9 |pages=842–4 |year=2012 |pmid=22929138 |doi=10.1097/PEC.0b013e318267a75e |url=}}</ref>  
Line 48: Line 32:
** Bloody [[Human feces|stool]] or occult [[blood]]<ref name="pmid1985640">{{cite journal |vauthors=Losek JD, Fiete RL |title=Intussusception and the diagnostic value of testing stool for occult blood |journal=Am J Emerg Med |volume=9 |issue=1 |pages=1–3 |year=1991 |pmid=1985640 |doi= |url=}}</ref>
** Bloody [[Human feces|stool]] or occult [[blood]]<ref name="pmid1985640">{{cite journal |vauthors=Losek JD, Fiete RL |title=Intussusception and the diagnostic value of testing stool for occult blood |journal=Am J Emerg Med |volume=9 |issue=1 |pages=1–3 |year=1991 |pmid=1985640 |doi= |url=}}</ref>
** Current jelly [[Human feces|stools]] (mixture of [[mucus]] and [[blood]])  
** Current jelly [[Human feces|stools]] (mixture of [[mucus]] and [[blood]])  
** Intermittent pain free intervals in between episodes of pain<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref>
** Intermittent pain free intervals in between episodes of [[pain]]<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref>


*Symptoms of [[bowel obstruction]], more common in adults:
*Symptoms of [[bowel obstruction]], more common in adults:
*Symptoms of [[diverticular]] inflammation (ie, Meckel's [[diverticulitis]]):  
**[[Colic|Colicky]] [[abdominal pain]] ([[Cramp|cramping]] and intermittent) in nature, with [[Spasm|spasms]] lasting a few minutes
*Symptoms of [[perforation]]:
**[[Nausea and vomiting|Vomiting]]
**[[Nausea and vomiting|Nausea]]
**[[Constipation]]
*Symptoms of [[diverticular]] inflammation (ie, Meckel's [[diverticulitis]]): may present with features similar to [[Appendicitis|acute appendicitis]]<ref name="pmid15776296">{{cite journal |vauthors=Ueberrueck T, Meyer L, Koch A, Hinkel M, Kube R, Gastinger I |title=The significance of Meckel's diverticulum in appendicitis--a retrospective analysis of 233 cases |journal=World J Surg |volume=29 |issue=4 |pages=455–8 |year=2005 |pmid=15776296 |doi=10.1007/s00268-004-7615-x |url=}}</ref><ref name="pmid15729078">{{cite journal |vauthors=Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR |title=Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002) |journal=Ann. Surg. |volume=241 |issue=3 |pages=529–33 |year=2005 |pmid=15729078 |pmc=1356994 |doi= |url=}}</ref><ref name="pmid308325">{{cite journal |vauthors=Ymaguchi M, Takeuchi S, Awazu S |title=Meckel's diverticulum. Investigation of 600 patients in Japanese literature |journal=Am. J. Surg. |volume=136 |issue=2 |pages=247–9 |year=1978 |pmid=308325 |doi= |url=}}</ref><ref name="pmid15586591">{{cite journal |vauthors=Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK |title=Meckel diverticulum: ten-year experience in adults |journal=South. Med. J. |volume=97 |issue=11 |pages=1038–41 |year=2004 |pmid=15586591 |doi=10.1097/01.SMJ.0000125222.90696.03 |url=}}</ref>
**Alternating [[diarrhea]] and [[constipation]] 
**[[Pain|Painful]] [[Abdominal pain|abdominal cramps]] 
** [[Rigor|Chills]] or [[fever]]
*Symptoms of [[perforation]]:<ref name="urlIntestinal Perforation Clinical Presentation: History, Physical Examination">{{cite web |url=https://emedicine.medscape.com/article/195537-clinical |title=Intestinal Perforation Clinical Presentation: History, Physical Examination |format= |work= |accessdate=}}</ref>
**Severe [[abdominal pain]] intensified by movement
**[[Rigor|Chills]]
**[[Fever]]
**[[Nausea and vomiting|Nausea]]
**[[Nausea and vomiting|Vomiting]]


==References==
==References==

Latest revision as of 15:48, 11 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

The presentation of Meckel's diverticulum is usually asymptomatic. The hallmark feature in symptomatic patients is the occurrence of painless lower gastrointestinal bleeding. Other symptoms of Meckel's diverticulum arise in complicated cases with features of intestinal obstruction, intussusception, volvulus and perforation. The age of presentation for approximately half of all patients is less than 10 years of age. Patients may also develop symptoms of diverticular inflammation (ie, Meckel's diverticulitis) which has a presentation similar to acute appendicitis.

History and Symptoms

The most common presenting symptom in patients is painless rectal bleeding, followed by less common symptoms of intestinal obstruction, volvulus and intussusception in complicated cases. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis.[1][2][3][4]

Common Symptoms

Common symptoms of Meckel's diverticulum include:

Less Common Symptoms

Less common symptoms of Meckel's diverticulum arise in complicated cases:[1][3][7][8][9][10]

References

  1. ↑ 1.0 1.1 Sagar J, Kumar V, Shah DK (2006). "Meckel's diverticulum: a systematic review". J R Soc Med. 99 (10): 501–5. doi:10.1258/jrsm.99.10.501. PMC 1592061. PMID 17021300.
  2. ↑ 2.0 2.1 Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR (2005). "Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002)". Ann. Surg. 241 (3): 529–33. PMC 1356994. PMID 15729078.
  3. ↑ 3.0 3.1 3.2 Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D (2006). "Complications of Meckel's diverticula in adults". Can J Surg. 49 (5): 353–7. PMC 3207587. PMID 17152574.
  4. ↑ Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi K (1992). "Complications and diagnosis of Meckel's diverticulum in 776 patients". Am. J. Surg. 164 (4): 382–3. PMID 1415948.
  5. ↑ St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H (1991). "Meckel's diverticulum in children: a 20-year review". J. Pediatr. Surg. 26 (11): 1289–92. PMID 1812259.
  6. ↑ Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, Biassoni L (2013). "Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years". Pediatr. Surg. Int. 29 (5): 511–7. doi:10.1007/s00383-013-3270-3. PMID 23417523.
  7. ↑ 7.0 7.1 West KW, Stephens B, Vane DW, Grosfeld JL (1987). "Intussusception: current management in infants and children". Surgery. 102 (4): 704–10. PMID 3660243.
  8. ↑ Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL (1997). "Stool appearance in intussusception: assessing the value of the term "currant jelly"". Am J Emerg Med. 15 (3): 293–8. PMID 9148991.
  9. ↑ Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL (2001). "Meckel's diverticulum". J. Am. Coll. Surg. 192 (5): 658–62. PMID 11333103.
  10. ↑ Arnold JF, Pellicane JV (1997). "Meckel's diverticulum: a ten-year experience". Am Surg. 63 (4): 354–5. PMID 9124758.
  11. ↑ Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B (2012). "Intussusception: clinical presentations and imaging characteristics". Pediatr Emerg Care. 28 (9): 842–4. doi:10.1097/PEC.0b013e318267a75e. PMID 22929138.
  12. ↑ Losek JD, Fiete RL (1991). "Intussusception and the diagnostic value of testing stool for occult blood". Am J Emerg Med. 9 (1): 1–3. PMID 1985640.
  13. ↑ Ueberrueck T, Meyer L, Koch A, Hinkel M, Kube R, Gastinger I (2005). "The significance of Meckel's diverticulum in appendicitis--a retrospective analysis of 233 cases". World J Surg. 29 (4): 455–8. doi:10.1007/s00268-004-7615-x. PMID 15776296.
  14. ↑ Ymaguchi M, Takeuchi S, Awazu S (1978). "Meckel's diverticulum. Investigation of 600 patients in Japanese literature". Am. J. Surg. 136 (2): 247–9. PMID 308325.
  15. ↑ Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK (2004). "Meckel diverticulum: ten-year experience in adults". South. Med. J. 97 (11): 1038–41. doi:10.1097/01.SMJ.0000125222.90696.03. PMID 15586591.
  16. ↑ "Intestinal Perforation Clinical Presentation: History, Physical Examination".

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