59. Meckel’s diverticulum. Diverticulitis (hemorrhage and perforation). Flashcards
Diverticulum definition
- An outpouching of the gut wall
Diverticulum types
True (involves all layers of wall)
False (mucosa + submucosa protruding through a mucosal defect)
Duodenal diverticula = most common acquired form
Meckel’s diverticula - Key points
Most common true congenital diverticula
Meckel’s diverticula - Rules
Rule of 2’s
2% of population
2 yr old most common age + 2x more in boys
2 inches long
2ft proximally located to ileocecal valve
2 types of ectopic tissue (gastric + pancreatic)
Meckel’s diverticula - Etiopathogenesis
- Results from incomplete closure of omphalomesenteric duct (vitelline duct)
- Can present as omphalomesenteric fistula. Enterocyst. Fibrous band that connect intestine to umbilicus
- Bleeding due to ulceration of ileal mucosa that occurs adjacent to acid producing gastric mucosa
- Intestinal obstruction = due to volvulus of intestine around fibrous band
Meckel’s diverticula - Clinical presentations
- Asx unless complications arise
- Sx = bleeding, intestinal obstruction, diverticulitis
(indistinguishable from acute appendicitis)
Meckel’s diverticula - Diagnosis
- Discovered incidentally
- Radio nucleotide scan – taken up by mucus secreting cells of gastric mucosa of diverticulum
Meckel’s diverticula - treatment
- For sx = surgery = diverticulectomy with removal of any assoc bands
- If bleeding = segmental resection – inc. diverticulum + ulcer (due to gastric cells) regions
Diverticulitis - definition
Inflam + infx assoc with a diverticulum
most seen in sigmoid low fibre diet. Low fibre diet = increased pressure = diverticulum
Diverticulitis - types
Uncomplicated diverticulitis - charac by LLQ pain + tenderness
Responds well to abx + doesn’t require surgery, increased fibre content (fybogel – bulk formed)
Failure to respond = abscess formation
Diverticulitis - types no.2
Complicated
Fever, increased WBC, increased CRP + tender colour
Complicated Diverticulitis - Treatment
Analgesics
NBM
IV fluids + abx
Complicated Diverticulitis - Treatment If perforation
Treat like acute abdomen.
Perform Hartmann procedure
i. Proctosigmoidectomy – resection of rectosigmoid with closure of anorectal stump + formation of end colostomy
Complicated Diverticulitis - Treatment If haemorrhage. Onset
Is sudden + painless
Complicated Diverticulitis - Treatment If haemorrhage. Cause
Rectal bleeds
