Meckel's diverticulum

What is a Meckel's diverticulum?

	From the Merck Manual Consumer Version (Known as the Merck Manual in the US and Canada and the MSD Manual in the rest of the world), edited by Robert Porter. Copyright 2021 by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ. Available at merckmanuals.com. Accessed 9-3-21.

How does it affect my child?

Most patients lead their whole life with no problems from the Meckel's diverticulum. People who are bothered by the diverticulum may have different symptoms from other people. Common symptoms are nausea, vomiting, or pooping problems. These symptoms are often caused by the Meckel's diverticulum having bleeding, infection, or a block in the intestines.

Bleeding is caused when an ulcer forms by the Meckel's diverticulum. The ulcer forms because the Meckel's diverticulum may make something like stomach acid. Acid is ok in the stomach but in the intestine causes ulcers. An ulcer can lead to bleeding in the intestines and can be seen as blood coming from your child's bottom or poop. Often this bleeding can be quite a lot of blood. A child with a lot of bleeding needs to be seen by a doctor immediately. There are other things that can causes bleeding but this is the most common. Most doctors will tell you the Meckel's diverticulum should be taken out by surgery. This will remove the ulcer and stop the bleeding too. It should stop other problems in the future also.

If the Meckel's diverticulum causes an infection, a child likely has symptoms of pain in their belly and fever. The pain is often very sudden, severe and does not go away on its own. Some children also have nausea and vomiting. We are often able to make the diagnosis using an ultrasound or CT scan. The treatment for this is surgery to remove the Meckel's diverticulum with a laparoscopic surgery.

Obstruction can occur when the Meckel's diverticulum causes the intestine to twist too much. This twist prevents the partially digested food from passing through the intestine. This often causes severe crampy belly pain, nausea and vomiting. A CT scan or X-rays may show an obstruction but often do not help us to see the cause of the obstruction. Many intestinal obstructions require surgery. If the surgeon finds the Meckel's diverticulum is what caused the obstruction during the surgery and they will remove it.

There are a few other different ways to find out if your child's symptoms are from a Meckel's diverticulum. If it is causing the bleeding, a child's intestines can be looked at with a special scan, like an x-ray, called a Meckel's scan. A Meckel's scan is done by putting a medicine in a child's IV and that medicine will go to the Meckel's diverticulum and make it show on the special x-ray test. This scan may not always show the pouch or confirm that the problem is from a Meckel's diverticulum. Sometimes we recommend more tests. If needed, a small camera put through the child's belly button area on the stomach can be used to look inside. This is called a laparoscope camera. If they find the Meckel's with a laparoscope it may be removed at the same time. This process would be done under anesthesia and with medicines to keep a child comfortable. It is important to be sure we do not miss a Meckel's diverticulum that could cause bleeding or other problems to happen later.

When should my child have surgery?

Any patient that presents with complications from a Meckel's diverticulum we will recommend surgery to remove the Meckel's diverticulum. Surgery is typically recommended during the hospital stay that brought your child to the hospital.

How will my child be prepared for surgery?

Your child will have an IV (intravenous tube) put into a vein in your child's hand or foot. The IV will give your child fluid and if they are having bleeding may be used to give blood. These fluids will keep your child from getting dehydrated and keep your child safe. A doctor or nurse may put a tube, called a nasogastric or NG tube, down your child's nose and into the stomach. This tube will drain the stomach and may prevent vomiting. The drainage may be clear, brown, yellow or green. IV antibiotics may be given to reduce the risk of infection after surgery.

What is done during surgery?

Your child will need to have general anesthesia for the surgery. Your child will be given medicine to make them comfortable and forget about most things during the surgery. Surgery is done either by a laparoscopic (with the camera) or open approach. The laparoscopic way involves making 3-4 small (<1cm) incisions, or cuts, in the belly area. We can place a camera and small tools to identify the Meckel's diverticulum into those incisions. In some patients, the laparoscopic surgery may not be possible, and your surgeon may recommend an open surgery. This is a surgery that needs a larger incision. During the surgery the surgeon will remove the Meckel's diverticulum and sometimes a very short part of the adjacent intestine.

What care will my child need after surgery?

• Your child will be given pain medicine after surgery to keep them comfortable.
• Your child will be asked to take deep breaths, cough, and sit in a chair.
• Your child will be helped to walk after surgery. This helps prevent pneumonia. Babies may be held.
• A urinary catheter (tube) may be put in your child's bladder during surgery to empty it. Your child may also need this tube after surgery.
• Your child may not be able to drink anything right after surgery. An IV will still be needed to give fluids.
• The NG tube may be needed to empty your child's stomach. It will be removed when your child's stomach starts to growl and your child starts to pass gas. The doctors will tell you when your child can then drink and eat.