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Query: UMLS:C0153429 (Meckel's diverticulum)
 1,196 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Congenital and acquired diverticula of the jejunum and ileum in the adult are unusual and occur in approximately 1 percent to 2 percent of the population. They are pulsion diverticula thought to be the result of intestinal dyskinesia. These lesions can produce a significant diagnostic and therapeutic dilemma. They are multiple in the jejunum and solitary distally and are characteristically found in 60- or 70-year-old males. The diagnosis may be confirmed with contrast studies of the small intestine, arteriography, or nuclear scan. Consider these disorders in patients with 1) unexplained gastrointestinal bleeding, 2) unexplained intestinal obstruction, 3) an unexpected cause of acute abdomen, 4) chronic abdominal pain, 5) anemia, or 6) malabsorption. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management. Asymptomatic diverticula discovered on routine contrast studies need not be resected. At surgery, incidental diverticula should be removed when evidence of dilated, hypertrophied loops of small bowel with large diverticula is found. Intraoperative air distention will aid in diagnosis. Resection and primary anastomosis is the preferred treatment for non-Meckelian diverticula. Diverticulectomy is reserved for a Meckel's diverticulum without evidence of ulceration. An incidental Meckel's diverticulum should be removed in the presence of mesodiverticular bands or ectopic tissue. Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patient undergoing restorative proctocolectomy for ulcerative colitis.
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PMID:Clinical implications of jejunoileal diverticular disease. 158 62

Meckel's diverticulum is a rare, but serious cause of acute abdominal pain. The prevalence of Meckel's diverticulum is 2% and lifetime risk of illness in a diverticulum is 4.2%. The risk declines with age and approaches zero after the age of 70. Morbidity after resection of symptomatic Meckel's diverticulum is 11.1-17.6% with 6.0-7.5% mortality. The morbidity rate for resection of incidentally discovered diverticulum is 1.2-8.9%. Symptoms and complications are related to age. Below the age of one year the most prevalent complication is gastrointestinal obstruction. Later in childhood the most dominating complication is peptic ulcer with serious gastrointestinal bleeding, while various kinds of gastrointestinal obstruction and diverticulitis are most prevalent in adults. The treatment of symptomatic Meckel's diverticulum is resection. However, the treatment of incidentally discovered Meckel's diverticulum is a subject of dispute. After a thorough study of the literature we conclude that resection should be the routine for all incidentally discovered Meckel's diverticulums in persons younger than 40. After this age resection should be reserved for patients with palpable stigmata of heterotopic tissue, diverticulums of some length and the presence of omphaloenteric- or omphalodiverticulare chords.
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PMID:[Meckel's diverticulum. Symptoms, diagnosis and treatment]. 204 55

Eosinophilic gastroenteritis is a rare condition, characterized by diffuse infiltration of the gastrointestinal tract by eosinophils. This involves mainly the stomach, duodenum and small bowel and rarely the esophagus, colon, pancreas, gallbladder, prostate and urinary bladder. Most reported cases have occurred in adults in the third decade of life. The authors report on a 15-day-old infant who initially presented with rectal bleeding and a scan that indicated a Meckel's diverticulum was present. At laparotomy, however, a Meckel's diverticulum was not found. The appendix was slightly distended and there was a mild inflammatory reaction. Appendectomy was performed. Microscopically the appendix showed diffuse eosinophilic infiltration. The blood eosinophil count was elevated. The patient recovered well, but had several minor episodes of rectal bleeding following ingestion of milk. He remained asymptomatic on a milk-free diet. The etiology of eosinophilic gastroenteritis is unknown and there is no specific treatment. In uncomplicated cases, diet, corticosteroids and adrenocorticotropic hormone are used. Operation is reserved for cases of obstruction and hemorrhage.
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PMID:Eosinophilic gastroenteritis. 670 27

Lower gastro intestinal bleed (LGIB) is defined as any bleeding that occurs distal to the ligament of Treitz (situated at the duodeno jejunal junction). It constitutes the chief complaint of about 0.3 % of children presenting to the pediatric emergency department(ED). Among Indian children the most common causes are colitis and polyps. In most of the cases of LGIB the bleeding is small and self limiting, but conditions like Meckel's diverticulum often presents with life threatening bleeds. The approach in ED should include in order of priority-assessment and maintenance of hemodynamic stability, confirmation of LGIB and then to attempt for specific diagnoses and their management. This is achieved with help of rapid cardiopulmonary assessment, focused history and examination. The management of all serious hemodynamically significant bleeds includes, rapid IV access, volume replacement with normal saline 20 ml/kg, blood sampling (for cross matching, hematocrit, platelet, coagulogram and liver function tests), Inj. Vit K 5-10 mg IV, acid suppression with H2 antagonists/PPI and nasogastric lavage to rule out upper gastrointestinal bleed. Continuous ongoing monitoring of vital signs is important after stabilization. In ill looking infant, infectious colitis, Necrotizing enterocolitis (NEC), Hirschsprung enterocolitis and volvulus and in older infants and children, intussusceptions, typhoid fever, volvulus should be looked for. Proctosigmoidoscopy remains the first investigation to be done and reveals majority of etiology. Multidetector CT scan, Tc 99 m RBC scan, angiography and Push enteroscopy are the further investigation choices according to the clinical condition of the child. Intra operative enteroscopy is reserved for refractory cases with an obscure etiology.
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PMID:Emergency management of lower gastrointestinal bleed in children. 2335 12