Abstract
Complicated Meckel's diverticulum was found at operation in 20 children.
These symptomatic diverticula presented in the following manner: intestinal obstruction (10) including intussusception (3), hemorrhage (5), perforation (4), and inflammation (1).
Meckel's diverticulum can give rise to surgical problems in many ways.
In paticular, the possibility of intesinal obstruction must be stressed. This study suggested that gastrographin enema was helpful to determine the operation for intestinal obstruction. In 10 cases of intestinal obstruction, it took 23.8 hours on an average from the onset of symptoms to admission, and 10.3 hours on an average from admission to operation. Those lesions were predominantly strangulated type, where rapid worsening of the disease in a short period was observed.
Gastrographin enema successfully visualized intestinal obstruction in 5 of 7 cases. These lesions were caused by volvulus in 3 cases, intussusception in 3 cases, mesodiverticular band, adheasion at the tip of diverticulum, and volvulus of diverticulum in each one case.
In 5 hemorrhage cases the mean Hb level was 8.5g/dl. All cases had gastric mucosa and were diagnosed preoperatively by 99mTc-pertechnetate scintigraphy. Ulcer was seen in the borderline area between gastric mucosa and ileum mucosa.
In 4 perforation cases pnuemoperitoneum was revealed on a simple X-ray film in 2 cases. Three cases had gastric mucosa which was caused by ulcer.
Histology of the diverticula was available in 18 of the 20 cases, and 13 of these (72%) had areas of ectopic gastric mucosa. Ectopic gastric mucosa occurred in all cases which presented with intestinal hemorrhage and perforation.
Therefore, the importance of considering a diagnosis of Meckel's diverticulum with acute intestinal obstruction and intestinal hemorrhage should be emphasized.
