Meckel’s diverticulum is a common condition in which there is a small pouch attached to the intestinal wall, usually at the junction where small and large intestines meet.
The pouch is located near the ileocecal valve and has both gastric and pancreatic tissue. The gastric tissue can secrete hydrochloric acid, which causes ulcers in the ileum. It can become inflamed and block the intestines and also bleed at times.
About 2-3% of the general population have Meckel's diverticulum, but related symptoms are seen only in a fraction of affected people. Some people do not exhibit any symptoms of Meckel's diverticulum all their lives. Meckel's diverticulum affects males and females, though its complications are seen 2-3 times more in males.
Causes of Meckel's Diverticulum
Meckel's diverticulum develops in the fetus during early stages of pregnancy – mostly between the fifth and seventh week of fetal development. Under normal circumstances, the vitelline duct, which connects the terminal ileum to the navel, is absorbed into the growing fetus by sixth or seventh week of gestation. When it is not fully absorbed, what remains is a sac-like structure that develops into a Meckel’s diverticulum.
Thus, Meckel’s diverticulum is a remnant from the digestive system of the growing fetus. The sac is not made up of intestinal tissue but of tissue similar to that found in the pancreas or stomach. Hence this tissue is capable of secreting hydrochloric acid just like stomach cells, and can cause ulcers in the intestine which can result in bleeding.
Symptoms of Meckel's Diverticulum
Children with Meckel’s Diverticulum show symptoms including bowel obstruction, bleeding, and inflammation. The most common symptom in children is the passage of a dark red-colored blood through the rectum. Stools may be brick-red in color and jelly-like. Blood usually passes without causing pain, but some kids may experience abdominal pain. Regardless of pain (or lack thereof), passing blood from the rectum is a serious symptom and warrants immediate medical attention.
Some of the symptoms of Meckel's diverticulum may be the same as those seen in other conditions, so there is also a chance of misdiagnosis. Symptoms usually occur within the first 12 months after birth, but can also be seen in adulthood. Not all people with Meckel’s diverticulum develop complications, only 2% of them do.
Common symptoms of Meckel’s diverticulum are as follows:
- Bloody stool
- Intestinal bleeding
- Tenderness around the belly button
- Abdominal cramps and pain
- Bowel obstruction which can cause bloating, pain, constipation, diarrhea, and vomiting
- Swelling of the walls of the intestine
Obstruction of bowel is mostly seen in adults and older children. Tumors are a rare sign of Meckel’s diverticulum and are mostly seen in adults. A child showing any of the symptoms listed above needs to see a pediatrician right away.
Abdominal tenderness and pain is localized and felt around the navel. It is often similar to that of appendicitis except for site of tenderness or pain. Children may have repeated episodes of bleeding from the rectum without any pain. This is not serious enough to trigger shock in the children. Adults may pass melena which is tarry feces instead of red bloody feces.
Reviewed by Afsaneh Khetrapal BSc (Hons)