Does your little one sometimes have unexplained stomach aches? Or have you been scared to death when you see blood in their stool? Many parents are worried about this. But it doesn't always have to be something serious. Today we're going to talk about a condition that can cause these symptoms, but many people haven't heard of it. That's Meckel's diverticulum. Although the name may sound strange, it's something we should know about.
What is Meckel's Diverticulum?
Simply put, a Meckel's diverticulum is a small pouch or pocket that forms on the inside of the wall of our small intestine. Think of it like a small pouch on the inside of a dress. This is a birth defect that is present at birth. But don't be alarmed by the word "disorder." This is very common. About 2 or 3 out of every 100 babies have this condition, and most of the time it doesn't cause any harm.
Normally, we can develop diverticula in our digestive system (gastrointestinal tract). They develop especially in the colon as we age. But Meckel's diverticulum is a little different. Because it develops while the baby is still in the womb.
The special thing about this is that sometimes there can be other types of tissue left inside this small protrusion that don't belong there. In medicine, we call this 'ectopic tissue'. That is, a type of tissue that should be in one place grows in a place where it doesn't belong. Imagine, what happens if a part of the tissue in our stomach, which produces acid, grows inside this small protrusion? The stomach has a special coating that can withstand acid. But the small intestine doesn't have such a coating. So when the stomach tissue that has grown inside that protrusion starts releasing acid, that acid damages the wall of the small intestine and starts forming ulcers. That's when problems arise.
This is an easy one to remember: the "Rule of 2s"
There is an easy way to remember some basic facts about Meckel's diverticulum. It is called the "Rule of 2s".
- Prevalence: About 2% of the population has this condition.
- Complications: Only 2% of people with this condition develop symptoms or complications. That means 98 out of 100 people will live their entire lives without even knowing they have it.
- Age: Symptoms usually appear in children under 2 years of age.
- Gender: Boys are twice as likely to develop this condition as girls.
- Location: This protrusion is usually located about 2 feet above the lower end of the small intestine.
- Tissue types: There may be two types of ectopic tissue (gastric tissue or pancreatic tissue) within this.
What are the symptoms of Meckel's Diverticulum?
First of all, it's entirely possible for you or your child to have this condition, but it's entirely possible that you'll live your entire life without any symptoms. Symptoms only appear if the complications we discussed earlier develop. These complications often appear in childhood, but can rarely occur in adulthood.
Imagine, your one and a half year old son suddenly starts crying for no reason, holding his stomach. He won't even drink any milk. When you change his diaper, you see that it is stained with bright red blood. It is a scene that scares any mother. At a time like this, a doctor might suspect a condition called Meckel's diverticulum.
Let's look at the main complications that can occur and their symptoms.
| Complication | Symptoms and explanation |
|---|---|
| Gastrointestinal Bleeding | This is the most common complication. Acid released from the stomach lining inside the esophagus causes ulcers in the intestines and bleeding. The special thing is that this bleeding is often painless . In young children, the blood passes with the stool in a dark red color . In adults, the stool may be black like tar . If the bleeding continues, symptoms such as anemia (low blood count) and paleness and fatigue may also occur. |
| Diverticulitis | Rarely, this pouch can become infected with bacteria and become inflamed, causing abdominal pain, swelling, and tenderness. This pain is especially felt around the navel . If you or your baby has appendicitis, it will feel similar to that pain. |
| Intestinal Obstruction | This is also rare. This protrusion can completely or partially block the food passage in the intestine. Sometimes this protrusion folds inward, causing one part of the intestine to move inside another. We call this intussusception . This can cause symptoms such as bloating, stomach pain, nausea, and vomiting . |
Can these complications be serious?
Yes, some complications can be life-threatening if left untreated. But symptoms usually appear before they become serious. For example, if a wound continues to bleed, the body can lose too much blood and go into shock. There can also be perforation of the intestinal wall, which can lead to serious infection (sepsis). Therefore, if you notice any of these symptoms, you should see a doctor immediately.
Why does Meckel's Diverticulum form?
This is a bit of a complicated story, but I'll explain it simply. During the early stages of development, the baby receives nourishment from something called the yolk sac. This is connected to the baby's intestines by a small tube (vitelline duct). After a few weeks, the baby begins to receive nourishment from the mother through the placenta. At that point, the yolk sac and the tube connected to it are no longer needed. Normally, this tube and the sac should be completely absorbed by the body.
But sometimes a small part of this tube remains. That remaining part forms a protrusion called a Meckel's diverticulum. Scientists still don't know exactly why this happens.
How do doctors diagnose this condition?
Some people find out they have it by accident. It's discovered when they have something like an abdominal scan for another reason. Others find out when symptoms start to appear. Doctors will suspect it, especially if a child under 2 years old has unexplained stomach pain or if they have blood in their stool without any pain. This is the main reason why children have blood in their stool.
There are several tests to confirm this:
- Meckel's scan: This is the most commonly used test. A small, harmless radioactive substance is injected into a vein. If there is stomach tissue inside this vein, the tissue absorbs the substance. Then, when viewed with a special camera (gamma camera), the area is beautifully highlighted.
- Mesenteric arteriography (angiogram): This involves injecting a dye into the blood vessels in the stomach and taking X-ray pictures. This test can detect if there is an active bleeding site from an intestinal injury.
- Endoscopy: This involves inserting a small tube (endoscope) with a camera attached through the mouth to examine the intestines. Another method is to swallow a small pill-like camera (capsule endoscopy). This camera travels along the intestines and takes pictures. For small children, this capsule can also be placed in the stomach after anesthesia.
What are the treatments for this?
If complications arise from Meckel's diverticulum, the best treatment is to have it surgically removed. This surgery is called a 'small bowel resection.' This involves cutting out a small piece of the intestine where the diverticulum is located and then reconnecting the two remaining sections of the intestine.
Remember, most people don't need surgery. Surgery is only done for those who have symptoms and complications.
Sometimes, even if there are no symptoms, if a scan confirms that a small child has stomach tissue inside this protrusion, the doctor may suggest surgery to prevent future problems.
Most of the time, this surgery is done laparoscopically. That is, surgery is performed without making a large incision in the abdomen, but rather through a few small incisions, where a camera and instruments are inserted. This results in faster healing and less scarring.
What happens after the surgery?
The recovery time after surgery is usually short. If you have a laparoscopic surgery, you will be fully recovered in about two to three weeks. If you have an open surgery, it can take about six to eight weeks. There is a small risk of minor complications, such as infection, after the surgery, of about 5%. However, once the surgery is successful, this Meckel's diverticulum problem will never bother you or your baby again.
If there are no symptoms, should I be worried about this?
No. Most people never have a problem with this. Only 2% will have complications. The most important thing is to be aware of this. If you or your child has unexplained stomach pain, loss of appetite, or blood in the stool, see your doctor right away. If you haven't had any problems as an adult, there's a good chance that you won't have any problems in the future.
Take-Home Message
- Meckel's diverticulum is a common, often harmless, birth defect.
- Many people go their entire lives without even knowing they have this.
- Symptoms are rare. This may be suspected if children under 2 years old have painless blood in their stools or unexplained stomach pain .
- If you notice these symptoms, don't panic and see a doctor as soon as possible.
- If there are symptoms, surgery can completely cure this condition.
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