Meckel's diverticulum (diverticulum = pear-shaped or sac-shaped protrusion of the wall of a hollow organ) is a malformation of the small intestine, which is caused by insufficient regression of a duct formed during embryonic development (remnant of the so-called embryonic yolk duct or omphaloenteric duct). This duct can be only a few millimetres to centimetres long, but can also extend to the navel.

Overall, Meckel's diverticulum is found in around 2% of the population, of which only around 2% develop clinical symptoms. These mainly occur in the first two years of life, with boys being affected twice as often as girls.

The diverticulum, which is approx. 30-40 cm away from the passage from the small intestine to the large intestine (so-called ileocecal valve), can contain "scattered" (ectopic) mucosa from the stomach or pancreas. This mucous membrane can become inflamed (diverticulitis) or lead to internal bleeding into the small intestine (gastrointestinal bleeding), which can manifest itself in dark stools (so-called tarry stools) or bright red blood discharge from the anus. Furthermore, the Meckel's diverticulum can protrude into the intestinal lumen(intussusception) or lead to intestinal obstruction(bridenileus) due to a connective tissue strand of the persistent omphaloenteric duct.

Furthermore, symptoms such as abdominal pain and vomiting can occur, which in the acute stage can resemble the symptoms of appendicitis.

If the Meckel's diverticulum is an incidental finding during an operation or ultrasound examination, no action is required. However, if inflammation or gastrointestinal bleeding occurs, the Meckel's diverticulum must be surgically removed.

Initial contact is always made by means of an outpatient consultation in our pediatric surgery outpatient clinic (see below for contact details). The treatment options will be presented and your questions will be discussed in detail. Please bring all available examination results with you to the first outpatient consultation.

In the event of gastrointestinal bleeding or visible blood discharge from the anus, we will carry out a blood test to determine the red blood pigment (haemoglobin). The diagnosis of a Meckel's diverticulum can only be confirmed or ruled out with absolute certainty by means of laparoscopy. Although it is possible to detect a dispersed gastric mucosa in the diverticulum by means of a nuclear medical examination with X-rays (scintigraphy with sodium pertechnetate 99mTc or "Meckel scan"), this has only a low accuracy and does not help us to decide whether we need to perform a laparoscopy. For this reason, we do not perform scintigraphy in our Clinical Department to diagnose a Meckel's diverticulum.

The indication for surgery is given if we suspect that your child has a Meckel's diverticulum, which causes clinical symptoms (e.g. bleeding into the small intestine, inflammation, intussusception or bowel obstruction).

 

 

Laparoscopy and, if necessary, removal of the Meckel's diverticulum (Meckel's diverticulectomy) can be performed in two different ways: As a "multitrocar laparoscopy" and as a laparoscopy with only one trocar ("single-port laparoscopy"). We will discuss which procedure is best for your child with you before the operation.

 

Laparoscopy via only one access point at the navel (synonyms: "single-incision laparoscopy", SILS, "single-port laparoscopy")

In this surgical method, the pediatric surgeon inserts a special trocar (so-called "SILS port") into the abdomen via the navel. The SILS port consists of a flexible rubber sleeve with 3 openings for inserting the laparoscopic instruments. The principle of laparoscopy is the same as for laparoscopy with three trocars, with the only difference that the additional trocars or skin incisions are omitted. As "only" the incision in the center of the navel is visible after the operation, some authors refer to this method as "scarless" surgery. Strictly speaking, a scar still remains, but it is usually cosmetically less prominent or more visible than with a splenectomy with three trocars.

Both procedures are used in our Clinical Department with a high level of patient satisfaction. We will discuss which procedure is most suitable for your child with you before the operation as part of the detailed surgical consultation.

After the operation, your child will initially remain in the recovery area, where you will be able to sit at the bedside again. You will then be transferred to the normal ward. A few hours after the operation, your child will usually be able to eat again. After an uncomplicated Meckel's diverticulectomy, an inpatient stay of 2-4 days in hospital is usually sufficient.

 

Laparoscopy with three trocars ("multitrocar laparoscopy")

The pediatric surgeon makes a small incision in the navel through which a thin tube (trocar) is inserted into the abdominal cavity. Air is blown into the abdominal cavity through the trocar and a camera is inserted (laparoscopy). This allows the entire abdomen to be inspected. Two further small (0.3 cm) incisions are then made in the abdominal wall under visualization and further working channels (trocars) are inserted into the abdomen. The entire small intestine can now be examined for the presence of a Meckel's diverticulum. Laparoscopy can also be used to rule out other possible diagnoses (appendix infection, ovarian cyst, etc.). If a Meckel's diverticulum is found, it can be separated using a mechanical stapler and pulled out via the navel. Alternatively, the entire loop of small intestine from which the Meckel's diverticulum originates can be pulled through the navel in front of the abdominal wall and removed outside the body. The resulting defect in the intestinal wall is then sutured shut again before the intestinal loop is put back into the abdomen.

As a rule, you will not be seen again for a follow-up examination by us, but by the colleagues who referred you to us for surgery. However, if you still have questions regarding the operation itself or if we consider an earlier follow-up examination to be appropriate in individual cases, you can arrange an outpatient appointment at any time.

The stitches we use are usually self-dissolving and do not need to be removed separately. Depending on your physical condition, you will need to refrain from sport for around three weeks.