Rattan Kamal Nain, Singh Jasbir, Dalal Poonam, Rattan Ananta
Department of Pediatric Surgery, PGIMS, Rohtak, Haryana, India.
Department of Pediatrics, PGIMS, Rohtak, Haryana, India.
Afr J Paediatr Surg. 2016 Oct-Dec;13(4):170-174. doi: 10.4103/0189-6725.194671.
Meckel's diverticulum (MD) is the one of the most common congenital malformation of gastrointestinal tract and has varied clinical presentations. We are presenting here our 12-year experiences with MD in children at tertiary care hospital in North India. It highlights the fact that isolated gangrene of MD can occur, and it is associated with increased morbidity.
This retrospective study is conducted by analysing the medical records of the patients who were operated for MD in the last 12 years in paediatric surgery department at our hospital.
Sixty-five patients were operated for MD in study period; in this 52 were males and 13 were females with mean age of presentation 3.2 years. The most common presentation was intestinal obstruction seen in 86.1% (56 cases). Intestinal haemorrhage was seen in 4.6% (3 cases) and diverticulitis in 3% (2 cases). Perforation of the gut with peritonitis was present in 6.1% (four cases). Cause of obstruction was intussusception in 21.4% (12 cases), fibrous band connected to umbilicus in 17.8% (10 cases), volvulus in 17.8% (10 cases), kinking in 16.0% (9 cases), knotting in 14.2% (8 cases) and herniation of gut below in 12.5% (7 cases). Isolated gangrene of MD was present in ten cases with intestinal obstruction. The ectopic gastric mucosa was seen in three and pancreatic mucosa in two cases. Mortality and morbidity during the study were one and three cases, respectively.
MD may remain clinically silent for lifetime, or it may have life-threatening complications. In our series, intestinal obstruction and not the haemorrhage was the most common presentation. Isolated gangrene of MD with obstruction was present in significant numbers, which we failed to find in literature.
梅克尔憩室（MD）是最常见的胃肠道先天性畸形之一，临床表现多样。我们在此介绍在印度北部一家三级护理医院对儿童MD的12年治疗经验。这突出了MD可发生孤立性坏疽这一事实，且其与发病率增加相关。
本回顾性研究通过分析我院小儿外科过去12年中因MD接受手术治疗的患者病历进行。
在研究期间，65例患者因MD接受手术；其中男性52例，女性13例，平均就诊年龄3.2岁。最常见的表现是肠梗阻，见于86.1%（56例）。肠出血见于4.6%（3例），憩室炎见于3%（2例）。肠道穿孔伴腹膜炎见于6.1%（4例）。梗阻原因包括肠套叠21.4%（12例）、与脐相连的纤维带17.8%（10例）、肠扭转17.8%（10例）、肠扭结16.0%（9例）、肠打结14.2%（8例）和肠疝入12.5%（7例）。10例肠梗阻患者存在MD孤立性坏疽。3例可见异位胃黏膜，2例可见异位胰腺黏膜。研究期间死亡率和发病率分别为1例和3例。
MD可能终生无临床症状，也可能出现危及生命的并发症。在我们的系列研究中，肠梗阻而非出血是最常见的表现。大量存在伴有梗阻的MD孤立性坏疽，这在文献中未被发现。
