| Objective:To understand the clinical characteristics, laboratory examination, surgical operation and pathological examination of Meckel’s diverticulum and its complications, in order to improve the understanding of Meckel’s diverticulum and reduce the possibility of missed diagnosis and misdiagnosis.Method:Retrospectively analyzed the medical records of children with 662 cases about Meckel’s diverticulum in our hospital diagnosed by surgical operation from January 1990 to December 2014.Results:1.There are 662 cases of children, the male-to-female ratio is 3.11:1. The median age of onset is 45 months of the children with MD(2days-2months and 15 years),≤12 years old up to 94.1%.2.The children with MD will have some clinical manifestations when its complications happened. The most common complication is gastrointestinal bleeding, there are 261 cases(39.43%),201 cases (30.36%) complicated with small bowel obstruction,125 cases(18.88%) complicated with Meckel’s diverticulitis,53 (8.01%) cases complicated with intestinal perforation,22 cases (8.43%) existed with other congenital malformations. Once MD existed with other congenital malformations, it will be found in early age when abdominal operation for other complicating disease, the median age of onset is 3.65 months(0.03months-166months). The median age of onset is 19 months of the children complicated with small bowel obstruction(0.06months-166months). The age of MD complicated Meckel’s diverticulitis is older, the median age of onset is 88 months (0.06months-180months).3.Hematochezia is the main manifestation when MD complicating gastrointestinal bleeding, the character of bloody stools are changeable, the most common is dark red stool(120 cases,45.98%), in the last cases,59 cases(22.61%) are red bloody stool,55 cases(21.07%) are black stool,18 cases are tarry stools, there are 9 children (3.45%), their stool is like jam.235 cases (90.04%) complicated with anemia,140 cases(59.57%) are moderate degree of anemia, the number of mild and severe anemia is 48 cases and 47 cases.4.There are 201 MD cases complicated with small bowel obstruction, abdominal pain or cry is the most common manifestation 141 cases, 70.15%), vomiting in 175 cases (87.06%), abdominal distention in 53 cases (26.37%), hematochezia in 63 cases(31.34%),52.38% of their stools like jam, stop to defecation in 13 cases(6.47%). Analyze the reason for SBO,72 cases(35.82%) are because of intussusception,60 cases(29.85%) are result from adhere of intestine,50 cases(24.88%)are suffered from pressure of strap.5.125 MD cases complicated with Meckel’s diverticulitis,abdominal pain or cry in 122 cases(97.60%), vomiting in 73 cases(58.40%), fever in 45 cases (36.00%).6.53 cases complicated with intestinal perforation, abdominal pain or cry in 43 cases (81.13%), vomiting in 25 cases (47.17%), fever in 17 cases (32.08%), hematochezia in 14 cases (26.42%).7.There are 193 cases do the examination of 99mTcO4- scanning,182 cases (94.30%) have the positive result.383 cases do ultrasonic testing of gastrointestinal tract,58 cases (15.14%) indicate the possible of MD.8.The distance from ileocecal valves to MD range from 5cm to 120cm, the mean±standard is (48.78±19.57)cm,99.68% of them is≤100cm. There are 80 cases found ectopic tissue through pathological examination,70 cases are gastric mucosa,7 cases are pancreatic tissue, gastric mucosa and pancreatic tissue are existed at the same time in 3 cases.Conclusion:MD is the most common congenital anomaly of digestive tract, it’s trend to happened in male, the distance from ileocecal valves to MD is always≤100cm. The MD could have ectopic tissue, gastric mucosa is the most common ectopic tissue, the second is pancreatic tissue, in some patients the gastric mucosa and pancreatic tissue can existed at the same time. MD will have some clinical manifestations when its complications happened, most of them is younger than 12 years old, the first complication is gastrointestinal bleeding, then the second is small bowel obstruction, Meckel’s diverticulitis and intestinal perforation also could be happen. We must choose different examination to help diagnose when MD complicated with different disease,99mTc04-scanning is more valuable than ultrasonic testing of gastrointestinal tract. |
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