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Meckels Di Verticulum

canal, diverticulum, umbilicus, prolapse, intestinal and abdominal

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MECKEL'S DI VERTICULUM (See Knopfelmacher, vol. i.) Etiology and Pathological Anatomy. the eighth fetal week the canal which connects the intestinal tract with the vitelline mem brane generally closes and becomes obliterated.

If the vitelline membrane is partially or entirely preserved, mal formations may result which are in part visible outside the abdominal cavity at the umbilicus in the shape of a fistula or prolapse of the umbili cal membrane, while another part can be observed within the abdominal cavity as a cord or canal running from the umbilicus to the small intes tine. This canal may be obliterated wholly or partly, its umbilical end may completely disappear, and there remains in the abdominal cavity a diverticulum of the small intestine without outward communication which is known as Meckers divertieulum.

If this canal is patent in its entire length there will be a fistula of the umbilicus, excreting mucus and also fecal matter, provided the lumen is wide enough.

If this canal has become obliterated before arriving at the umbilicus a cyst may be formed which often protrudes through the umbilicus later in life. The result is a cherry-red, more or less spherical tumor at the umbilicus with a central indentation from which the milky secretion, as described above, exudes (Fig. 22). The velvety condition of the face, resembling mucous membrane, will easily lead to its recognition. This anomaly, though slight in itself, may be fraught with serious consequences. If of sufficient calibre, the entire canal may prolapse, drawing into it its intestinal end and leading to intestinal occlusion by invagination.

Other loops of the small intestine may slide from the abdomen into the folds of the prolapse, representing that pernicious combination of prolapse and hernia of the abdominal intestines which is occasionally observed in rectal prolapse (after Piechaud).

If the canal should merely persist as a cord within the abdomen without giving rise to any disturbance, it may remain concealed for life. In transverse position, however, it easily leads to complications in connection with the movements of the intestine. In strangulation

and torsion this canal has often been regarded as the cause.

Among 10,300 autopsies Turner found S1 cases with persistent vitelline membrane and a large number (360) in which there were patho logical changes from this cause.

Disturbances may be caused also by a pedicular torsion of Meckel's diverticulum itself, the consequence of which is intestinal perforation and peritonitis (Fehre). Schwarz observed an intestinal stenosis due to prolapse of the diverticulum into the lumen of the small intestine. I myself have seen severe intussusception started by inversion of Meckel's diverticulum.

Another possibility is perforation in the diverticulum itself which may occur in the manner of perforative appendicitis. Impeded circula tion, fecal stasis owing to occlusion of the lumen, may lead to ulcerations of the wall and perforation with all its consequences (Gebbele, Brentano).

Illustrative case: A child one year and nine months old fell ill with symptoms of acute appendicitis. Vomiting, tenderness of the abdomen on the right side, distinctly palpable tumor, and fever. Laparotomy disclosed diffuse serofibrinous peritonitis of the superficial intestinal coils, the tumor itself being a growth the size of a child's fist withmul tiple adhesions to the neighboring loops and to the omentum. was found on exposure that the growth was the enormously enlarged end of a free Meckel's diverticulum (Fig. 23). There was a gangrenous spot at the lower end where the perforation had taken place. The diverticu ium itself was completely filled with ascarides, and its open end was totally occluded by a bunch of them. It was probably owing to this occlusion that stasis of the contents and tumefaction had resulted. After excision of the diverticulum the patient was cured.

Umbilical tumors, known as umbilical adenomata, may originate from the adenoid tissue of the diverticulum and its remnants.

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