The diagnosis of an open Meckel's diverticulum is very easy if fecal matter can be demonstrated in the secretion. But these cases arc exceedingly rare. Examining the lumen with a sound, when possible, may facilitate the differential diagnosis from fistula of the urachus, the direction of the sound in the latter case being toward the base of the bladder. Acid reaction of the secretion points to fistula of the urachus, as does also the demonstration of urinary constituents.
Alkaline reaction of the secretion renders a rectal communication probable. Subcutaneous injection of methylene blue can be employed as an aid in diagnosis, as there would be blue coloration of the urine in a short time if there is communication with the bladder.
If there is only a short cul-de-sac or cyst the histological examination of their wall lining will in most cases have to be resorted to in order to decide their origin. Prolapse of the mucous membrane may occur in fistula of the urachus as well as in Meckel's diverticulum, although in the latter it is more frequent. A serious confusion occurs only when an umbilical adenoma is mistaken for a granuloma (umbilical fungus), but the central depression of the cherry-like growth always points to the presence of a fistular duct. The smooth consistency of the surface in
prolapse and in adenoma distinguishes them from the raspberry-like surface of an umbilical granulation tumor. In any case precaution is necessary in excising larger growths of this kind, as there is a possibility of injuring a loop of the small intestine.
With ileus or symptoms of intestinal strangulation in young patients that are afflicted with other degenerative malformations, such as harelip, etc., the possibility of a diverticular band should always be kept in mind.
The prognosis is entirely dependent upon the complications already referred to, which may have been caused by the diverticulum.
The treatment consists in the extirpation of the open duct, of the cyst or the cul-de-sac. From a small incision along the mesial margin of the rectus muscle the entire duct can be easily removed as far as the intestinal wall. The stump is treated by invagination secured by purse string suture.
The treatment of the other possible complications depends upon their nature iu each ease.