DIAGNOSIS AND PECULIARITIES OF SURGICAL TACTICS IN PATHOLOGIES OF MECKEL'S DIVERTICULUM IN CHILDREN

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 101 DIAGNOSIS AND PECULIARITIES OF SURGICAL TACTICS IN PATHOLOGIES OF MECKEL'S DIVERTICULUM IN CHILDREN N. Sh. Ergashev1, A.Y. Markayev2, M.Sh. Boboyev3 Tashkent State Medical University (TSMU)1,2,3 https://doi.org/10.5281/zenodo.17451817 Abstract. The paper presents literature data and the results of our own observations on the diagnosis and surgical treatment of 46 children with Meckel's diverticulum who were under our supervision during the period from 2010 to 2021. The frequency and nature of complications, features of pathological conditions, and methods of surgical interventions for Meckel's diverticulum in children were studied. Meckel's diverticulum without pathological changes was detected during surgery in 7 cases as an accidental finding; in 39 cases it was accompanied by various complications such as intestinal intussusception, strangulation intestinal obstruction, diverticulitis, and bleeding. The methods of surgical intervention were selected taking into account the diameter of Meckel's diverticulum, the width of its base, and the nature of complications. Keywords: complications, Meckel's diverticulum, clinical manifestations, treatment, children. Introduction. Meckel’s diverticulum (MD) is a localized sac-like protrusion containing the lumen and all layers of the ileal wall, formed as a result of incomplete obliteration of the vitelline duct. It is the most common anomaly of the gastrointestinal tract and occurs in about 2% of the general population [3]. It is located in the distal part of the ileum, 50–70 cm from the ileocecal junction [1, 2, 3]. The average length of MD is 5–7 cm. In the literature, a giant MD measuring 35 cm in length and 15 cm in diameter has been described [2, 11]. This anomaly, with or without visible changes and/or with various complications, is observed in both children and adults, and is detected during laparotomy or laparoscopy, as well as in the course of radioisotope studies and capsule video endoscopy of the gastrointestinal tract. According to V.M. Timerbulatov et al. (2017), among 77 patients with complicated forms of MD, 30 were aged from 21 to 80 years and 47 were children. MD occurs more frequently in males: in adults — 2.3 times, and in children — 8.4 times more often than in females. Complicated forms occur with a frequency of 0.61 per 100,000 adults and 6.6 per 100,000 children. Some authors note a gradual decrease in the frequency of complications with increasing age — from 4% at 10 years to 0% at 75 years [8, 9]. The incidence of malignant transformation of MD ranges between 1% and 6.4% [10, 11, 12]. Uncomplicated MD in 95–98% of cases is asymptomatic; however, its presence often serves as a source of complications and pathological processes. Clinical manifestations are determined by the type of complication and the patient’s age [13]. In most cases, the disease is diagnosed by symptoms of intestinal obstruction, gastrointestinal bleeding, or localized and diffuse peritonitis caused by diverticulitis, or when MD serves as a reservoir for swallowed foreign bodies in the gastrointestinal tract. In children, simultaneous development of acute phlegmonous appendicitis and smallbowel intussusception may occur against the background of Meckel’s diverticulum with ectopic pancreatic tissue [6, 7]. The purpose of the study is to analyze the frequency, nature of SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 102 complications, and features of the clinical manifestations of pathological conditions, and to determine the surgical tactics for Meckel’s diverticulum in children based on the materials of the clinic. Materials and Methods. Among 373 children aged from 1 day to 18 years with diseases of the gastrointestinal tract who underwent small intestine surgery in 2010–2021 at the clinical bases of the Department of Pediatric Surgery of (TSMU), MD was detected in 46 (12.3%) patients, becoming the cause of complications in 25 (54.4%) and associated diseases in 14 (30.4%) cases. Surgical intervention was performed in 7 (15.2%) children with MD without pathological changes. As an intraoperative finding, MD was detected during surgery for appendicitis in 4 patients, for congenital anomalies of the anterior abdominal wall in 2, and for inguinal-scrotal hernia in 1 patient. Among the patients, there were 31 (67.4%) boys and 15 (32.6%) girls. The examination in the clinic included standard clinical, laboratory, and instrumental methods: ultrasound examination (US) of the abdominal cavity, computed tomography (CT), contrast radiography of the intestine, laparoscopy, upper gastrointestinal endoscopy, and, when necessary, colonoscopy. Results and Discussion. Meckel’s diverticulum (MD) without pathological changes, as well as with various complications serving as the main cause of pathological conditions in the abdominal cavity, was observed in children from the neonatal period to adolescence. There were 4 (8.7%) children aged from 3 months to 1 year and 12 (26.1%) aged from 7 to 12 years. No specific clinical manifestations were noted in uncomplicated MD. The manifestations of the disease were signs of pathology associated with the structural features of the diverticular wall. Remnants of the rudimentary vitelline duct in the form of a fixed cord connecting Meckel’s diverticulum to the umbilicus and mesentery can provoke volvulus, external compression of the intestine, and manifestation of symptoms of intestinal obstruction (Table 2). Bleeding due to MD occurred in 9 (16.6%) patients. In 4 cases, it manifested as painless bloody discharge in the form of melena or tarry black stools. Episodes of single or double mild or occult bleeding that stopped spontaneously or after conservative treatment were noted in 4 children. In one child, the bleeding was massive, with increasing clinical and laboratory signs of anemia. This can be explained by peptic ulcerations of the ectopic gastric or pancreatic mucosa. Diverticulitis was observed in 22 (47.8%) patients and manifested with signs of acute abdominal diseases. In 13 (59.1%) cases, children were operated on with suspected acute appendicitis. During surgery, an intact vermiform appendix was found. Further revision revealed diverticulitis: catarrhal in 3 (23.1%) patients, phlegmonous in 8 (61.5%), and gangrenous in 2 (15.4%). A combination of diverticulitis with appendicitis was not observed in our cases. In 9 (40.9%) observations, abdominal pain had a more diffuse character, accompanied by symptoms of peritoneal irritation. During plain abdominal radiography, free gas under the diaphragm dome in a moderate amount was detected in 5 (55.6%) cases. On abdominal ultrasound, fluid accumulation was noted in 7 (77.8%) patients. In these cases, during surgical intervention, perforation of Meckel’s diverticulum was found with characteristic morphological signs of phlegmonous (in 1 — 11.1%) and gangrenous (in 8 — 88.9%) types. The size and localization of the perforation varied from barely visible to extensive, mainly in the apical part and closer to the base. This explains the absence of clinical and radiological signs of perforative peritonitis in some patients. In one 2.5year-old child operated on with suspicion of a foreign body complication in the gastrointestinal tract, an MD without inflammatory changes was found, measuring up to 7 cm in length and 0.6 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 103 cm in diameter at the base, located 40 cm from the ileocecal valve, with a rudimentary cord connecting it to the mesentery of the small intestine without signs of intestinal obstruction. Revision revealed perforation of the terminal ileum caused by a toothpick, penetrating through all layers into the lumen of the vermiform appendix. Due to tight adhesion of the intestinal loops at the perforation sites, abscesses did not form. According to the anamnesis, the foreign body had been present for 9–10 days. The operation was completed with appendectomy, suturing of the perforation in the ileum, and diverticulectomy using a ligature method with the stump inverted into a purse-string suture. Among 46 operated patients with MD pathology, clinical signs of peritonitis were noted in 9 (19.6%) patients: localized — in 3 (33.3%) and generalized — in 6 (66.7%). The source of peritoneal inflammation in 9 (19.6%) patients was destructive diverticulitis (phlegmonous — in 1, gangrenous-perforative — in 8). In 2 (25%) cases, peritonitis developed due to intestinal necrosis caused by strangulation obstruction that occurred against the background of MD. Table 1. Forms of Meckel’s Diverticulum Pathology Identified During Surgical Intervention Depending on the Age of Patients (n = 46) MD without changes and forms of pathology Total number of patients Newborns and up to 3 months From 3 months to 1 year From 1 year to 3 years From 3 to 7 years From 7 to 12 years From 12 to 18 years Diverticulum without changes 7 2 (4.3%) 1 (2.2%) 2 (4.3%) 2 (4.3%) Diverticulitis without peritonitis 13 2 (4.3%) 1 (2.2%) 7 (15.2%) 3 (6.6%) Diverticulitis with signs of peritonitis (perforation) 9 1 (2.2%) 2 (4.3%) 2 (4.3%) 3 (6.6%) 1 (2.2%) Intussusception associated with MD 6 3 (6.5%) 1 (2.2%) 1 (2.2%) 1 (2.2%) Strangulation intestinal obstruction associated with MD 8 2 (4.3%) 1 (2.2%) 1 (2.2%) 2 (4.3%) 2 (4.3%) Incomplete closure of the vitelline duct with evagination 1 1 (2.2%) SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 104 Foreign body in MD 1 1 (2.2%) Massive intestinal bleeding from ulcerated MD 1 1 (2.2%) Total 46 6 (13.0%) 4 (8.7%) 7 (15.2%) 8 (17.4%) 12 (26.1%) 9 (19.6%) Table 2. Clinical Signs of Meckel’s Diverticulum in Its Complications in Children (n = 39) Clinical Signs Intestinal Intussusceptio n (n=6) Strangulatio n Obstruction (n=8) Intestina l Bleeding (n=1) Diverticuliti s (n=13) Perforation of Diverticulu m (n=9) Total (n=39 ) Pain syndrom e 6 8 13 9 38 Vomitin g 6 8 1 5 9 29 Fever 2 9 20 Melena 5 3 1 9 Signs of peritoniti s 9 9 Meckel’s diverticulum (MD) in 15 (32.6%) observations was the cause of intestinal obstruction: in 6 (40%) of these cases — intestinal intussusception (ileocecal — 3, ileocolic — 3), in 8 (53.3%) — strangulation obstruction in the form of volvulus of the small intestine around the non-reduced remnant of the vitelline duct, and in 1 (6.7%) — external compression of the small intestine by a residual fibrous cord. In these cases, typical clinical and radiological signs of intestinal obstruction were noted during examination. In one newborn with complete patency of the vitelline duct, measuring 5–6 mm at the base, with moderate discharge on the 12th day of life, an evagination with strangulation developed, causing intestinal obstruction that required emergency surgery. Surgical treatment of Meckel’s diverticulum, depending on the nature of the pathology, consisted of diverticulectomy, wedge excision at the base, or resection of the ileal segment bearing the diverticulum, followed by restoration of intestinal continuity. In cases of pronounced inflammatory changes in the abdominal organs, in addition to diverticulectomy or resection of the intestinal segment, the operation was completed by the creation of an enterostomy. These manipulations were performed via laparotomy or laparoscopy [4]. When selecting the method of surgical treatment, it is necessary to consider the risk of leaving residual areas of ectopic gastric mucosa, and in cases of bleeding — the presence of ulcerated tissues along the mesenteric border of the intestine. Therefore, to prevent postoperative complications, it is important to strictly adhere to the established indications and techniques of intervention. A case is described in the literature of recurrent intestinal intussusception three days after removal of Meckel’s diverticulum by the ligature method with inversion of the stump into a SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 105 purse-string suture. This required re-laparotomy, disinvagination of the intestine, and wedge resection of the small bowel segment containing the MD stump [5]. The surgical approach to incidentally detected MD or its complications is determined individually. This issue is widely discussed in the literature. Some authors emphasize the need for removal of the diverticulum in all cases where it is detected [4]. Others believe that MD should only be removed when complications are present. There are also contradictions in the management strategy when a diverticulum is incidentally discovered during other surgical procedures. In cases of complicated acute appendicitis, an incidentally discovered Meckel’s diverticulum should be left in place. In uncomplicated appendicitis, an intact diverticulum should be removed [10]. The choice of surgical technique was based on the diameter of the diverticulum, the width of its base, the nature of the complications, the extent of the inflammatory process along the length and base of the diverticulum, the condition of the ileal wall, the involvement of the peritoneum, and the severity of the patient’s condition caused by the underlying disease and associated complications (Table 3). In 7 (15.2%) cases, MD without pathological changes was found incidentally during surgery for acute appendicitis — in 4 (57%) patients, laparotomy for anterior abdominal wall pathology — in 2 (28.6%), and herniotomy — in 1 (14.4%). Along with performing surgery for the main pathology, diverticulectomy was carried out in all these cases. With a narrow base of MD (diameter up to 10 mm) and no pronounced ileitis, diverticulectomy was performed similarly to a standard appendectomy in 4 (8.6%) patients. When the diameter of the diverticulum ranged from 10 to 20 mm with infiltration at the base, diverticulectomy with wedge resection of the ileal wall was performed in 5 (10.9%) patients. In cases of purulent-destructive diverticulitis with inflammatory and infiltrative changes of the ileal wall or questionable viability due to strangulation obstruction and intussusception, resection of the ileal segment containing the MD was performed in 14 (30.4%) patients, with restoration of intestinal continuity and the formation of an enteroenteric anastomosis. Resection of the ileum containing the MD with protective ileostomy was performed in 9 (19.6%) patients due to concerns about anastomotic integrity in cases of diffuse peritonitis, marked intestinal paresis, and inflammatory changes in the ileal wall associated with underlying diseases and their complications. Table 3. Types of Surgical Procedures Performed for Meckel’s Diverticulum (n = 46) Type of Operation Num ber of Patie nts With out Chan ges (n=7) Divertic ulitis (n=13) Perfora tion of MD (n=9) Bleed ing from MD (n=1) Forei gn Body in MD (n=1) MD with Intestinal Intussusce ption (n=6) MD with Other Forms of Intestin al Obstruc tion (n=9) Diverticule ctomy 4 3 1 Wedge resection of 5 4 1 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 106 the intestine bearing MD Segmental resection of the intestine bearing MD with anastomosis 28 12 1 6 9 Segmental resection of the intestine bearing MD with stoma formation 9 9 Total 46 Postoperative complications occurred in 6 (13%) patients (Table 3). Partial anastomotic leakage was observed in 2 cases after emergency resection of the intestine bearing MD with immediate anastomosis formation, and early adhesive intestinal obstruction developed in 3 patients after resection with stoma formation. These complications can be attributed to technical errors made by on-duty surgeons who lacked sufficient experience in bowel resection and stoma creation. Closure of the small intestinal fistula resulting from partial anastomotic leakage with external fistula formation was performed 4–6 weeks after the initial operation. Adhesive intestinal obstruction unresponsive to conservative therapy was eliminated by open or laparoscopic intervention. Superficial wound infections were resolved by conservative management. No deaths were recorded. Follow-up results from 1 to 10 years were available for 40 (87%) operated patients. None of the children required reoperation, and their physical and developmental progress corresponded to age norms. Table 4. Postoperative Complications in Pathologies of Meckel’s Diverticulum (n = 6) Type of Complication Number of Patients Diverticulectomy (Abs / %) Wedge Resection (Abs / %) Bowel Resection with Anastomosis (Abs / %) Bowel Resection with Stoma Formation (Abs / %) Anastomotic leakage 2 (4.3%) — — 2 (4.3%) — Adhesive intestinal obstruction 3 (6.5%) — — 2 (4.3%) 1 (2.2%) Wound infection 1 (2.2%) — — — 1 (2.2%) Mortality 0 — — — — Total 6 (13.0%) — — 4 (8.6%) 2 (4.4%) SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 107 Conclusion Meckel’s diverticulum without pathological changes, as an incidental intraoperative finding, or with complications serving as a cause of acute abdominal diseases, constitutes №% among diseases of the small intestine requiring surgical treatment and is observed in children of all age groups. There are no specific clinical manifestations in uncomplicated MD. The symptoms of the disease are always signs of the resulting complications — diverticulitis, intestinal bleeding, or secondary pathology such as intestinal obstruction and peritonitis. The method of choice for the treatment of Meckel’s diverticulum is diverticulectomy. The variants of its performance and the type of simultaneous interventions depend on the nature of the complications, the severity and extent of the inflammatory process along the ileal wall, as well as secondary pathological changes of the peritoneum and abdominal organs. Diverticulectomy is indicated in cases of incidental detection of Meckel’s diverticulum during surgical procedures and in complicated forms of the pathology. Exceptions include cases of MD with a wide base, which require bowel resection in conditions of diffuse peritonitis or other surgical diseases of the abdominal organs. REFERENCES 1. Kirsanov I.I., Makedonskaya T.P., Tarasov S.A., Yartsev P.A. 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