Læknablaðið - 01.03.1979, Page 50

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LÆKNABLAÐIÐ
eru talsverð dauðsföll. Meðal þeirra
manna, sem dáið hafa úr sjúkdómi í
Meckels-gúl, hafa verið þó nokkrir, sem áð-
ur höfðu verið skornir holskurði, án þess
að gúllinn væri tekrnn burt. Þegar ástand
sjúklings er þannig, að ekki þykir ráðlegt
að leggja á hann ónauðsynlegt hnjask, má
taka gúlinn síðar, þegar ástand sjúklings-
ins er betra. Alla vega ber að útskýra fyr-
irbærið nákvæmlega fyrir slíkum sjúklingi
eða foreldrum hans, svo hægt sé að vera
vel á verði, ef sjúklingur fær einkenni frá
gúlnum seinna.
Ekki þykir fært, að draga neinar stórar
ályktanir af þessum samanburði á íslensk-
um og erlendum sjúklingum með Meckels-
gúl, til þess eru þeir of fáir. Tvennt er þó
athyglisvert. Annað er, að það eru engin
dauðsföll. Það er trúlega að einhverju leyti
því að þakka, hversu fljótt sjúklingarnir
komast undir læknishendur. Reyndar fer
dauðsföllum fækkandi ár frá ári við allar
skurðaðgerðir. Hitt athyglisverða atriðið
er, að tiltölulega margir sjúklingar hafa
gúlbólgu, en skýringin á því er mér ráð-
gáta. í því sambandi væri fróðlegt að vita
hvort botnlangabólga sé álíka algeng hér
og erlendis.
HEIMILDIR:
1. Aitken, John: Remnants of the vitello- in-
testinal duct. A clinical analysis of 88 cases.
Arch.Dis.Childhood 28:1-7, Feb. 1953.
2. Aubrey, D. Alan: Meckel’s Diverticulum.
A Review of 66 Emergency Meckel’s
Diverticulectomies. Arch.Surg. Vol 100, Feb.
1970.
3. Brookés, Victor S.: Meckels Diverticulum in
Children. Brit.J.Surg., Vol XLII No 171
July 1954.
4. Dovey, P.: Calculus in a MD — A Pre-
operativ Radiological Diagnosis. Brit.J.
Radiol., 44, 888-890.
5. Enge, I. & Frimann-Dahl, J.: Radiologi in
acute abdominal disorders due to Meckel’s
diverticulum. Brit.J.Radiol., 37, 775-780.
6. Hildanus, F., quoted by Weinstein et al.
7. Jewett, Theodore C., Jr., Duszynski, Diana
O. & Allen, James E.: The visualization of
Meckel’s diverticulum with 99mTc-per-
technetate. Ped.surg. Vol. 68, No 3, pp 567-
570.
8. Kittle, C.F. et al.: Patent omphalomesen-
teric duct and its relation to the diverti-
culum of Meckel. Arch.Surg. 54:10, 1947.
9. Lang, H.D. und Vinz, H.: Das Meckelsche
Divertikel als Ursache eines acuten Ab-
domens in der Neugeborenperiode.
10. Meckel, J.F. quoted by Soderlund.
11. Rutherford, Robert B & Ankers, David R.:
Meckel’s diveriticulum: A review of 148
pediatric patients, with special reference to
the pattern of bleeding and to mesodiverti-
cular vascular bands. Pediatric Surg. Vol.
59, No 4, pp 618-626.
12. Seagram, C..GF.: Meckel’s Diverticulum.
10-year Review of 218 cases, patent vitelline
duct 14 cases. Canad.J.Surg. 11:368-373.
13. Smithy, H.G. and Chamberlin J.A.: Per-
sistence of the vitelline (omphalomesen-
teric) artery as a clinical problem.
14. Steck, M.W.D. and Helwig, E.B.: Cutaneous
Remnants of the omphalomesenteric Duct.
Arch.Derm. Vol. 90 Nov. 1964, 463-470.
15. Soderlund, Sigrid: Meckel’s diverticulum. A
clinical and histological study. Acta chir.
scand. 1959 (Suppl. 248).
16. Vaage, Sigmund: Meckels divertikel og
andre dysplasier av ductus omphaloenteri-
cus hos mennesket. T. norske Lægeforen
1971, 91, 416-427.
17. Weinstein, E.C., Cain, J.C. & Remine, W.H.:
MD: 55 years of clinical and surgical
experience. Journal of the American As-
sociation 182, 251-253.
ENGLISH SUMMARY
During the period 1957 to 1976, 26 cases of
Meckel’s diverticulum were admitted to the
Pediatric Department of The National Hospital,
Reykjavik, Iceland.
History, embryology, histology and pathology
are briefly reviewed.
Twenty three of the patients had an opera-
tion for some complication of the diverticulum
but three were found incidentally.
The patient material consisted of 8 girls and
18 boys. Their age was 4 weeks to 11 years.
Four patients had additional congenital
abnormalities.
Histological examination was performed in
all removed diverticula (24 cases). Heterotopic
gastric mucosa was found in 7 cases. Pancreatic
tissue was present in 1 of them. In 3 diverti-
cula, peptic ulceration was seen at the opera-
tion but no gastric mucosa was found at the
histological examination.
The indications for operation were bleeding
in 7 cases, inflammation in 4 cases, invagina-
tion in 4 cases, obstruction ofter than invagi-
nation in 2 cases, indeterminate 3 cases, dis-
charge from the navel 2 cases and 1 case of
hernina. These findings were similar to other
reported series.
The appendix was removed in 21 cases. Only
11 appendices were histologically normal. Four
patients had appendicitis and diverticulitis
simultaneously.
Postoperative complications occurred in 2
patients, wound infection with evisceration in
both cases.
There were no deaths in the series.