Meckel’s diverticulu

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A Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric (vitellointestinal) duct

Meckel's diverticulum is the most prevalent congenital anomaly of the GI tract 2% of the general population 2% prevalence, 2:1 female predominance 2 ft proximal to the ileocecal valve in adults 50% symptomatic under 2 years Heterotropic tissue Gastric mucosa Pancreatic acini

Epidemiology

Development

Failure or incomplete vitelline duct obliteration in wk. 8 Omphalomesenteric fistula Enterocyst

Pathophysiology

Asymptomatic Bleeding is the most common presentation in children

acid-producing from heterotopic gastric mucosa located within the diverticulum.

Intestinal obstruction; mechanisms

1. Volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus

2. Entrapment of intestine by a mesodiverticular band

3. Intussusception with the diverticulum

4. Stricture secondary to chronic diverticulitis Diverticulitis

Clinical Presentation

Clinical Presentation

Mesodiverticular band

Intestinal obstruction Hematochezia Appendicitis Intussusception Lower GI bleeding Angiodysplasias Malignancy Arteriovenous malformations

Differential diagnosis

Diagnosis

Incidentally found 99mTc-pertechnetate scintigraphy (ectopic gastric mucosa)

Indication for surgerySymptomatic Meckel

diverticulum- hemorrhage- intestinal obstruction- diverticulitis- umbilico-ileal fistulas

Indication for surgeryIncidentally discovered Meckel

diverticulum- Patients younger than 40

years- Diverticula longer than

2cm- Diverticula with narrow

necks- Diverticula with fibrous

bands- Suspected ectopic gastric

tissue- Inflamed, thickened

diverticula

1. Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.2. Kuwajerwala K N. Meckel Diverticulum [Internet]. Medscape [updated 2013 Mar 7; cited 2014 Jun 25]. Available from: http://emedicine.medscape.com

References