Class presentation by Dr. Ranjit Kumar Makaju

1. Meckel’s Diverticulum
Ranjit Kumar Makaju

2. • It is the congenital diverticulum arising from the
antimesenteric border of terminal ileum
• During the eighth week of gestation, the
omphalomesenteric (vitelline) duct normally
undergoes obliteration
• Failure or incomplete obliteration of vitelline duct
results in some congenital abnormalities, the
most common of which is Meckel's diverticulum.

3. Meckel’s Diverticulum

4. • Sometimes this diverticulum can be attached to the
umbilical region by the vitelline ligament, with the
possibility of vitelline cysts, or even a patent vitelline
canal forming a vitelline fistula when the umbilical cord is
cut

5. • Most common congenital abnormality of the
gastrointestinal tract
• Contains all three layers of bowel with
independent blood supply
• Often contain heterotropic tissue- gastric,
occasionally pancreatic
• Sometime Meckel’s Diverticulum is found in
an inguinal or femoral sac – Littre’s hernia

6. Rule of 2’s
• 2% of the population
• Usually found 2 feet proximal to the ileocecal
valve
• About 2 inches long
• 2 times more common in males than females
• Symptomatic mostly before 2 years of age
• In adult patients it symptomatic in only about
2%

7. Clinical presentations
• Majority of Meckel’s diverticuli are clinically
silent
Symptoms in order of frequencies—
a) Severe haemorrhage
b) Intussuception
c) Meckel’s Diverticulitis
d) Chronic peptic ulceration
e) Intestinal obstruction

8. Pathophysiology
• Severe Hemorrhage
-painless per rectal bleeding, maroon colored
Hemorrhage may be caused by:
• Ectopic gastric or pancreatic mucosa: When
diverticulum contains embryonic remnants of mucosa
of other tissue types.
• Secretion of gastric acid or alkaline pancreatic juice
from the ectopic mucosa leads to ulceration in the
adjacent ileal mucosa i.e. peptic or pancreatic ulcer
• Perforation and bleeding from ulcer

9. • Meckel’s Diverticulitis
Inflammation of the diverticulum can mimic symptoms
of appendicitis
Diverticulitis results from---
-Peptic ulceration resulting from ectopic gastric mucosa
of the diverticulum
-Following perforation by trauma or ingested food
residue
-Luminal obstruction due to tumors, foreign body,
causing stasis or bacterial infection

10. • During perforation, the symptoms may
resemble those of a perforated duodenal ulcer
• Whether perforated or not, urgent surgery is
required
• In non perforated cases, an inflamed
diverticulum should be sought as soon as it
has been demonstrated that the appendix and
fallopian tubes are not at fault

11. • Intestinal obstruction
Causes—
• Volvulus of the intestine around the fibrous band
attaching the diverticulum to the umbilicus
• Entrapment of intestine by a mesodiverticular
band
• Intussusception with the diverticulum acting as a
lead point
• Stricture secondary to chronic diverticulitis
• Tumors e.g. Carcinoid, adenocarcinoma, GIST
arising in the diverticulum

13. Diagonosis
• A technetium-99m (99mTc) pertechnetate scan, also
called Meckel scan.
positive only when the diverticulum contains
associated ectopic gastric mucosa that is capable of
uptake of the tracer
• Laparoscopy
• Enteroclysis/ small bowel enema under fluoroscopy
• CT scan
• Angiography

14. Indications of surgery
• When the base is narrow, and lengthy
diverticulum
• Presence of adhesions or band which may
precipitate obstruction, intussusception or
volvulus
• Symptomatic patients or presence of
complications
• If it is found in children below 2 years

15. Management
• Meckelian Diverticulectomy:
Meckel’s diverticulum with the broad base should
not be amputated and invaginated
A linear stapler device may be used. If induration of
base, hetrotropic gastric tissue extending to adjacent
ileum is present then- short segment of ileum is
resected and end to end anastomosis is done
restoring the continuity

18. Thank you