MECKEL’S DIVERTICULUM

1. MECKEL’S DIVERTICULUM

2. • It is a congenital diverticulum arising from the
terminal ileum and is part of the unobliterated
proximal portion of the vitellointestinal duct.

3. It is:
• ™
. 2% common.
• ™
. 2 feet from the ileocaecal valve.
• ™
. 2 inch in length.
• ™
. 2% of Meckel’s diverticulum only will be
symptomatic.
• ™
. 50% of symptomatic are below 2 years of age.
• ™
. 20% heterotopic epithelium.
• ™
. 2:1 female preponderance is seen.

4. • It is congenital, results from incomplete
closure of vitellointestinal duct.
• It is the most common congenital anomaly of
small intestine.
• Arises from the antimesenteric border of the
ileum, containing all three layers of the bowel
with independent blood supply.

5. • In 20% of cases mucosa contains heterotopic
epithelium like gastric (commonest—50%),
colonic and pancreatic tissues (5%).
• It may be connected to or communicated with
the umbilicus through a band or fistula.
• It may be associated with oesophageal atresia,
exomphalos and anorectal malformations.

6. (A) Anatomy of Meckel’s
diverticulum;
(B) Meckel’s diverticulum.

7. Presentations in Meckel’s Diverticulum
• Asymptomatic—in majority cases.
• Severe haemorrhage most common, seen in children
aged 2 year or younger (Maroon-coloured blood).
• Intestinal obstruction due to bands/adhesions/
intussusception.
• Perforation.
• Intussusception, volvulus of small bowel.
• Peptic ulceration.
• Diverticulitis (20%)—features mimic acute appendicitis.
• Littre‘s hernia—it is presence of Meckel’s diverticulum
in hernial sac as content.
• It is observed in inguinal/femoral hernia

8. Diagnosis
• Technetium (Tc99) radioisotope scan is very useful (90–95%
accuracy). 90% of heterotrophic gastric mucosa can be
identified in Meckel’s diverticulum by radioisotope study. It
can detect
• Meckel’s diverticulum with minimal bleeding also (0.1 ml/
minute). So it is very useful investigation in children
presenting with bleeding.
• X-ray abdomen to see complications like obstruction,
perforation.
• Laparoscopy is very useful.
• Enteroclysis/small bowel enema under fluoroscopy may
show the
• Meckel’s diverticulum. It is probably the most accurate
investigation.

9. Treatment
• Asymptomatic Meckel’s diverticulum can be
left alone when identified during laparotomy.
• Resection of a short segment of ileum
containing Meckel’s diverticulum and end-to-
end anastomosis is done.
• Meckelian diverticulectomy with closure of
enterotomy also can be done, but chances of
retaining heterotopic tissues and stenosis are
higher.

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