2. Introduction
• It is the most prevalent congenital anomaly of the GIT,
affecting approximately 2% of the general population
• They are designated true diverticula because their walls
contain all of the layers found in normal small intestine
• Their location varies among individual patients, but they
are usually found in the ileum within 100 cm of the
ileocecal valve
• Approximately 60% of Meckel's diverticula contain
heterotopic mucosa, of which more than 60% consist of
gastric mucosa
– Pancreatic acini are the next most common
3. Cont.
• “Rule of twos"
– 2% prevalence
– 2:1 female predominance
– 2 feet proximal to the ileocecal valve in adults
– Half of those who are symptomatic are younger
than 2 years of age
4. Pathophysiology
• The omphalomesenteric (vitelline) duct normally
undergoes obliteration
• Failure or incomplete vitelline duct obliteration
(which normaly occurs during the 8th week of
gestation) results in a spectrum of abnormalities,
the most common of which is Meckel's diverticulum
• Other abnormalities include omphalomesenteric
fistula, enterocysts, and a fibrous band connecting
the intestine to the umbilicus
5. Clinical Presentation
• Meckel's diverticula are asymptomatic unless
associated complications arise
• The lifetime incidence rate of complications
arising in patients with Meckel's diverticula
has been estimated to be approximately 4%
6. Cont.
• The most common presentations associated with
symptomatic Meckel's diverticula
– Bleeding (most common presentation in children)
• The result of ileal mucosal ulceration that occurs adjacent to
acid-producing, heterotopic gastric mucosa
– Intestinal obstruction (most common presentation in
adults)
• 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
– Diverticulitis (present in 20% of patients with
symptomatic Meckel's diverticula)
• Associated with a clinical syndrome that is indistinguishable from
acute appendicitis
7. Diagnosis
• Most Meckel's diverticula are discovered
incidentally on radiographic imaging, during
endoscopy, or at the time of surgery
• Investigative modalities
– CT-scan
– Enteroclysis
– Radionuclide scans (99mTc-pertechnetate)
8. Treatment
• Diverticulectomy with removal of associated bands
connecting the diverticulum to the abdominal wall or
intestinal mesentery
– Sometimes segmental resection of ileum might be required
• Until recently, most authors recommended against
prophylactic removal of asymptomatic Meckel's
diverticula, given the low lifetime incidence of
complications
– More recently, greater enthusiasm for prophylactic
diverticulectomy has appeared in the literature
