Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct that connects the fetal intestine to the umbilical cord. It is the most common congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the population. Meckel's diverticulum can occur anywhere along the small intestine but is usually located about 2 feet from the ileocecal valve. It often contains heterotopic or abnormal tissue such as gastric or pancreatic cells. Symptoms generally occur in children under 2 years of age and include bleeding, intestinal obstruction, or diverticulitis. Diagnosis can be made through scintigraphy or surgery is usually recommended for symptomatic cases.

1. Meckel’s
diverticulum

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

3. 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

4. Development

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

6.  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

7. Clinical Presentation
Mesodiverticular band

8.  Intestinal obstruction
 Hematochezia
 Appendicitis
 Intussusception
 Lower GI bleeding
 Angiodysplasias
 Malignancy
 Arteriovenous malformations
Differential diagnosis

9. Diagnosis
 Incidentally found
 99mTc-pertechnetate
scintigraphy
(ectopic gastric mucosa)

10. Indication for surgery
Symptomatic Meckel diverticulum
- hemorrhage
- intestinal obstruction
- diverticulitis
- umbilico-ileal fistulas

11. Indication for surgery
Incidentally 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

12. 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