Hey all ! 😍 This presentation is About Meckel’s diverticulum. I hope it clears all your doubts . Thank you 😇

1. MECKEL’S DIVERTICULUM
- AJAY S

2. SYNOPSIS:
● Introduction
● Embryology
● Definition
● Salient Features
● Clinical Presentation
● Diagnosis
● Treatment

3. INTRODUCTION:
● Meckel’s diverticulum is the abnormality /
pathology in the last part of small intestine ( ie in
ileum ) and it is a congenital condition.
● It was reported initially in 1598 by Hildanus and
then described in detail by Johann Meckel in
1809.
● Diverticulum - an abnormal pouch or sac ,
opening from a hollow organ

4. EMBRYOLOGY

5. PRIMITIVE GUT : DEVELOPED GUT :

6. VITELLOINTESTINAL DUCT :
● Aka vitelline duct , yolk stalk ,
omphalomesenteric duct ,
omphaloenteric duct
● It connects midgut with yolk
sac.
● It appears at the end of 4th
week and disappears by 8th to
9th week of Intrauterine life
after the placenta replaces the
yolk sac.

7. What if vitellointestinal duct doesn’t obliterates (or)
disappears?
The failure to disappear completely or
any part of the duct doesn’t disappear it
will produce anomalies of vitellointestinal
duct . They are :
● Meckel’s diverticulum
● Umbilical sinus
● Umbilical ( vitelline fistula )
● Vitelline cyst

8. NORMAL ILEUM : ILEUM WITH MECKEL’S DIVERTICULUM:

9. Meckel’s diverticulum - Definition:
● A congenital anomaly in which a small
part of vitellointestinal duct persists
close to midgut ( ileum ) . It present as
an outpouching or bulge in the small
intestine (terminal / end of ileum) .
● It’s apex is usually free but sometimes
may be connected to anterior
abdominal wall by a fibrous cord ( the
obliterated remaining part of
vitellointestinal duct ) .

10. Salient features of Meckel’s diverticulum:
● Meckel's diverticulum is the most common congenital
defect of the Small intestine.
● Arises from antimesenteric border of the ileum.
● Contains all layers of bowel ( so it is called , TRUE
DIVERTICULUM )
● Meckel’s diverticulum has independent blood supply.
● A Meckel's diverticulum may ( in 20% cases ) contain
cells from both the stomach and pancreas (
HETEROTOPIC EPITHELIUM ) Cells from the
stomach can secrete acid, which can cause ulcers and
bleeding

12. Rule of 2 :
● 2% of population is affected
● 2 inches long
● 2 feet proximal from the ileocecal junction
● 2% of Meckel’s diverticulum patient will be symptomatic
● 2 types of epithelium ( heterotrophic ) in 20% of
population ( that is presence of gastric and pancreatic
type of epithelial cells )
● 2:1 ratio ( m:f )

13. Clinical presentation:
● Though 2% to 3% of the population gets
Meckel's diverticulum, it causes symptoms
in only a small number of those people .
● Majority of People can live their whole lives
without ever knowing they have Meckel's
diverticulum (Asymptomatic)
● Symptoms of Meckel's diverticulum usually
occur during the first year of a child's life (
<2 years of age ), but can occur into
adulthood.

14. The patient may present with :
● Gastrointestinal bleeding ( M/C Presentation )
● Meckel’s diverticulitis
● Perforated diverticulum
● Bowel obstruction due to mesodiverticular band
● Volvulus , intussusception of small bowel
● Littre's hernia
● Tumor

15. Gastrointestinal bleeding:
● Most common presentation .
● Lower GI hemorrhage and pain due to
gastric mucosa present in diverticulum
secretes acid which causes bleeding
and ulceration resulting in rectal bleed
or Malena.
● Management - self limiting usually but if
persists embolisation / diverticulectomy
( embolisation - procedure that blocks
or closes a specific blood vessel using
embolic agents like balloons or metallic
coils )

16. Meckel’s diverticulitis:
● Infection and inflammation of Meckel’s diverticulum
due to bacterial infection which can go on to
Gangrene .
● Mimics acute appendicitis.
● Seen in 20% cases and the patient presents with
abdominal pain in right lower quadrant and rectal
bleeding .
● Diagnosis- USG , CT
● Management- diverticulectomy

17. Perforated diverticulum:
● If perforated , peritonitis occurs.
● Management- Resection and
Anastomosis ( ileocolic anastomosis )

18. Bowel obstruction:
● Due to trapping of a bowel loop by
mesodiverticular band or due to
volvulus or due to intussusception.
● Mesodiverticular band - embryological
remnant of vitelline circulation which
carries the arterial supply to the Meckel's
diverticulum

19. VOLVULUS :
● Portion of small intestine may twist around
the Meckel’s diverticulum causing
compromised blood supply ( necrosis) and
bowel obstruction.
INTUSSUSCEPTION :
● When one part of the bowel ( here
Meckel’s diverticulum) slides into the next ,
much like a pieces of telescope.
● It may be ileoileal or ileocolic
intussusception.

20. Littre’s Hernia :
● Any hernia ( femoral or inguinal )
which contains Meckel’s diverticulum
as content in the hernial sac. It can
also cause bowel obstruction.
● Management- Resection of
diverticulum and herniorrhaphy (
surgical repair of hernia and the
weakness in the abdominal wall )

21. Tumor :
● Tumor can also occur in Meckel’s
diverticulum with Neuroendocrine Tumor (
NET ) or carcinoid Tumor is the most
common malignant tumor ( in 77% of cases )
● NET - Tumor arising from neuroendocrine
cells
● Neuroendocrine cells are cells that receive
neural input and, as a consequence of this
input, release messenger molecules
(hormones) into the blood. Eg : cells in
stomach , pancreas , pituitary etc ..

22. Diagnosis

23. ● Meckel's diverticulum can be difficult to diagnose
because many of the symptoms, such as vomiting,
abdominal pain, and tenderness, can occur in
several different conditions.
● 99mTc-pertechnetate scan - Radioactive
technetium is injected into the body. This
substance is absorbed by stomach cells in the
diverticulum and can be detect diverticulum
● Colonoscopy : A small, flexible tube with a camera
on the end is inserted into the rectum and colon to
look for blockages and the cause of bleeding.
● Small bowel enema / enteroclysis - x-ray
procedure that examines the small bowel using
Contrast material.

24. Treatment

25. ● Many adults who have Meckel's
diverticulum never have symptoms.
They learn they have the condition
only after it is noticed during surgery
or during tests for another condition (
incidental finding ). In this case,
Meckel's diverticulum usually does not
have to be treated.
● Surgical management - Meckel’s
diverticulectomy with or without
small bowel resection.

26. MECKEL’S DIVERTICULECTOMY :
Surgical removal of Meckel’s diverticulum and
after resection, suture the defect at its base or
join with a linear stapler cutter.
The INDICATIONS for surgery are ,
● When the base and mouth of diverticulum
is narrow
● Lengthy diverticulum
● Presence of adhesions or any fibrous band
like mesodiverticular band
● Symptomatic Patients ( or ) patients with
complications
● If it is found in children below 2 years.

27. Complications of Meckel’s diverticulectomy:
● Damage to nearby organs in the body.
● Wound infections or the wound breaks open after
surgery.
● The edges of your intestines that are sewn or
stapled together (anastomosis) may come open.
● The area where the intestines are sewn together
can scar and create blockage of the intestine.
● Blockage of the intestine may occur later from
adhesions caused by the surgery

28. Thank you