Meckel's diverticulum is a congenital diverticulum that arises from the terminal ileum due to incomplete closure of the vitellointestinal duct during fetal development. It is the most common congenital anomaly of the small intestine. Symptomatic cases typically present with severe hemorrhage in children under 2 years old. A technetium scan is a useful diagnostic tool to detect Meckel's diverticulum, including cases with minimal bleeding. Treatment involves resection of the affected segment of ileum containing the 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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