MECKEL’S DIVERTICULUM

 embryological remnant
o vitelline duct connects yolk sac to gut in developing embryo
(provides nutrition until the placenta develops)
o involutes by week 7
o remnants = meckel’s diverticulum or persistent vitelline duct
 lining = ectopic gastric mucosa → acid secretion → ulceration

2% of population (most frequent congenital anomaly)

2 feet from the ileocaecal valve
2 inches in length
presents < 2yrs

Clinically
can present any time in the first decade – usually in the first 2 years
spectrum of presentations:
intermittent painless rectal bleeding ‘brick red’ or ‘currant jelly’
o can be maelena or acute rectal bleeding
o anaemia
o usually occurs <5yrs
bowel obstruction (eg intra-abdo bands)
intussusception (lead point)
diverticulitis (inflammation) → abdominal pain → may perforate
perforation/ peritonitis
peptic ulceration with ileal perforation

Investigations
bowel obstruction: no investigation helpful - plain AXR/barium meal not helpful
diagnosis made at surgery
painless rectal bleeding then: Meckel’s scan (Tc99 uptake by acid secreting cells)
o sensitivity 85% (don’t all have gastric mucosa)
 if don’t have gastric mucosa tend not to bleed!
 ↑ with ranitidine (↓ false –ves)
o specificity 95%
red cell labeled scans/ angiography

Treatment
surgical excision