Meckel's diverticulum

Introduction

Meckel diverticulum is a common congenital abnormality

of the small intestine caused by incomplete obliteration of
the vitelline (omphalomesenteric) duct.It provides
nutrition until the placenta forms. At about 7 weeks of
gestation, the duct separates from the intestine.The
incomplete obliteration of the duct results in a
diverticulum in the small intestine.Meckel diverticulum
occurs in 2% of the population, 2% are symptomatic,
children are usually less than 2 years, affects males twice
as often as females, is located 2 feet proximal to the
ileocecal valve, is 2 inches long or less, and can have 2
types of the mucosal lining
 Pathophysiology

This congenital diverticulum arises from the

antimesenteric margin of the intestine and contains
all layers of the normal bowel and is thus a true
diverticulum. In less than 25% of patients, a Meckel
diverticulum also contains heterotopic tissue of the
stomach (and thus contains parietal cells that secrete
hydrochloric acid), pancreas, or both
Complications

Bleeding

Obstruction may be due to

-intussusception, adhesions
,volvulus,foreign bodies, tumors, hernia

Diverticulitis

Perforation

Tumors including carcinoid tumors are

rare and occur mainly in adults.
Complications

In children - rectal bleeding resulting in anemia

in adults is a small bowel obstruction

obstruction may be secondary to the

omphalomesenteric band, internal hernia, volvulus
around the vitelline duct remnants, and
intussusception.The diverticulum can become
inflamed, resulting in Meckel diverticulitis with
perforation and peritonitis.
Signs and symptoms

often asymptomatic and is found incidentally in imaging

studies.

If patients develop symptoms, they usually present in the first

10 years of life with an average age of 2.5 years with painless
rectal bleeding. The rectal bleeding is typically described as
currant jelly or the color of brick. Children typically present
with the classic “currant jelly” colored stool, while adults
typically present with melena. The bleeding usually resolves
without intervention. As the patient becomes hypovolemic,
the splanchnic vessels constrict to prevent further bleeding.it
is classically described as painless rectal bleeding, some
patients may present with abdominal pain with tenderness
below or adjacent to umbilicus followed by vomiting
Differential diagnosis

In infants, swallowed maternal blood from bleeding

nipples, milk protein allergy, intussusception, and
anal fissures can commonly cause rectal bleeding.
Necrotizing enterocolitis should be on the
differential in neonates and premature infants.

Other common causes of rectal bleeding in older

children include colitis, gastroenteritis, HSP, HUS,
intussusception, inflammatory bowel disease, and
vascular malformation.
Diagnosis and test

Technetium scan

Colonoscopy

Wireless capsule endoscopy

CT with oral contrast

Treatment/Management

If the patient has had significant blood loss, the patient

should undergo volume resuscitation. Patients may
require a blood transfusion if a significant amount of
blood is lost.

The treatment of symptomatic Meckel diverticulum is

surgical excision. The diverticulum can be removed via
laparoscopic or open technique.

The diverticulum should be excised along with the

adjacent ileum.