Meckel's diverticulum

Meckel's diverticulum is a congenital malformation of the gastrointestinal tract. It is a true diverticulum, meaning it is composed of all three layers of the bowel wall, and is a remnant of the omphalomesenteric duct (also known as the vitelline duct or yolk stalk). It is the most common congenital malformation of the gastrointestinal tract and is present in approximately 2% of the population.

Anatomy

Meckel's diverticulum is located on the anti-mesenteric border of the ileum, approximately 2 feet proximal to the ileocecal valve. The size of the diverticulum varies, but it is typically 2 inches long and 2 cm in diameter. The diverticulum may contain ectopic tissue, most commonly gastric and pancreatic.

Pathophysiology

The pathophysiology of Meckel's diverticulum is related to its potential to develop complications. These include bleeding, obstruction, inflammation, and perforation. Bleeding is the most common complication in children and is due to the presence of ectopic gastric mucosa, which secretes acid that can cause ulceration of the adjacent ileal mucosa. Obstruction is the most common complication in adults and can occur due to intussusception, volvulus, or a band of adhesions.

Clinical presentation

The clinical presentation of Meckel's diverticulum is variable and depends on the age of the patient and the type of complication. In children, the most common presentation is painless rectal bleeding, which can be massive. In adults, the most common presentation is intestinal obstruction, which can manifest as abdominal pain, vomiting, and constipation.

Diagnosis

The diagnosis of Meckel's diverticulum can be challenging due to its variable presentation and the lack of specific symptoms. The gold standard for diagnosis is technetium-99m pertechnetate scintigraphy (Meckel's scan), which detects the ectopic gastric mucosa. Other diagnostic modalities include ultrasound, computed tomography, and magnetic resonance imaging.

Treatment

The treatment of Meckel's diverticulum depends on the presence and type of complications. Asymptomatic diverticula in adults are typically managed conservatively, while symptomatic diverticula and all diverticula in children are usually treated surgically. The surgical options include diverticulectomy, segmental resection, and laparoscopic surgery.

See also

• Gastrointestinal tract
• Congenital disorders
• Diverticulum
• Intestinal obstruction
• Rectal bleeding

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