Meckel Diverticulum

Key Features

• Most common form of omphalomesenteric duct remnant

• Usually located on the antimesenteric border of the mid to distal ileum

• Occurs in 1.5% of the population

• Familial cases have been reported

• If complications occur, they are three times more common in males than in females

Clinical Findings

• Asymptomatic is most cases

• Forty to 60% of symptomatic patients have painless episodes of maroon or melanotic rectal bleeding

• Bleeding may be voluminous enough to cause shock and anemia

• Occult bleeding is less common

• Intestinal obstruction occurs in 25% of symptomatic patients as a result of ileocolonic intussusception

• Intestinal volvulus may occur around a fibrous remnant of the vitelline duct extending from the tip of the diverticulum to the abdominal wall

• Meckel diverticula may be trapped in an inguinal herni

• Diverticulitis is clinically indistinguishable from acute appendicitis

Diagnosis

• Diagnosis of Meckel diverticulum is made with a Meckel scan

• Technetium-99 (^99mTc)-pertechnetate

  • Taken up by the heterotopic gastric mucosa in the diverticulum

  • Outlines the diverticulum on a nuclear scan

  • Sensitivity of test can be increased by giving pentagastrin or cimetidine before ^99mTc-pertechnetate

Treatment

• Surgical