GI - Meckel Diverticulum

Question 1

Defintion

Answer 1

Congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct (also called the Vitelli intestinal duct)

Question 2

Epidemiology

Answer 2

Commonest congenital malformation of the small bowel
Typically presents in infants and toddlers

Question 3

Rules of 2s

Answer 3

2% of the population
2 feet from the ileocaecal valve
2 inches long

Question 4

Risk factors

Answer 4

None

Question 5

Pathophysiology

Answer 5

During embryonic development, the omphalomesenteric duct connects the developing intestine to the yolk sac. Normally, this duct obliterates and disappears by the 7th to 9th week of gestation. However, in cases of Meckel’s diverticulum, the duct fails to completely close and persists as a small pouch or diverticulum.

Meckel’s diverticulum may contain heteroptic tissue = gastric mucosa (MC) or pancreatic and small intestinal mucosa.

Question 6

Symptoms

Answer 6

Usually asymptomatic
Abdo pain mimicking appendicitis
Painless rectal bleeding (Meckel’s diverticulum = MC cause of painless massive GI bleeding requiring a transfusion in children between ages 1-2 years)
Intestinal obstruction - secondary to an omphalomesenteric band (mc), volvulus and intussusception
Nausea and vomiting
Abdominal tenderness

Question 7

Investigations

Answer 7

FIRST LINE = CT Abdo
Meckels scan = if child haemodynamically stable with less severe bleeding
- uses 99m technetium pertechnetate - has an affinity of gastric mucosa

Other: mesenteric angiography

Question 8

Treatment

Answer 8

Treat clinical presentaton appropriately
Resection of the diverticulum

Question 9

Complications

Answer 9

Intussusception
Obstruction
Perforation