Meckel Diverticulum

Question 1

What is the definition of meckel diverticulum?

Answer 1

Vestigial remnant of the vitello intestinal duct

Question 2

What % of the general population have this malformation?

Answer 2

1.2-2%

Question 3

How does a meckel diverticulum present?

Answer 3

It is an incidental finding and is asymptomatic

So presents with complications

Question 4

What are the complications of a meckel diverticulum?

Answer 4

Haemorrhage
Intestinal obstruction
Diverticulitis
Perforation
Umbilical anomalies
Neoplasm
Miscellaneous

Question 5

How common is a meckel diverticulum haemorrhage?

Answer 5

Accounts for 25-50% of all complications

More common in children <2years and males

Question 6

How does a meckel diverticulum haemorrhage present?

Answer 6

Bright red blood in stool
Range from mild recurrent episodes - large haemorrhage
Blood can be bright = brisk bleeding, darker = slower, or malaena/tarry stool = ulcerated gastric tissue

Question 7

What is the investigation of choice for a meckel diverticulum haemorrhage?

Answer 7

99Tc pertechnate scintigraphy

Question 8

How common is an intestinal obstruction due to a meckel diverticulum?

Answer 8

10-43% of symptomatic patients

Question 9

How does intestinal obstruction due to a meckel diverticulum present?

Answer 9

Abdo pain
Vomiting
Constipation

Question 10

What are the 2 ways that a meckel diverticulum causes obstruction?

Answer 10

Diverticula attaches to abdo wall with fibrotic band –> small bowel volvulus
Intussusception with diverticulum as lead point

Question 11

What investigation is done for obstruction caused by a meckel diverticulum?

Answer 11

Operation reveals diagnosis

Question 12

How does diverticulitis from a meckel diverticulum present?

Answer 12

Diarrhoea
Abdo cramps
Periumbilical tenderness

These can cause adhesions –> obstruction

Question 13

When does perforation of a meckel diverticulum occur?

Answer 13

Spontaneously

Due to a foreign body e.g. fish bone

Question 14

What sort of umbilical anomalies can occur in a meckel diverticulum and where do they occur?

Answer 14

Fistulas
Cysts
Sinuses
Fibrous bands
Between diverticulum and umbilicus

Question 15

What features of the history would suggest umbilical anomalies with a meckel diverticulum?

Answer 15

Recurrent infection
Chronic sinus formation
Abscess in abdo wall

Question 16

How common is a neoplasm associated with a meckel diverticulum?

Answer 16

0.5-5% of complications

Question 17

How is a neoplasm associated with a meckel diverticulum investigated?

Answer 17

Scintigraphy
CT scan
Barium studies

Question 18

What other ‘miscellaneous’ complications can occur with a meckel diverticulum?

Answer 18

Stone formation
Vesicodiverticular fistulas
Daughter diverticula = formation of diverticulum within

Question 19

What is the management for a meckel diverticulum?

Answer 19

Appropriate management of complications

Question 20

Which complications require surgical resection?

Answer 20

Haemorrhage
Diverticulitis
Intestinal obstruction
Umbilico-ileal fistulas

Question 21

When do further complications tend to occur with a meckel diverticulum and how common are they?

Answer 21

Post-operatively

2-7% chance

Question 22

What further complications could occur from a meckel diverticulum?

Answer 22

Ileus
Intra-abdominal abscess
PE
Adhesions –> obstruction

Question 23

What is the prognosis of a meckel diverticulum?

Answer 23

Good if treatment is timely