Meckel Diverticulum Flashcards
What is the definition of meckel diverticulum?
Vestigial remnant of the vitello intestinal duct
What % of the general population have this malformation?
1.2-2%
How does a meckel diverticulum present?
It is an incidental finding and is asymptomatic
So presents with complications
What are the complications of a meckel diverticulum?
Haemorrhage Intestinal obstruction Diverticulitis Perforation Umbilical anomalies Neoplasm Miscellaneous
How common is a meckel diverticulum haemorrhage?
Accounts for 25-50% of all complications
More common in children <2years and males
How does a meckel diverticulum haemorrhage present?
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
What is the investigation of choice for a meckel diverticulum haemorrhage?
99Tc pertechnate scintigraphy
How common is an intestinal obstruction due to a meckel diverticulum?
10-43% of symptomatic patients
How does intestinal obstruction due to a meckel diverticulum present?
Abdo pain
Vomiting
Constipation
What are the 2 ways that a meckel diverticulum causes obstruction?
Diverticula attaches to abdo wall with fibrotic band –> small bowel volvulus
Intussusception with diverticulum as lead point
What investigation is done for obstruction caused by a meckel diverticulum?
Operation reveals diagnosis
How does diverticulitis from a meckel diverticulum present?
Diarrhoea
Abdo cramps
Periumbilical tenderness
These can cause adhesions –> obstruction
When does perforation of a meckel diverticulum occur?
Spontaneously
Due to a foreign body e.g. fish bone
What sort of umbilical anomalies can occur in a meckel diverticulum and where do they occur?
Fistulas Cysts Sinuses Fibrous bands Between diverticulum and umbilicus
What features of the history would suggest umbilical anomalies with a meckel diverticulum?
Recurrent infection
Chronic sinus formation
Abscess in abdo wall
How common is a neoplasm associated with a meckel diverticulum?
0.5-5% of complications
How is a neoplasm associated with a meckel diverticulum investigated?
Scintigraphy
CT scan
Barium studies
What other ‘miscellaneous’ complications can occur with a meckel diverticulum?
Stone formation
Vesicodiverticular fistulas
Daughter diverticula = formation of diverticulum within
What is the management for a meckel diverticulum?
Appropriate management of complications
Which complications require surgical resection?
Haemorrhage
Diverticulitis
Intestinal obstruction
Umbilico-ileal fistulas
When do further complications tend to occur with a meckel diverticulum and how common are they?
Post-operatively
2-7% chance
What further complications could occur from a meckel diverticulum?
Ileus
Intra-abdominal abscess
PE
Adhesions –> obstruction
What is the prognosis of a meckel diverticulum?
Good if treatment is timely
