Meckel Diverticulum Flashcards
A 13-month-old child is admitted to the hospital with lower GI bleeding. Which of the following is correct regarding the most common cause of lower GI bleeding in this patient?
A. Heterotopic pancreatic mucosa is likely to be the cause of bleeding.
B. The bleeding source is most commonly found on the mesenteric side of the intestine.
C. The most common location of the bleeding source is in the jejunum.
D. This problem is not likely to be confused with acute appendicitis.
E. It is a result of an incomplete closure of the omphalomesenteric duct.
ANSWER: E
COMMENTS: Meckel’s diverticulum results from an incomplete closure of the omphalomesenteric duct during development, resulting in a true diverticulum, which contains all layers of the intestinal wall.
Meckel’s diverticula account for 50% of lower GI bleeding in the pediatric population.
They are located on the antimesenteric side of the intestine.
There is an equal distribution among genders.
The rule of 2’s states that Meckel’s diverticulum usually presents by the age of 2, is 2 ft from the ileocecal valve, occurs in 2% of the population, and may contain 1 of the 2 types of heterotopic mucosa.
Gastric mucosa is the most common heterotopic mucosa present.
It may lead to ulcer formation just distal to the diverticulum with painless bleeding.
It has been estimated that 80% of bleeding Meckel’s diverticula contain heterotopic gastric mucosa.
Pancreatic mucosa is the next most common; however, it is not as commonly associated with bleeding.
Other manifestations of Meckel’s include an obstruction or intussusception, with the diverticulum acting as the lead point.
Symptomatic Meckel’s should be surgically excised, either with a diverticulectomy or bowel resection and anastomosis.
Diverticulitis within a Meckel’s can mimic acute appendicitis.
During a negative exploration for presumed appendicitis, the small bowel should be run to rule out a Meckel’s diverticulum, other small bowel diverticulosis, and Crohn’s disease.
What is the vitelline duct?
The vitelline duct, also known as the omphalomesenteric duct, is the embryonic structure that connects the extracoelomic yolk sac with the developing midgut.
When does the vitelline/ omphalomesenteric duct regress?
The regression of this embryonic duct occurs between weeks 5 and 9 of fetal development [2].
What are the potential remnants of the vitelline/omphalomesenteric duct if complete regression does not occur?
If complete regression of the vitelline duct does not occur, several different remnants are possible.
These remnants include Meckel’s diverticulum, omphalomesenteric cyst, congenital band, umbilical sinus and omphalomesenteric duct fistula.
If present, they usually occur in isolation; however, case reports of more than one anomaly have been described.
The most common remnant is Meckel’s diverticulum [3].
How do these remnants present in pediatric patients?
Most of these remnants are asymptomatic and remain that way for a lifetime.
If symptoms present, they are directly related to the portion of the vitelline duct that remains.
Meckel’s diverticulum can present with painless bloody stools, abdominal pain mimicking appendicitis, or symptoms of intestinal obstruction.
Omphalomesenteric duct cysts can present with abdominal pain, abdominal wall cellulitis or umbilical drainage.
A congenital band usually presents with symptoms of intestinal obstruction.
Umbilical sinus presents with umbilical drainage or umbilical cellulitis.
In the case of an omphalomesenteric duct fistula, intestinal contents can be noted at the umbilicus in the newborn.
How does intestinal obstruction occur in patients with Meckel’s diverticulum?
There are several different underlying etiologies for intestinal obstruction in Meckel’s diverticula.
In pediatric patients, a congenital band may attach to the Meckel’s which serves as a fixed point around which intestinal volvulus can occur.
An internal hernia may be formed from bands between the Meckel’s and surrounding mesentery.
The Meckel’s can serve as a lead point for intussusception.
More uncommonly, chronic inflammation secondary to diverticulitis may cause an intestinal stricture.
Perforation with adjacent abscesses may also cause obstruction or ileus [4].
A foreign body may be lodged in the Meckel’s or it may become incarcerated in a hernia defect, called a Littre hernia.
What are the “rule of 2′s” as they relate to Meckel’s diverticulum?
In general, Meckel’s diverticula occur in 2% of the population, 2% are symptomatic, they are 2 feet from the ileocecal valve, most are approximately 2 inches in length, they can contain 2 types of heterotopic mucosa (gastric and pancreatic) and most are symptomatic before the age of 2.
Meckel’s diverticula occur 2:1 in males versus females.
What imaging modalities are recommended to diagnose Meckel’s diverticula or other vitelline/omphalomesenteric duct remnants?
In addition to a quality physical examination, imaging can be utilized to assist in making the diagnosis of these remnants.
In cases of intestinal obstruction, abdominal flat and decubitus plain films may be the only imaging obtained preoperatively.
CT scan or MRI may assist in diagnosing a vitelline duct remnant as the source of symptoms, but many cases of obstruction are not fully delineated until the operating room.
A Meckel’s scan can assist in diagnosing a Meckel’s diverticulum.
Abdominal ultrasonography can diagnose omphalomesenteric duct cysts [4].
What is a Meckel’s scan?
The Meckel’s scan is a technetium-99m (Tc99m)-pertechnetate scintigraphy study.
Tc99m accumulates in the parietal cells of ectopic gastric mucosa within the diverticulum.
The sensitivity is 85% and specificity is 95% [4].
What pharmacologic adjuncts can be used to improve the sensitivity of the Meckel’s nuclear medicine scan?
Diagnostic accuracy of the Meckel’s scan has been improved with pentagastrin, histamine-2-blockers and glucagon [4].
What is the treatment recommendation for symptomatic Meckel’s diverticula?
Symptomatic Meckel’s diverticula are treated with surgical resection in all cases.
This involves open or minimally-invasive approaches to diverticulectomy versus segmental small intestinal resection.
What is the appropriate operation for a symptomatic Meckel’s?
As mentioned above, symptomatic Meckel’s diverticula require surgical resection.
This resection can be performed in an open or laparoscopic fashion.
In the absence of significant inflammation or intestinal wall thickening, an isolated diverticulectomy stapled or handsewn is sufficient.
It is important to note that in a minority of patients, ectopic tissue may be present in the base of the diverticulum and this area may not feel abnormal.
Segmental small intestine resection may be required if the diverticulum has resulted in significant surrounding inflammation, intestinal thickening at the diverticulum’s base or if there is concern for bleeding ulcerations in the remaining small intestine.
What should be done with an asymptomatic Meckel’s diverticulum discovered incidentally at the time of surgery for a different indication?
Incidental removal of an asymptomatic Meckel’s diverticulum is controversial.
Zani and colleagues noted a low lifetime mortality risk in patients.
Additionally, they noted a higher postoperative complication rate than morbidity rate of Meckel’s diverticulum left in situ.
By their calculations, nearly 800 Meckel’s would need to be removed to prevent one mortality.
Park and colleagues reviewed a large, retrospective series of patients of all ages at the Mayo Clinic with Meckel’s diverticula of which 16% were symptomatic.
They recommend considering selective excision of asymptomatic Meckel’s in patients less than 50 years of age, male patients, diverticula with a length greater than 2 cm or those containing abnormal/ectopic tissue [5, 6].
Regarding presentation of vitellointestinal duct anomalies, the following are false except:
A. Presents as intestinal obstruction when ectopic gastric mucosa.
B. Presents with melena when there is Meckel’s diverticulum with band.
C. Presents with abdominal pain, mass and redcurrant jelly in stool when patent intestinal duct.
D. Presents with shiny, spherical and deep nodule in the depth of umbilical cicatrix, when prolapse of patent vitellointestinal tract.
E. Presents with features of appendicitis, when there is diverticulitis.
E
Ectopic gastric mucosa presents with bleeding, bands presents with intestinal obstruction. Meckel’s diverticulum that leads to intussusception, presents with abdominal pain, mass, and red currant jelly in stool. Patent vitellointestinal duct presents with passage of air and faeces from umbilicus. Shiny, spherical red nodule is a feature of umbilical polyp (ectopic mucosa at umbilicus). Meckel’s diverticulitis presents with abdominal pain, vomiting, and fever. On examination, tenderness in right lower abdomen. These features are the same as appendicitis.
What type of discharge at umbilicus in patent/persistent vitellointestinal duct?
A. Air and faeces.
B. Pus.
C. Blood.
D. Urine.
E. Gastric contents.
A. Air and faces
Blood is noted in umbilical polyp and urine is seen in patient urachus.
Regarding skin incision in different vitellointestinal duct anomalies, which of the following is the best answer?
A. Supra-umbilical transverse incision.
B. Infra-umbilical transverse incision.
C. Incision at the level of umbilicus.
D. All of the above.
E. None of the above.
D. Skin incision depends upon features and type of presentation.
When vitellointestinal duct anomaly presents with feature of band or intussusception, supraumbilical transverse incision is preferred.
When presents with features of diverticulitis or ectopic gastric mucosa (melena), infra-umbilical incision is preferred.
When presents with patient vitellointestinal duct (fistula) then make an incision at the level of the umbilicus or an infra umbilical curved incision.
Regarding urachus, all are true except:
A. Connects midgut to yolk sac.
B. Normally obliterates.
C. Remnant forms median umbilical ligaments.
D. Pathological conditions includes patent urachus, sinus and cyst.
E. If not obliterated, leads to urine discharge from umbilicus.
A.
Urachus connects bladder to allantois. Omphalomesenteric duct connects mid-gut to yolk sac.
Remnant of structures related to development of umbilicus, which of the following is false?
A. Falciform is the remnant of the umbilical vein.
B. Lateral umbilical ligament is the remnant of the omphalomesenteric vein.
C. Meckel’s diverticulum is the remnant of the omphalomesenteric duct.
D. Median umbilical ligament is the remnant of the urachus.
E. Fibrous band to the umbilicus is the remnant of the omphalomesenteric arteries.
B
Lateral umbilical ligament is remnant of umbilical arteries.
Uses of umbilicus include all except:
A. Cannula for umbilical vein.
B. Site for laparoscopic equipment.
C. Incision site for pyloromyotomy.
D. Exit site for stoma and urinary diversion.
E. All of the above.
E
All of the above are uses of umbilicus
Syed/MCQ
Regarding Meckel’s diverticulum, which of the following is true?
A. It is an uncommon congenital anomaly of GIT.
B. It is caused by regression of vitelline duct.
C. Blood supply is from paired vitelline arteries that originate from the aorta.
D. Pancreatic mucosa is more commonly found than gastric mucosa.
E. May develop Richter’s hernia.
C
Meckel’s diverticulum is the most common anomaly of GIT caused by failure of regression of vitellin duct. The rich blood supply to the diverticulum is provided by the vitelline artery, which is a branch of the superior mesenteric artery. Among heterotopic mucosa, gastric mucosa is more commonly found than pancreatic mucosa. If Meckel’s diverticulum goes in hernia sac, it is called Littre’s hernia.
Syed/MCQ
Regarding Meckel’s diverticulum, which of the following is false?
A. Two percent incidence.
B. Two types of heterogeneous mucosa.
C. Located within two inches of ileocecal valve.
D. About two inches in length.
E. Usually symptomatic within two years of age.
C
Meckel’s diverticulum is usually located within two feet of ileocecal valve.
Syed/MCQ
Regarding the use of Technetium scan in detecting Meckel’s diverticulum, which of the following is false?
A. It is useful in detecting heterogeneous gastric mucosa.
B. Sensitivity is less than specificity.
C. Glucagon decreases the efficacy of scanning.
D. Nasogastric suction and catheterization may increase the yield of scanning.
E. False positive results may be due to duplication cyst.
C
Glucagon, pentagastrin, and histamine blockers increase the accuracy of scanning. False positive results may be due to duplication cysts, gastro-genic cysts, ulcers, inflammatory bowel disease, bowel obstruction, and neo plasm.
Regarding management of Meckel’s diverticulum, which of the following is false?
A. After excision of diverticulum, having two layer closure of ileum is preferable.
B. The feeding artery should be ligated.
C. If carcinoid has developed, there is greater potential for metastasis than for appendicular carcinoid.
D. In case of carcinoid development, aggressive surgical management of tumours larger than 5 cm is recommended.
E. If left intact, the lifetime risk of complication is 2 percent.
E
If left intact, the lifetime risk of complication of Meckel’s diverticulum is 6.4%.
Syed/MCQ
Regarding the use of Technetium scan in detecting Meckel’s diverticulum, which of the following is false?
A. It is useful in detecting heterogenous gastric mucosa.
B. Sensitivity is less than specificity.
C. Glucagon decreases the efficacy of scanning.
D. Nasogastric suction and catheterization may increase the yield of scanning.
E. False positive results may be due to duplication cyst.
C
Glucagon, pentagastrin, and histamine blockers increase the accuracy of scanning. False positive results may be due to duplication cyst, gastro-genic cyst, ulcers, inflammatory bowel disease, bowel obstruction and neoplasm.
Syed/MCQ
Regarding the management of Meckel’s diverticulum, which of the following is false?
A. After excision of diverticulum, having two layer closure of ileum is preferable.
B. The feeding artery should be ligated.
C. If carcinoid has developed, there is greater potential for metastasis than for appendicular carcinoid.
D. In case of carcinoid development, aggressive surgical management of tumors larger than 5cm is recommended.
E. If left intact, the lifetime risk of complication is 2 percent.
E
If left intact the lifetime risk of complication of Meckel’s diverticulum is 6.4 percent.
Syed/MCQ
What is the rule of 2s regarding Meckel diverticulum?
The commonly cited “rule of 2s” regarding the diverticulum is:
- occurs in 2% of the population
- has a 2:1 male-to-female ratio
- usually discovered by 2 years of age
- located 2 feet (60 cm) from the ileocecal valve
- commonly 2 cm in diameter and 2 inches (5 cm) long, and
- can contain two types of heterotopic mucosa
Gastric is the most common type of heterotopic mucosa, followed by pancreatic.
More rarely, it may contain duodenal, colonic, or endometrial tissue.
Which of the following is true regarding the development of Meckel’s diverticulum?
A Extracoelomic yolk sac forms the gut.
B The fetal foregut is attached to the yolk sac via the omphalomesenteric duct.
C The right vitelline artery remnant supplies the diverticulum.
D It is located on the mesenteric border of the small bowel.
E It is not a true diverticulum.
C
The intracoelomic yolk sac forms the gut. The fetal midgut is attached to the yolk sac via the omphalomesenteric duct (also known as vitelline duct or yolk stalk).
This regresses at 5–7 weeks’ gestation.
meckel’s diverticulum results from failure of proximal duct to obliterate.
The right and left vitelline arteries originate from the aorta within the yolk stalk. The left involutes and the right persists as the superior mesenteric artery and terminally supplies the diverticulum.
meckel’s diverticulum is a true diverticulum (containing all normal layers of the intestinal wall) located on the antimesenteric border of the small bowel.
SPSE 1
Omphalomesenteric duct anomalies include all of the following except:
A omphaloileal fistula
B umbilical polyp
C patent vitelline sinus
D vitelline duct cyst
E patent urachus.
E
meckel’s diverticulum is the most common vitelline duct (omphalomesenteric duct) abnormality.
Abnormal regression of the vitelline duct can also give rise to other abnormalities.
● Persistent vitelline duct: appearing as a draining fistula at the umbilicus.
● Patent vitelline sinus: can be a source of infection with purulent discharge. It can be connected to the meckel’s diverticulum, by a fibrous band around which volvulus can occur.
● Fibrous band connecting the ileum to undersurface of the umbilicus:
can cause obstruction or volvulus.
● Vitelline duct cyst: mucosal and muscular lined cyst, which persists after the proximal and distal duct obliterates.
● umbilical polyp: most are independent anomalies, although some can connect with deeper structures. Sometimes they can be mistaken for umbilical granulomas.
● omphaloileal fistula: persistent patency of the vitelline duct with the fetal intestine.
A urachus is a fibrous cord that originates from the allantois and extends from the bladder to the umbilicus.
Abnormal obliteration and regression of the urachus gives rise to various abnormalities, unrelated to vitelline duct abnormalities.
SPSE 1
Which of the following is true regarding the incidence of Meckel’s diverticulum?
A It is twice as common in females as in males.
B It commonly occurs 2 feet away from the ligament of Treitz.
C It is 2 cm long.
D It contains two main types of heterotopic mucosa – namely, gastric and pancreatic.
E All of the above.
D
The ‘rule of 2s’ is often used as a mnemonic for meckel’s diverticulum:
● occurs in 2% of the population
● twice as common in males as in females
● usually located 2 feet from ileocaecal valve
● 2 inches long
● 2 cm in diameter
● symptomatic by 2 years of age
● contains two types of heterotopic tissue – gastric and pancreatic.
male-to-female ratio is almost equal in asymptomatic group, but in symptomatic group males > females.
most cases become symptomatic within first 2 years. Approximately 60%–85% of heterotopic mucosa is gastric and 5%–16% is pancreatic. other mucosa like colonic, endometrial and pancreatic islet are quite rare.
SPSE 1
There is an increased incidence of the following associations with Meckel’s diverticulum except:
A oesophageal atresia
B Hirschsprung’s disease
C cardiovascular malformations
D Down’s syndrome
E urachal anomalies.
E
most cases of meckel’s diverticulum are sporadic. There is an increased incidence with other anomalies such as:
● oesophageal atresia
● duodenal atresia
● imperforate anus
● omphalocele
● malrotation
● Hirschsprung’s disease
● Down’s syndrome
● congenital diaphragmatic hernia
● congenital neurologic conditions
● cardiovascular malformations.
Concomitant urachal and omphalomesenteric duct anomalies are rare.
The presence of meckel’s diverticulum does not justify a search for other anomalies as <5% have associated anomalies.
There has been a high incidence of incidental finding of meckel’s diverticulum with Crohn’s disease (6%), but the presence of heterotopic mucosa in these cases is extremely rare.
SPSE 1
Which of the following is true of clinical presentation of Meckel’s diverticulum?
A The type of presentation correlates with age.
B Painful rectal bleeding is the most common presentation.
C Occult bleeding with anaemia is a common feature.
D Haematemesis is a common presentation.
E Helicobacter pylori is a common causative agent for ulceration and bleeding.
A
most patients with meckel’s diverticulum are asymptomatic. Approximately 4%–16% of patients have related symptoms.
The most common signs and symptoms of meckel’s diverticulum are bleeding, obstruction and inflammation. The type of presentation correlates with age.
Intestinal obstruction due to volvulus or intussusception is the most typical presentation in newborns.
In older infants and younger children, painless lower gastrointestinal bleeding is common.
older children usually present with inflammation mimicking appendicitis.
Children are more likely to be symptomatic than adults.
In adults inflammation and obstructive symptoms are common. Bleeding is generally painless, episodic and sometimes massive. occult bleeding with anaemia is rare.
H. pylori is rarely identified in the heterotopic gastric mucosa of a bleeding meckel’s diverticulum. This could be because of the bile salt toxicity, which affects the H. pylori microorganism.
SPSE 1
Possible mechanisms for intestinal obstruction seen with Meckel’s diverticulum include all except:
A intussusception
B volvulus
C prolapse through patent vitelline duct
D Littre’s hernia
E ectopic gastric mucosa.
E
The most common cause of intestinal obstruction secondary to meckel’s diverticulum is intussusception.
meckel’s diverticulum acts as a pathological lead point and should be suspected in all cases of intussusception occurring in older children (>5 years).
Pneumatic reduction in these cases is usually unsuccessful and the meckel’s diverticulum is identified at the time of bowel resection.
other mechanisms of intestinal obstruction include volvulus, inflammation, meckel’s diverticulum incarcerated in an inguinal hernia (littre’s hernia) and, rarely, prolapse through a patent vitelline duct.
Volvulus can occur because of persistent vascular or vitelline remnants from the bowel or diverticulum attached to the abdominal wall allowing twisting, kinking or herniation.
A giant meckel’s diverticulum can also cause volvulus in newborns.
Ectopic gastric mucosa seen with meckel’s diverticulum usually causes bleeding and ulceration.
SPSE 1
Which of the following pathologies can occur with Meckel’s diverticulum?
A foreign body
B stones
C carcinoid tumour
D carcinoid syndrome
E all of the above
E
Approximately 5% of patients with symptomatic meckel’s diverticulum present with umbilical abnormalities.
They could manifest as an umbilical polyp, a persistent umbilical sinus connecting to the meckel’s diverticulum or an omphaloileal fistula.
Rarely foreign bodies, stones and parasitic infections such as ascariasis or schistosomiasis have been reported within a meckel’s diverticulum. These can cause inflammation or can perforate through the diverticulum.
Carcinoid tumours are more often seen in adults and are relatively aggressive. Tumours larger than 5 mm have a significant risk for metastasis. Carcinoid syndrome can also occur with meckel’s diverticulum.
SPSE 1
Which of the following factors is not associated with an increased risk of developing complications from Meckel’s diverticulum?
A age <40 years
B male sex
C presence of heterotopic mucosa
D diverticular length >2 cm
E association with Crohn’s disease
E
The lifetime risk of complications developing from an incidentally diagnosed meckel’s diverticulum ranges from 4.2% to 6.4%.
The incidence of complications decreases with advancing age.
Factors associated with increased likelihood of complications include age younger than 40 years, male sex, presence of heterotopic mucosa and diverticular length >2 cm.
most cases of meckel’s diverticulum associated with Crohn’s disease are incidental findings at the time of hemicolectomy for Crohn’s disease.
The incidence of heterotopic mucosa seen with patients with Crohn’s disease is very rare.
SPSE 1
Regarding investigations for Meckel’s diverticulum, which of the following is true?
A Technetium-99m (99m Tc) scan is indicated in all cases of Meckel’s diverticulum.
B Intestinal duplications can give rise to a positive 99m Tc scan.
C Fasting decreases the yield of 99m Tc scan.
D Selective angiography can detect a Meckel’s diverticulum only in the presence of active bleeding.
E When used, barium enema should always be performed before a 99m Tc scan.
B
99m Tc pertechnetate scintiscan is useful when meckel’s diverticulum is complicated with episodes of bleeding.
Because this scan is specific for gastric mucosa (in the stomach or ectopic) and not specifically diagnostic of meckel’s diverticulum, positive results can occur in other conditions where ectopic gastric mucosa is present.
Duodenal ulcers, small intestinal obstruction, intestinal duplications, ureteric obstruction, aneurysms and angiomas of the small intestine yield false positive results.
False-negative results can occur when gastric mucosa is very slight or absent in the diverticulum, if necrosis of the diverticulum has occurred or if meckel’s diverticulum is superimposed on the bladder.
The sensitivity is 80%–90%, specificity is 95% and accuracy is 90% for meckel’s diverticulum.
Pentagastrin, histamine blockers and glucagons may enhance the accuracy of scanning. likewise fasting, nasogastric suction and bladder catheterisation may increase the yield of scanning.
Barium study has a low diagnostic yield and is not routinely used. If performed, it should never precede 99m Tc scintiscan, because barium may obscure the hot spot.
Selective arteriography may be helpful in patients in whom the results from scintiscan and barium studies are negative. They can detect a meckel’s diverticulum even in the absence of bleeding.
SPSE 1
Which of the following is true regarding treatment of Meckel’s diverticulum?
A In cases of bleeding, a Meckel’s diverticulectomy is the procedure of choice.
B All cases of Meckel’s diverticulum require surgical resection.
C Elective removal of Meckel’s diverticulum can result in adhesive bowel obstruction in 5%–10% of cases.
D Only symptomatic cases of Meckel’s diverticulum need surgical resection.
E Meckel’s diverticulum associated with intussusception do not need surgical removal.
C
The treatment for meckel’s diverticulum is either a simple diverticulectomy or small-bowel resection with end-to-end anastomosis.
Incidental appendicectomy is usually performed.
The definitive treatment of complicated meckel’s diverticulum such as bleeding is by excision of the diverticulum along with adjacent ileal segment either using a stapling device of by hand-sewn anastomosis, which can also be accomplished laparoscopically.
The ectopic gastric mucosa may extend along the adjacent ileum as well, on the mesenteric side opposite the ileum.
Hence, in cases of bleeding, resection of a segment of adjacent ileum with end to-end anastomosis is a safer option.
A persistent right vitelline artery supplying the diverticulum is sometimes found during operation and must be identified and ligated.
The role of elective removal of asymptomatic meckel’s diverticulum is still controversial. The most common complication following elective removal of meckel’s diverticulum is adhesive bowel obstruction in 5%–10% of cases.
In cases of intussusception secondary to meckel’s diverticulum, complete reduction with pneumatic or contrast enema is attempted followed by elective excision of meckel’s diverticulum. However, complete reduction is usually unsuccessful, and the diverticulum is often detected at the time of bowel resection.
SPSE 1
Indications for elective resection of incidentally discovered Meckel’s diverticulum are:
A palpable thickening suggestive of heterotopic mucosa
B history of unexplained abdominal pain
C in patients with abdominal wall attachments
D in children less than 8 years old
E all of the above
E
management of asymptomatic meckel’s diverticulum is controversial. In the past, if meckel’s diverticulum was encountered in patients undergoing abdominal surgery, many surgeons recommended its removal. This has now been questioned given the overall likelihood of developing complications around 4.2%–6.4% and a decreasing risk with increasing age.
A large number of meckel’s diverticulums would have to be excised to prevent one death. On the other hand, some authors argue that the resection of meckel’s diverticulum is a simple operation, and the management of its complications is associated with high morbidity and mortality.
Elective resection is recommended in cases with a palpable thickening suggestive of heterotopic mucosa, in those with unexplained abdominal pain, and in cases with abdominal wall attachment.
In general, removal of incidental meckel’s diverticulum is indicated in children less than 8 years old, because infants and young children are at a greater risk for complications.
SPSE 1
Contraindications for elective removal of incidental Meckel’s diverticulum are:
A immunocompromised patients
B patients undergoing insertion of prosthetic material
C babies with gastroschisis
D generalised peritonitis
E all of the above.
E
Elective excision of incidental meckel’s diverticulum is not recommended in cases highly susceptible to sepsis.
It is generally contraindicated in immunocompromised patients, those undergoing insertion of a prosthetic material and babies with gastroschisis, owing to the presence of a thickened serosal peel or prosthetic patch.
SPSE 1
