Meckel’s diverticulum Flashcards

1
Q

Define Meckel’s diverticulum.

A

Outpouching of the ileum along the antimesenteric border containing heterotopic tissue of the stomach (acid secreting parietal cells), pancreas or normal intestinal mucosa.

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2
Q

Explain the embryological aetiology of Meckel’s diverticulum.

A

During embryogenesis the vitelline duct runs between the terminal ileum, the umbilicus + the yolk sac; usually regresses by 7/40.

Failure to atrophy; can cause either a remaining fibrous band running from the diverticulum to the umbilicus, an umbilical cyst, an ileo-umbilical fistula or MD.

MD is the most common + is formed when the entire duct except the portion adjacent to the ileum is obliterated.

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3
Q

Explain the general aetiology of Meckel’s diverticulum.

A

Partial or incomplete involution of vitelline duct (omphalomesenteric duct) during embryogenesis. True diverticulum containing all 3 layers of intestinal wall + its own blood supply.

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4
Q

What is the “rule of 2s” with Meckel’s diverticulum?

A

2% of the population

2 inches (3–5 cm) long

2 feet (60 cm) from the ileocaecal valve

2% are symptomatic

2 types of ectopic tissue (gastric or pancreatic)

clinical presentation commonly aged 2

males 2–3X more likely to be affected.

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5
Q

Summarise the epidemiology of Meckel’s diverticulum.

A

2% of population

M > F

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6
Q

What are the signs and symptoms of Meckel’s diverticulum?

A

Most children asymptomatic. 4.2–16% of children with MD estimated to be symptomatic.

Intermittent painless rectal bleeding: Secondary to ulceration of ileal mucosa by ectopic acid production. Characteristically bright red blood. Normal abdo examination.

Signs + Sx of anaemia: Lethargy, pallor + failure to thrive.

Intussusception: MD may be a lead point.

Meckel diverticulitis: Characterised by peritoneal irritation which may localise to the RIF; may be identical presentation to acute appendicitis.

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7
Q

What are appropriate investigations for Meckel’s diverticulum?

A

Bloods: FBC for anaemia.

Microbiology: Stool sample for foecal occult blood with MC+S.

Imaging: Meckel Scan – radionucleotide scan with IV technetium-99m (binds to gastric mucosa is pre-scan H2- antagonist provided, e.g. ranitidine). Only positive scans are helpful.

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8
Q

What is the general management for Meckel’s diverticulum?

A

If incidentally found during surgery, removal not recommended due to associated surgical morbidity. Only remove pathological.

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9
Q

What is the surgical management for Meckel’s diverticulum?

A

Ileal resection + primary anastomosis.

Laparoscopic approach involves delivery of the MD via the umbilicus with extracorporeal anastomosis. Laparoscopy is also recommended for the Ix of PR bleeding possibly secondary to MD.

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10
Q

What are complications associated with Meckel’s diverticulum?

A
Anastomotic complications (stricture, leak) with surgical intervention. 
Rarely may contain sarcomas/carcinoid/adenocarcinoma tumours.
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11
Q

What is the prognosis of Meckel’s diverticulum?

A

Excellent

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