Meckel's Diverticulum

Question 1

What is it?

Answer 1

REMNANT of the OMPHALOMESENTERIC duct, VITELLINE duct, which connects the yolk sac with the primitive midgut in the embryo

Question 2

What is its claim to fame?

Answer 2

Most common small bowel CONGENITAL abnormality

Question 3

Usual location??

Answer 3

WITHIN ~2 feet of the ileocecal valve on the ANTIMESENTERIC border of the bowel

Question 4

What is the major differential dx?

Answer 4

Appendicitis

Question 5

Is it a true diverticulum?

Answer 5

YES; all layers of the intestine are found in the wall

Question 6

What is the incidence?

Answer 6

~2% of the population at autopsy

Question 7

What is the gender ratio?

Answer 7

2x in MEN

Question 8

What is the average age at onset of symptoms?

Answer 8

Most frequently in the first 2 years of life..but can occur at any age

Question 9

What are the complications?

Answer 9

intestinal HEMORRHAGE(painless)-50% of all the GI bleeding in patients younger than 2years
BLEEDING sec to gastric mucosa secreting acid without, ulcer, bleeding
INTESTINAL OBSTRUCTION - 25% MC in adults
INFLAMMATION (with perforations) 25%

Question 10

What are the signs/symtpoms?

Answer 10

LGIB, abdominal pain, SBO

Question 11

What is the most common complication of Meckel’s in adults?

Answer 11

intestinal obstruction

Question 12

% of heterotropic tissue found in the diverticulum

Answer 12

50%

Question 13

What is heterotropic tissue type most often found?

Answer 13

Gastric mucosa(50%)

Question 14

What is the rule of 2s?

Answer 14

2% in patients asymptomatic
~2 ft form ileocecal valve
2% of the population
<2 y.o. most commonly found
Ectopic in one out of 2!
2 to 1 M:F ratio

Question 15

What is the role of incidental Meckel’s divertulectomy?

Answer 15

1. children

2. adults: ectopic tissue(fullness) or mesodiverticular band

Question 16

What is a Meckel’s scan?

Answer 16

Scan for ectopic gastric mucosa in Meckel’s, uses TECHNETIUM PERTECHNETATE IV(taken up by gastric mucosa)

Question 17

Treatment of MD that is causing bleeding?

Answer 17

Surgical resection, with small bowel resection as the actual ulcer is usually the MESENTERIC wall opposite the diverticulum

Question 18

What is the name of HERNIA associated with incarcerated MD?

Answer 18

Littre’s Hernia (Think alphabeticalty: Littre’s, Meckels)

Question 19

In patients with GUAIAC-positive stools and negative upper and lower GI workup, what must be ruled out?

Answer 19

SB tumor, evaluate with enteroclysis(small bowel contrast study)

Question 20

What is the most common cause of small bowel bleeding?

Answer 20

Small bowel ANGIODYSPLASIA