Merkels diverticulum

Question 1

Define Meckels’ diverticulum

Answer 1

congenital diverticulum of the small intestines

-remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa.

Question 2

rules of 2 for Meckels’ diverticulum 5

Answer 2

2% of the population
M:F ratio 2:1
2 feet from the ileocecal valve
2 inches in length
2% develop complications
(50% before age 2)
2 types of heterotopic mucosa

Question 3

presentation of Meckels’ diverticulum 4

Answer 3

-usually asymptoamtic

abdo pain mimicking appendicitis

rectal bleeding

intestinal obstruction
-secondary to omphalomesenteric band(most commonnly)
-can be volvulus or intussusception

Question 4

specific point about Meckels’ diverticulum in paeds

Answer 4

-most common cause of painless massive rectal GI bleed requiring transfusion between the ages of 1 and 2 yo

Question 5

investigations for Meckels’ diverticulum
-haemodynanically stable 1

Answer 5

if haemodynamically stable with less severe or intermittent bleeding:
‘Meckel’s scan’
-99m technetium pertechnetate(has affinitity for gastric mucosa)

Question 6

investigations for Meckels’ diverticulum
-severe cases 1

Answer 6

mesenteric arteriography

Question 7

management of Meckels’ diverticulum 1

Answer 7

removal:
-if narrow neck or sympotmatic

Question 8

what are the options for removal of Meckels’ diverticulum 2

Answer 8

wedge exicsion

or

formal small bowel resection and anastomosis

Question 9

pathophys of Meckels’ diverticulum

Answer 9

normally, in the foetus, there is an attachment between the vitellointestinal duct and the yolk sac. This disappears at 6 weeks gestation
the tip is free in the majority of cases
associated with enterocystomas, umbilical sinuses, and omphaloileal fistulas.
arterial supply: omphalomesenteric artery.
typically lined by ileal mucosa but ectopic gastric mucosa can occur, with the risk of peptic ulceration. Pancreatic and jejunal mucosa can also occur.