meckel's diverticulum
TRANSCRIPT
Meckel’s diverticulu
m
A Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric (vitellointestinal) duct
Meckel's diverticulum is the most prevalent congenital anomaly of the GI tract 2% of the general population 2% prevalence, 2:1 female predominance 2 ft proximal to the ileocecal valve in adults 50% symptomatic under 2 years Heterotropic tissue Gastric mucosa Pancreatic acini
Epidemiology
Development
Failure or incomplete vitelline duct obliteration in wk. 8 Omphalomesenteric fistula Enterocyst
Pathophysiology
Asymptomatic Bleeding is the most common presentation in children
acid-producing from heterotopic gastric mucosa located within the diverticulum.
Intestinal obstruction; mechanisms
1. Volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus
2. Entrapment of intestine by a mesodiverticular band
3. Intussusception with the diverticulum
4. Stricture secondary to chronic diverticulitis Diverticulitis
Clinical Presentation
Clinical Presentation
Mesodiverticular band
Intestinal obstruction Hematochezia Appendicitis Intussusception Lower GI bleeding Angiodysplasias Malignancy Arteriovenous malformations
Differential diagnosis
Diagnosis
Incidentally found 99mTc-pertechnetate scintigraphy (ectopic gastric mucosa)
Indication for surgerySymptomatic Meckel
diverticulum- hemorrhage- intestinal obstruction- diverticulitis- umbilico-ileal fistulas
Indication for surgeryIncidentally discovered Meckel
diverticulum- Patients younger than 40
years- Diverticula longer than
2cm- Diverticula with narrow
necks- Diverticula with fibrous
bands- Suspected ectopic gastric
tissue- Inflamed, thickened
diverticula
1. Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.2. Kuwajerwala K N. Meckel Diverticulum [Internet]. Medscape [updated 2013 Mar 7; cited 2014 Jun 25]. Available from: http://emedicine.medscape.com
References