Meckel’s Diverticulum

Question 1

Definition

Answer 1

Most common remnant of vitelline duct that connects yolk sac with primitive midgut

Question 2

Incidence

Answer 2

1-3% of population M:F = 3:1 Present most frequently during first 5 yr of life Symptomatic in 2% of cases
2 rule

Question 3

Pathophysiology

Answer 3

Failure of vitelline duct to regress 5-7 wk in utero; 50% contain heterotopic tissue (e.g. gastric mucosa, ectopic pancreas); other associated anomalies include omphalomesenteric fistula, umbilical sinus, umbilical cyst, fibrous band

Question 4

Clinical manifestations

Answer 4

-sx
🌚BRBPR(bright red blood per rectum) (heterotopic gastric mucosa in Meckel’s causing mucosal ulceration and bleeding in adjacent small bowel mucosa)
🌝 Abdominal sepsis (Meckel’s diverticulitis ± perforation)
🌚Small bowel volvulus around fibrous band
-examination \ Tenderness (lower abdomen) near umbilicus

Question 5

Investigations

Answer 5

AXR Meckel scan: scan for ectopic gastric mucosa with technetium Tc99m pertechnetate IV (sensitivity 85%, specificity 95%)

Question 6

Tx

Answer 6

Stabilize
Surgery/
resection by laparotomy or laparoscopy
Hemorrhage - In cases of hemorrhage, wedge or segmental resection ensures adequate excision of the part containing gastric and ulcerated ileal mucosa