Meckel's diverticulum (ileal diverticulum)
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Introduction
persistence of the vitelline duct
Epidemiology
- the most frequent developmental abnormality of the gut
- 1-2 % of population
- accounts for 50% of cases of lower GI bleeding in children & young adults
- male:female ratio is 3:1[6]
Pathology
- persistence of the vitelline duct, manifesting as a pouch like remnant (3-6 cm long)
- found within 100 cm (typically within 50 cm in adults & 40 cm in infants) of the ileocecal valve on the anti-mesenteric] border of the ileum
- contains all layers of mucosa, thus is a true diverticulum
- mucosa is generally ileal, but may be gastric
- acid-producing ectopic gastric mucosa in the diverticulum may lead to development of an ulcer in adjacent normal mucosa
- may be attached to the umbilicus (26%) or free (74 %)
Clinical manifestations
- generally painless[6]
- no palpable mass[6]
- hematochezia
- may become inflamed & produce pain that may mimic that of appendicitis
Laboratory
- complete blood count if evidence of GI bleed
Diagnostic procedures
- upper GI endoscopy is normal
Radiology
- generally not helpful
- technetium-99m scan (gastric parietal cells concentrate technetium-99m) may show the diverticulum
Complications
- hemorrhage resulting from ileal mucosa adjacent to gastric mucosa
- small bowel obstruction due to intussusception & volvulus around the band fixing the diverticulum to the bowel wall
- benign leiomyomas & malignant carcinoids & leiomyosarcomas within the diverticulum
- diverticulitis is uncommon
- incarceration in an indirect inguinal hernia
- perforation with peritonitis
Differential diagnosis
- inflammatory bowel disease
- likely symptomatic, abdominal pain & tenderness
- extra-intestinal manifestations
- Crohn's disease
Management
- surgery should remove all ectopic mucosa[5]
- diverticulectomy for a diverticulum with a narrow base
- wedge or segmental resection for a diverticulum with a broad base[5]
More general terms
Additional terms
References
- ↑ Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999.
- ↑ Grant's Atlas of Anatomy, 10th edition, AMR Agur & MJ Lee (eds), Lippincott Williams & Wilkins, Philadelphia, PA 1999.
- ↑ Clinically Oriented Anatomy, 4th edition, KL Moore & AF Dalley (eds), Lippincott Williams & Wilkins, Philadelphia, PA 1999.
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 299
- ↑ 5.0 5.1 5.2 Rothaus C A Boy with Gastrointestinal Bleeding. Resident 360. Mar 29, 2017. https://resident360.nejm.org/content_items/2525/
- ↑ 6.0 6.1 6.2 6.3 6.4 NEJM Knowledge+ Gastroenterology