TTT earel, C3, 12 September 1994 Anatomy & Embryology the incomplete obliteration of the vitelline duct (connecting midgut with embryonic yolk sac) during fetal development can lead to vitelline fistula, vitelline cyst and Meckel’s Diverticulum (MD). Clinical symptoms may result from the presence of heterotopic (most commonly gastric) tissue in a Meckel’s diverticulum. Epidemiology veckel’s diverticulum is not uncommon and the incidence ranges from 0.2 to 4 percent. The "Rule of Two" is useful to keep in mind: > Male: female ratio > MD within 2 feet of ileocecal junction > average length of MD is 2° > 2 types of ectopic tissue (gastric & pancreatic) » 2 major complications: diverticulitis & obstruction in adults; obstruction & hemorrhage in children Pathology castric ectopic tissue is the most conmon and often presents as peptic ulceration with accompanying pain, hemorrhage or perforation. Pancreatic tissue may lead to intussusception. Complications Rate of complications vary from 4 to 35% and result mainly from the presence of ectopic tissue. Obstruction is the most common presenting symptom and occurs frequently in the first decade. Hemorrhage (especially with a Meckel’s diverticulum containing gastric mucosa) is another complication. Finally, diverticulitis is also possible which in its acute presentation can mimic appendicitis. Diagnosis is a challenge because MD can resemble many other common diseases. Any obscure abdominal illness or unexplained intestinal bleeding should raise the index of suspicion for Meckel’s diverticulum. A Meckel’s scan involves technetium- 99m pertechnetate which is taken up by secretory epithelium (including gastric acid-secreting cells). A Meckel’s diverticulum thus appears as a "hot" spot (indicated by the arrow) in the abdomen. Note also the uptake in the stomach and bladder. False positives & false negatives are also possible. Management surgical resection is usually indicated for complicated Meckel’s diverticulum. The management of incidentally found MD is a controversy with most authors recommending prophylactic diverticulectony but others suggest a more conservative approach. References chia, UG, et al, (299%), *Mackel’s Diverciculua: Another “0% Gerretson. DC and Frederich, ME (1999), “Mackel's Diverticulum, At. Fen. Physician, 42:21s. Ronupgro, Mot a1, (0992), “Complications and Diognosis of Meckel's Diverticelum in 776 Fatiente,* AR. J. Surgery. Leljomarck, C.-E, e& al, (1986) “Wockel’s aiverticulun sn the adult,” sr, J. gura., 73:146 Mettler, TA and ulberteau, M0, (1986), ‘Essentials of Mclesr Medicine Imging,* 2nd ed., Grune & seratton, Orlando: “hbote scan ie reproduced ton pape 331