Meckel’s Diverticulum

It is a true diverticulum which means it contains all 3 layers of intestine. Located on antimesenteric
border of ileum 45 to 60cm proximal to ileocecal valve. Results from incomplete closure of
vitellointestinal duct.

Equal incidence among men and women

No familial predisposition

Most common heterotopic tissue in meckel’s diverticulum is gastric mucosa.

Most commonly encountered congenital anomaly of small intestine

Rule of 2’s
  2% prevalence
 2 inch in length
 Half of these who are symptomatic are less than 2 years of age
 2 feet proximal to ileocecal valve

Clinical Features

 Most common presentation is GI bleeding.

 Hemorrhage is the most common symptomatic presentation in child less than 2 years of age.
Hemorrhage is painless bright red blood from rectum, intermittent episodes.
 Source of bleeding is chronic acid induced ulcer in the ileum containing gastric mucosa.

Diagnosis

 Most accurate diagnostic tool in children: Scintigraphy with sodium 99mTc-pertechnetate. This
is usually taken up by the heterotopic gastric mucosa.

 In adults, barium studies should be performed.

Treatment

 In symptomatic cases: Diverticulectomy or resection of segment of ileum

 In asymptomatic cases it can be resected if found during laparotomy
  Incidentally found Meckel’s Diverticulum should be removed at any age upto 80 years.

Complications

 Hemorrhage
 Strangulation
 Intusssusception
 Most common complication in children and young adults: Bleeding
 Most common complication in adults: Intestinal obstruction
 Progression of diverticulitis may lead to perforation or peritonitis

Differential Diagnosis

 Anatomic: Diverticulosis
 Vascular: Angiodysplasia, Hemorrhoids, Post biopsy or polypectomy
 Inflammatory: IBD, Ulcer
 Neoplastic: Polyp, Carcinoma

Sources: Uptodate
Written By: Dr Divya Ranasaria