Meckel's Diverticulum

Name: Shahad Elkanzi

UG: 1701659
Meckel's Diverticulum
• Meckel's diverticulum is an abnormal sac or pouch that develops at a weak point
in the intestines (usually in the ileum ). Meckel's diverticulum is known as a "true
diverticulum" because it contains all 3 layers of the bowel wall. It is the most
common congenital abnormality of the small intestine and is caused by an
incomplete obliteration of the vitelline duct (also called the omphalomesenteric
duct).
Omphalomesenteric duct

• Omphalomesenteric duct, is a long

narrow tube that joins the yolk sac
to the midgut lumen of the
developing fetus. It appears at the
end of the fourth week, when the
yolk sac presents the appearance of
a small pear-shaped vesicle (the
umbilical vesicle).
Epidemiology & Etiology

• Meckel's diverticulum is the most

common vitelline duct abnormality and
the most common congenital anomaly of
the gastrointestinal tract.

• The fetal midgut is attached to the yolk

sac via the vitellointestinal duct, also
known as the omphalomesenteric duct or
yolk stalk.
• This duct normally obliterates between 5
and 8 weeks' gestation. Meckel's
diverticulum results from failure of the
proximal duct to obliterate.
 Pathophysiology

• In early fetal life, the vitelline or omphalomesenteric duct that connects the
midgut to the yolk sac is normally obliterated by the 6th week. If the portion
connecting to the ileum fails to atrophy, a Meckel diverticulum results. This
congenital diverticulum arises from the antimesenteric margin of the intestine
and contains all layers of the normal bowel and is thus a true diverticulum. In
less than 25% of patients, a Meckel diverticulum also contains heterotopic
tissue of the stomach (and thus contains parietal cells that secrete hydrochloric
acid), pancreas, or both.
• Only about 2% of people with Meckel diverticulum develop complications.
Although diverticula are equally common among males and females, males are
2 to 3 times more likely to have complications.
 • People can live their whole lives without ever
knowing they have a Meckel diverticulum, but
occasionally the abnormality causes
complications. Although diverticula are equally
common among boys and girls, boys are 2 to 3
Complications times more likely to have complications.
of Meckel Complications of Meckel diverticulum include
diverticulum • Bleeding
• Obstruction (blockage)
• Diverticulitis
• Perforation
• Tumors
 Risk Factors for Meckel's Diverticulum

• Complications from Meckel's diverticulum can develop at any age,

and it is estimated that there is a 4 percent to 25 percent lifetime risk
of complications occurring. However, this risk decreases with age.
Infants and children appear to be at highest risk for complications,
with more than 50 percent of symptomatic Meckel's diverticula
occurring in children less than 2 years of age.
• An increased incidence of Meckel's diverticula is seen in association
with other congenital anomalies, including esophageal atresia,
imperforate anus (anorectal malformations), omphalocele,
Crohn's disease, and various neurological and cardiovascular
malformations.
 Clinical presentations

• Lower GI bleeding due to ulceration by heterotopic gastric

mucosa
• Intestinal obstruction due to internal segmental volvulus or
intussusception
• Local inflammation with or without perforation resembling
appendicitis due to diverticulitis
• Rare presentations: Neoplasms
 Signs and Symptoms of Meckel's Diverticulum

• Symptoms occur only if the diverticulum bleeds, becomes

infected or causes an obstruction, and they are twice as common
in males than in females. The symptom most commonly seen in
young children is painless rectal bleeding. The color of blood
may vary from bright red (35 percent) to dark red or maroon (40
percent) to black tarry (7 percent).
Symptoms of Meckel’s Diverticulum
• Gastrointestinal bleeding (which
can be seen in the stool)
• Abdominal pain and cramping
• Tenderness near the navel (belly
button)
• Obstruction of the bowels, a
blockage that keeps the contents
of the intestines from passing.
• This can cause pain, bloating,
diarrhea, constipation, and
vomiting.
• Diverticulitis (inflammation or
infection of the diverticulum)
• Anemia
Meckel's diverticulum diagnosis
Differential Diagnosis

• Diverticulosis
• Angiodysplasia
• Hemorrhoids
• Crohn’s disease
• Ulcerative colitis
• Colon carcinoma
 Treatment for Meckel's Diverticulum

• Surgery
• Surgery to remove the diverticulum will be required if bleeding develops. The
segment of small intestine that contains the diverticulum is removed. The ends of the
intestine are then sewn back together.
• Iron supplements to treat anemia are also prescribed and a blood transfusion if
bleeding was severe.
• If there is underlying infection or inflammation(peritonitis, ulcerative colitis,
diverticulitis):Control of the inflammation by using antibiotics(cefotxime)
(metro/clindamycin )and surgical excision of the diverticulum