Introduction
Meckel's diverticulum is a congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa
Rule of 2's
Rule of 2's
- occurs in 2% of the population
- is 2 feet from the ileocaecal valve
- is 2 inches long
Epidemiology
- Incidence: 15.00 cases per 100,000 person-years
- Peak incidence: 1-5 years
- Sex ratio: more common in males 2:1
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Pathophysiology
Pathophysiology
- normally, in the foetus, there is an attachment between the vitellointestinal duct and the yolk sac. This disappears at 6 weeks gestation
- the tip is free in the majority of cases
- associated with enterocystomas, umbilical sinuses, and omphaloileal fistulas.
- arterial supply: omphalomesenteric artery.
- typically lined by ileal mucosa but ectopic gastric mucosa can occur, with the risk of peptic ulceration. Pancreatic and jejunal mucosa can also occur.
Clinical features
Presentation (usually asymptomatic)
- abdominal pain mimicking appendicitis
- rectal bleeding
- Meckel's diverticulum is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years
- intestinal obstruction
- secondary to an omphalomesenteric band (most commonly), volvulus and intussusception
Management
Management
- removal if narrow neck or symptomatic. Options are between wedge excision or formal small bowel resection and anastomosis.