Meckel Diverticulum

Snapshot

• A 2-year-old boy with no significant past medical history presents with bright red blood per rectum in his diaper. His parents were immediately concerned and called the pediatrician. The patient is not in much pain but cries when the RLQ is palpated. A technetium-99m scan comes back positive for Meckel’s diverticulum.

Introduction

• Congenital diverticulum presenting in childhood
  • note, is a “true” diverticulum, with all 3 layers of the gut wall outpouched 
  • note, distinct from diverticulosis (false diverticula) and diverticulitis (inflammation of diverticula)
• Pathogenesis
  • persistence of vitelline (omphalomesenteric) duct in small intestine   
    • due to failed obliteration of the vitelline duct
  • may have ectopic acid-secreting gastric or pancreatic tissue 
• Epidemiology
  • most common congenital anomaly of gastrointestinal tract
• Rule of 2’s 
  • affects 2% of population
  • 2 feet from ileocecal valve 
  • 2 inches long
  • 2 types of epithelia tissue: gastric and pancreatic
  • male:female ratio 2:1
  • patients < 2 years old
• 2% symptomatic

Presentation

• Symptoms 
  • painless rectal bleeding
    • due to gastric acid secretion causing damage to small bowel tissue
  • normal abdominal exam
  • may serve as lead point for intussusception
• small bowel obstruction

Evaluation

• Most commonly discovered as incidental finding on laparotomy
• Technetium-99m scan aka Meckel scan 
  • most accurate test
  • technetium-99m pertechnetate radioisotope is taken up by ectopic gastric mucosa
• Upper GI series with small bowel follow-through can also detect

Differential Diagnosis

• Intussusception 
• Appendicitis 
• Hirschsprung’s disease 

Treatment

• Surgical removal

Prognosis, Prevention, and Complications

• Complications
  • hemorrhage (most common)
  • SBO
  • diverticulitis
  • perforation