Meckel diverticulum is the commonest congenital abnormality of the small bowel.
Many people with Meckel diverticulum remain asymptomatic for their entire lives.
The majority of symptomatic patients present before the age of 2 years.
Gastrointestinal bleeding is a common presenting symptom in children and adults. The most useful diagnostic tool in cases with bleeding is the technetium-99m pertechnetate scan (Meckel scan).
Obstructive symptoms are another common presenting symptom and may be caused by several mechanisms, including intussusception.
Meckel diverticulitis occurs in 20% of patients who become symptomatic and is clinically indistinguishable from appendicitis.
Symptomatic Meckel diverticulum is managed by surgical resection with a laparoscopic or open approach.
Meckel diverticulum (MD) is the commonest congenital malformation of the small bowel. The reported prevalence is between 0.3% and 2.9% of the general population. It is a true diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development, leading to an intestinal blind pouch. Patients are often asymptomatic. However, this embryologic remnant may cause bleeding, obstruction, inflammation, or perforation. It was named after Johann F. Meckel, a German anatomist who described the structure in 1809.
History and exam
Key diagnostic factors
- age <2 years
- passage of bright red blood per rectum (hematochezia)
- intractable constipation (obstipation)
Other diagnostic factors
- male sex
- nausea and vomiting
- abdominal cramps
- lower abdominal pain
- diffuse abdominal tenderness
- palpable abdominal mass
- there are no known risk factors
1st investigations to order
- technetium-99m pertechnetate scan ("Meckel scan")
- CT scan of the abdomen and pelvis
- ultrasound of the abdomen
Investigations to consider
- contrast enema
- mesenteric angiography
- endoscopic exploration of the small intestine
- surgical exploration of the abdomen
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