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Meckel's Diverticulitis
Aka: Meckel's Diverticulitis, Meckel's Diverticulum, Meckel Diverticulum
- See Also
- Appendicitis
- Epidemiology
- Most common cause of significant Gastrointestinal Bleeding in children
- More common in males by ratio of 3:2
- Lifetime complication rate: 4%
- More than 50% of complications occur before age 10
- History
- Initial report by Hildanus in 1598
- Detailed description by Johann Meckel in 1809
- Pathophysiology: Meckel's Diverticulum
- Incomplete closure of vitelline duct (omphalomesenteric remnant)
- Lined with gastric mucosa and heterotopic tissue
- Location
- Proximal to ileocecal valve by 100 cm
- Usually within 45 to 60 cm of ileocecal valve
- Follows the rule of 2's (roughly)
- Affects 2% of the population
- Symptomatic presentations or complications affect 2-4% of those with Meckel's Diverticulum
- If symptoms are to occur, they occur by age 2 years in 50% of cases (age 10 in some references)
- Occurs 2 feet proximal to the ileocecal valve
- Meckel's Diverticulum is 2 cm wide and 2 cm long
- Differential Diagnosis of Meckel's Diverticulitis
- See Appendicitis
- Complications of Meckel's Diverticulum
- GI Bleeding (25-50% of complications)
- Often associated with ectopic gastric mucosa
- Hemorrhage is most common presentation under age 2
- Resolves spontaneously in most cases
- Meckel's Diverticulitis (10-20% of complications)
- Similar in presentation to Appendicitis
- Bowel Obstruction
- Volvulus at fibrotic band attached to abdominal wall
- Intussusception
- Incarcerated Inguinal Hernia (Littre's Hernia)
- Other complications
- Carcinoid Tumor
- Imaging
- Radionuclide Scintigraphy (Sodium Tc-pertechnetate)
- Preferential uptake by gastric tissue
- Most accurate test in Meckel's Diverticulum
- Test Sensitivity: 85% in children
- Test Specificity: 95% in children
- Less accurate in adults
- Cimetidine increases accuracy in adults
- Small Bowel enema
- Indicated for negative scintigraphy in adults
- Arteriography (indicated for acute Hemorrhage)
- Tests not useful in evaluation for Meckel's
- CT Abdomen
- Ultrasound
- Abdominal XRay
- Management: Meckel's Diverticulum
- Symptomatic (e.g. Meckel's Diverticulitis)
- Prompt surgical resection
- Asymptomatic incidental finding on other surgery
- Prophylactic resection recommended
- References
- Townsend (2001) Sabiston Surgery, Saunders, p. 907-9
- Cullen (1994) Ann Surg 220:564-9 [PubMed]
- Rossi (1996) AJR 166:567-73 [PubMed]
- Yahchouchy (2001) J Am Coll Surg 192:658-62 [PubMed]