Meckel's Diverticulitis

Aka: Meckel's Diverticulitis, Meckel's Diverticulum, Meckel Diverticulum

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