Surgery Book

Stomach Disorders


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]

Meckel Diverticulum (C0025037)

Definition (MSHCZE) Vrozený divertikl vyskytující se u některých osob na tenkém střevě jako zbytek embryonální tkáně. Může být zdrojem zánětu, krvácení nebo střevní neprůchodnosti. Je přítomen cca u 1% populace. (cit. Velký lékařský slovník online, 2013 )
Definition (NCI) A congenital pouch in the distal ileum. It may cause painless rectal bleeding and bowel obstruction.
Definition (MSH) A congenital abnormality characterized by the outpouching or sac formation in the ILEUM. It is a remnant of the embryonic YOLK SAC in which the VITELLINE DUCT failed to close.
Concepts Disease or Syndrome (T047) , Congenital Abnormality (T019)
MSH D008467
ICD9 751.0
ICD10 Q43.0
SnomedCT 127962001, 37373007, 204685004, 204686003, 204689005, 156955000, 264256006, 253775007, 204690001
LNC LP30125-6, MTHU012047
English Meckel's diverticulum NOS, Meckel's diverticulum unspec., Meckel's diverticulum, unspecified, Persist omphalomesenteric duct, MECKEL DIVERTICULUM, Diverticulum Meckel's, Meckel's diverticulum (diagnosis), persistent omphalomesenteric duct (diagnosis), persistent omphalomesenteric duct, Diverticulum of Meckel, Ileal diverticulum, Diverticulum ilei, Meckel Diverticulum, Meckel diverticulum, Meckel Diverticulum [Disease/Finding], meckel diverticulum, meckel's diverticulum, diverticulum meckel, diverticulum meckel's, diverticulum meckels, diverticulum meckels's, Meckel's diverticulum, unspecified (disorder), (Persistent omphalomesenteric duct) or (persistent vitelline duct), (Meckel's diverticulum) or (persistent omphalomesenteric duct) or (persistent vitelline duct), Persistent vitelline duct (disorder), (Meckel's diverticulum) or (persistent omphalomesenteric duct) or (persistent vitelline duct) (disorder), (Persistent omphalomesenteric duct) or (persistent vitelline duct) (disorder), Meckel's diverticulum NOS (disorder), Meckel's diverticulum (body structure), Meckel's Diverticulum, Diverticulum, Meckel, Meckel's diverticulum, Persistent intestinal end of vitelline duct, Persistent omphalomesenteric duct, Persistent vitelline duct, MD - Meckel's diverticulum, Meckel's diverticulum (disorder), Meckel's diverticulum (morphologic abnormality), Meckel; diverticulum, diverticulum; Meckel, duct; omphalomesenteric, persistent; omphalomesenteric duct, persistent; vitelline duct, Meckels diverticulum, meckels diverticulum
Swedish Meckels divertikel
Dutch divertikel van Meckel, Meckel-divertikel, Meckel; divertikel, divertikel; Meckel, ductus; omphalomesentericus, persisterend; ductus omphalomesentericus, persisterend; ductus vitellinus, Divertikel, Meckel's, Meckel's divertikel
Japanese メッケルケイシツ, Meckel憩室, メッケル憩室, 先天性臍腸管膜憩室, 臍腸間膜憩室
Czech Meckelův divertikl
Finnish Meckelin divertikkeli
Korean 멕켈 곁주머니(게실)
Latvian Mekeļa divertikuls
French Diverticule iléal de Meckel, Diverticule de Meckel
Polish Uchyłek Meckela, Uchyłek jelita krętego
Hungarian Meckel féle diverticulum, Diverticulum Meckel
Norwegian Meckels divertikkel, Diverticulum ilei, Diverticulum ilei verum, Diverticulum Meckeli
Spanish divertículo de Meckel, SAI, divertículo de Meckel (estructura corporal), divertículo de Meckel, no especificado (trastorno), divertículo de Meckel, no especificado, divertículo de Meckel, SAI (trastorno), Divertículo de Meckel, conducto onfalomesentérico persistente, conducto vitelino persistente, divertículo de Meckel (anomalía morfológica), divertículo de Meckel (trastorno), divertículo de Meckel, porción final intestinal del conducto vitelino persistente, Divertículo Ileal
Portuguese Divertículo do Íleo, Divertículo de Meckel, Divertículo Ileal
German Meckel-Divertikel, Meckelsches Divertikel
Italian Diverticolo di Meckel
Derived from the NIH UMLS (Unified Medical Language System)

Meckel's diverticulitis (C0267497)

Concepts Disease or Syndrome (T047)
SnomedCT 48241004
Italian Diverticolite di Meckel
Dutch Meckel-diverticulitis, diverticulitis van Meckel
German Meckel-Divertikulitis, Meckel' Divertikulitis
Japanese メッケル憩室炎, メッケルケイシツエン
English Meckel Diverticulitis, Meckel's Diverticulitis, Diverticulitis Meckel's, Meckel diverticulitis, Meckel's diverticulitis, Meckel's diverticulitis (disorder)
Czech Meckelova divertikulitida, Zánět Meckelova divertiklu
Hungarian Meckel-diverticulitis
Spanish diverticulitis de Meckel (trastorno), diverticulitis de Meckel, Diverticulitis de Meckel
Portuguese Diverticulite de Meckel
French Diverticulite de Meckel
Derived from the NIH UMLS (Unified Medical Language System)

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