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A Meckel's diverticulum, a true congenital diverticulum, is a small bulge in the small intestine present at birth. It is a vestigial remnant of the omphalomesenteric duct, and is the most frequent malformation of the gastrointestinal tract. It is present in approximately 2% of the population, with an equal distribution between males and females, although males more frequently experience symptoms. It is named after Johann Friedrich Meckel, who first described this type of diverticulum in 1809.
Meckel's diverticulum is located in the distal ileum, usually within about 60-100 cm of the ileocecal valve. It is typically 3-5 cm long, runs antimesenterically and has its own blood supply. A memory aid is "2 percent (of the population) - 2 feet (from the ileocecal valve) - 2 inches (in length)". This association with the number 2 continues with the fact that the above statements are about 2% true.
Also can be present in an indirect hernia, where it is known as "Hernia of Littre." Furthermore, it can be attached to the umbilicus, with the possibility of local cysts, torsions of intestine around the intestinal stalk, leading to obstrucion, ischemia, and necrosis.
Symptoms
Approximately 98% of people afflicted with Meckel's diverticulum are asymptomatic. If symptoms do occur, they typically appear before the age of two.
The most common presenting symptom is painless rectal bleeding, followed by intestinal obstruction, volvulus and intussusception. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis. Also, severe pain in the upper abdomen is experienced by the patient along with bloating of the stomach region. At times, the symptoms are so painful such that they may cause sleepless nights with extreme pain in the abdominal area.
Diagnosis
A technetium-99m (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa; since approximately 50% of Meckel's diverticula have ectopic gastric (stomach) cells contained within them, this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence. Other tests such as colonoscopy and screenings for bleeding disorders should be performed, and angiography can assist in determining the location and severity of bleeding.
Treatment
Treatment is surgical, consisting of a resection of the affected portion of the bowel.
"Meckel's diverticulum"