Mecke's diverticulum

1. Meckel’s Diverticulum
Dinoosh De Livera
Group 49
5th course
Oversease Students Training Faculty
Vitebsk State Medical University
Paediatric Surgery

2. Meckel’s Diverticulum

3. Definition: It is a congenital diverticulum arising
from the antimesenteric border of terminal ileum
• During the eighth week of gestation, the
omphalomesenteric (vitelline) duct normally
undergoes obliteration
• Failure or incomplete obliteration of vitelline duct
results in some congenital abnormalities, the
most common of which is Meckel's diverticulum.

4. Development

5. • Sometimes this diverticulum can be attached to the
umbilical region by the vitelline ligament, with the
possibility of vitelline cysts, or even a patent vitelline
canal forming a vitelline fistula when the umbilical cord is
cut

6. • Most common congenital abnormality of the
gastrointestinal tract
• Contains all three layers of bowel with
independent blood supply
• Often contains heterotropic tissue- gastric,
occasionally pancreatic
• If the Meckel’s Diverticulum is found in an
inguinal or femoral sac – Littre’s hernia

7. Meckel's diverticulum is the most prevalent
congenital anomaly of the GI tract
• 2% of the general population
• 2% prevalence, 2:1 male predominance
• 2 ft proximal to the ileocecal valve in adults
• 50% symptomatic under 2 years
• Heterotropic tissue
 Gastric mucosa
 Pancreatic acini
Epidemiology

8. Rule of 2’s
• 2% of the population
• Usually found 2 feet proximal to the ileocecal valve
• About 2 inches long
• 2 times more common in males than females
• Symptomatic mostly before 2 years of age
• In adult patients it symptomatic in only about 2%

9. Clinical presentations
• Majority of Meckel’s diverticuli are clinically
silent (Asymptomatic)
• Symptoms in order of frequencies—
a) Severe haemorrhage
b) Intussuception
c) Meckel’s Diverticulitis
d) Chronic peptic ulceration
e) Intestinal obstruction

10. Pathophysiology
• Severe Hemorrhage
-painless per rectal bleeding, maroon colored
Hemorrhage may be caused by:
• Ectopic gastric or pancreatic mucosa: When
diverticulum contains embryonic remnants of mucosa
of other tissue types.
• Secretion of gastric acid or alkaline pancreatic juice
from the ectopic mucosa leads to ulceration in the
adjacent ileal mucosa i.e. peptic or pancreatic ulcer
• Perforation and bleeding from ulcer

11. Meckel’s Diverticulitis
Inflammation of the diverticulum can mimic symptoms
of appendicitis
Diverticulitis results from-
• Peptic ulceration resulting from ectopic gastric mucosa
of the diverticulum
• Following perforation by trauma or ingested food
residue
• Luminal obstruction due to tumors, foreign body,
causing stasis or bacterial infection

12. • During perforation, the symptoms may
resemble those of a perforated duodenal ulcer
• Whether perforated or not, urgent surgery is
required
• In non perforated cases, an inflamed
diverticulum should be sought as soon as it
has been demonstrated that the appendix and
fallopian tubes are not at fault

13. • Intestinal obstruction
Causes—
• Volvulus of the intestine around the fibrous band
attaching the diverticulum to the umbilicus
• Entrapment of intestine by a mesodiverticular
band
• Intussusception with the diverticulum acting as a
lead point
• Stricture secondary to chronic diverticulitis
• Tumors e.g. Carcinoid, adenocarcinoma, GIST
arising in the diverticulum

15. Diagonosis
• A technetium-99m (99mTc) pertechnetate scan, also
called Meckel scan.
positive only when the diverticulum contains
associated ectopic gastric mucosa that is capable of
uptake of the tracer
• Laparoscopy
• Enteroclysis/ small bowel enema under fluoroscopy
• CT scan
• Angiography

16. A technetium-99m
(99mTc)
pertechnetate scan,
also called Meckel
scan.
positive only when the
diverticulum contains
associated ectopic gastric
mucosa that is capable of
uptake of the tracer

17. 1) Intestinal obstruction
2) Hematochezia
3) Appendicitis
4) Intussusception
5) Lower GI bleeding
6) Angiodysplasias
7) Malignancy
8) Arteriovenous malformations
Differential diagnosis

18. Complications of Meckel Diverticulum
• Ulceration
• Hemorrhage
• Small intestinal obstruction
• Diverticulitis
• Perforation

19. Indication for surgery
Symptomatic Meckel diverticulum
- hemorrhage
- intestinal obstruction
- diverticulitis
- umbilico-ileal fistulas

20. Indication for surgery
Incidentally discovered Meckel diverticulum
- Patients younger than 40 years
- Diverticula longer than 2cm
- Diverticula with narrow necks
- Diverticula with fibrous bands
- Suspected ectopic gastric tissue
- Inflamed, thickened diverticula

21. Management
• Meckelian Diverticulectomy:
Meckel’s diverticulum with the broad base should not be amputated and
invaginated
A linear stapler device may be used. If induration of base, hetrotropic
gastric tissue extending to adjacent ileum is present then- short segment
of ileum is resected and end to end anastomosis is done restoring the
continuity

24. 1. Schwartz’s principles of surgery, 9th
edition. Mc Graw-Hill, 2009.
2. Medscape http://emedicine.medscape.com
References

25. THANK YOU!