What Is Meckel’s Diverticulum?
Meckel’s diverticulum is the most common congenital abnormality of the gastrointestinal (GI) tract, occurring in about 2% of the population. It results from the incomplete obliteration of the omphalomesenteric duct, leading to a true diverticulum in the ileum.
10 Crucial Facts About Meckel’s Diverticulum
1. Rule of 2s – A Key Mnemonic
- Present in 2% of the population.
- Located 2 feet from the ileocecal valve.
- Approximately 2 inches in length.
- More common in males (2:1 ratio).
- Can contain 2 types of ectopic tissue (gastric and pancreatic).
- Often symptomatic by age 2 but can present at any age.
2. Symptoms and Clinical Presentation
While many cases remain asymptomatic, symptomatic Meckel’s diverticulum can present with:
- Painless rectal bleeding (most common in children).
- Intestinal obstruction due to volvulus or intussusception.
- Diverticulitis, mimicking appendicitis.
- Perforation leading to peritonitis.
3. Ectopic Tissue and Its Effects
Meckel’s diverticulum often contains ectopic gastric or pancreatic tissue, which can secrete acid, leading to ulceration and GI bleeding.
4. Diagnosis – How to Identify It?
- Technetium-99m Pertechnetate Scan (Meckel’s Scan): Highly specific for detecting ectopic gastric mucosa.
- CT Scan or MRI: Useful in complicated cases with perforation or obstruction.
- Angiography: Helps detect active bleeding.
- Capsule Endoscopy: Can be used in cases of obscure GI bleeding.
5. Common Complications
- Hemorrhage: Due to ulceration from ectopic gastric mucosa.
- Obstruction: Due to intussusception, volvulus, or adhesions.
- Inflammation: Mimicking appendicitis, leading to misdiagnosis.
- Perforation: A surgical emergency requiring immediate intervention.
6. Differential Diagnoses – Conditions Mimicking Meckel’s
- Appendicitis
- Crohn’s disease
- Intussusception
- Peptic ulcer disease
- Colonic polyps
7. When Is Surgery Required?
- Symptomatic cases (bleeding, obstruction, inflammation)
- Incidentally found in adults with high-risk features (long, narrow-necked diverticula or presence of ectopic tissue)
8. Surgical Management
- Diverticulectomy: Simple resection of the diverticulum.
- Segmental Ileal Resection: Required in cases with significant inflammation or involvement of surrounding bowel.
- Laparoscopic Surgery: Increasingly preferred due to reduced recovery time and complications.
9. Prognosis and Outcomes
- Excellent after surgical removal in symptomatic cases.
- Asymptomatic cases often remain undiagnosed for life.
10. Key Takeaways for Clinicians
- Always consider Meckel’s diverticulum in a child with painless GI bleeding.
- A Meckel’s scan is the best diagnostic tool for children.
- Prompt surgical intervention is crucial in complicated cases.
Final Thoughts
Meckel’s diverticulum is an often-overlooked cause of GI symptoms. Awareness of its presentation, diagnostic techniques, and treatment options ensures timely intervention and improved patient outcomes.
