Meckel's Diverticulum

Question 1

What is Meckel’s Diverticulum?

Answer 1

Congenital abnormality where an outpouching develops on the anti-mesenteric border of the ileum

Question 2

Why is Meckel’s Diverticulum a true diverticulum?

Answer 2

Contains all layers of the small intestine

Question 3

What causes a Meckel’s Diverticulum?

Answer 3

Incomplete obliteration of the vitelline duct (normally connection between yolk sac and small intestine)

Question 4

What is the Rule of 2s in Meckel’s Diverticulum?

Answer 4

2% of population
2 feet proximal to ileocaecal valve
2 inches in length
2 types of ectopic tissue - gastric and pancreatic
2x more common in men
Under 2s

Question 5

What are the clinical features of MD?

Answer 5

Mainly asymptomatic

Can cause:

• Inflammation or ulceration of the surrounding mucosa
• PR bleeding (dark red)
• Abdominal pain (diverticulitis) - similar presentation to acute appendicitis
• Can cause bowel obstruction

Question 6

When can MD cause bowel obstruction?

Answer 6

Adhesional band formation

or

Intussusception of the small bowel

Question 7

What investigations are used for MD?

Answer 7

Acute Setting
CT imaging pre-op or intra-op with diagnostic laparoscopy

Outpatient
Nuclear scintigraphy - absorbed by ectopic gastric mucosa for visualisation

Can also use CT angiogram

Question 8

How is MD managed?

Answer 8

Urgent surgery
Meckel’s Diverticulectomy

If there is perforation or bowel obstruction - small bowel resection can be needed

If PR bleeding - can consider IR