Pathophysiology
Meckel’s diverticulum is a congenital abmormality that occurs due to incomplete regression of the omphalomesenteric duct, also known as, the vitellointestinal duct.
This duct is normally attached to the yolk sack in foetus but disappears at week 6 of gestation. In the majority of cases, the tip remains free.
This diverticulum will contain ectopic tissue from the ileal, gastric, or pancreatic mucosa.
Rule of 2’s for Meckel’s diverticulum:
- 2% of the population
- 2 feet from the ileocaecal valve
- 2 inches long (5cm)
- 2 years old is most symptomatic
- 2 tissue types mainly - gastric and pancreatic.
😷 Presentation
It presents on the anti mesenteric side of the small intestine, approximately 60cm from the ileocaecal valve. It is usually asymptomatic, but can present as
- Abdominal pain similar to appendicitis.
- Rectal bleeding, especially in children.
- Intestinal obstruction - that is 2º to an omphalomesenteric band, volvulus or intussusception.
🔍 Investigations
Imaging
99m technetium pertechnetate - is used as a radiopharmaceutical to aid imaging as it has affinity for gastric mucosa, so can be used to identify ectopic gastric tissue. It is used in haemodynamically stable children. ➡️
Mesenteric arteriography may be used in haemodynamically unstable patients (more severe cases where transfusion may be needed).
🧰 Management
Surgical resectioning is needed if the patient is symptomatic or if there diverticulum has a narrow neck.
This is done through a laparoscopic diverticulectomy by performing a wedge resection.
