Meckel’s diverticulum is the most common congenital abnormality of the small intestine that results from incomplete closure of the vitelline (omphalo-mesenteric) duct. This true diverticulum is approximately 2 ft from the ileocecal valve commonly found on the anti-mesenteric border of the ileum, is benign and in majority of cases asymptomatic.
RULE OF 2- It is 2 inches long, 2feet from IC junction, 2cm in diameter, 2types of heterotopic mucosa, 2times common in males and found in 2% of population
- Meckels is a true diverticulum with all the layers of bowel wall
- ¾ times meckels are free from the abdominal wall
- Gastric mucosa is the most common heterotopic mucosa seen in meckels
- Incidence of mucosal bleeding is as high as 80%
- A litters hernia is one containing meckels diverticulum in it
- Symptomatic in young patients, common in less than 2yrs of age
- Patients may present with hemorrhage, intestinal obstruction, intussusceptions, diverticulitis
- Malignancy common in elderly
- Technetium -99m pertecnate radionuclide scan is used
- Accuracy can be improve by giving pentagastrin which stimulates gastric mucosa
- Angiography- is usually negative unless the bleeding rate is greater than 0.5ml/min
- Wireless capsule endoscopy has also been used
– Meckels diverticulum accounts for 50% of all the lower gastro-intestinal bleedings
– The colour of stool is bright red, maroon.
– Younger patients are anaemic
-episodic painless bleeding is the most common presenting scenario
- Meckels can cause small bowel obstruction via intussusception, volvulus, vitelline bands, incarcerated littre hernia
- Patients can present with pain abdomen, vomiting, bloody stools, palpable abdominal mass
- Volvulus can result from a omphalodiverticular fibrous band or a vascular vitelline remanant, which provides a fixation point for the bowel to twist around
- Meso-diverticular intestinal remanants can create internal hernia
- Treatment of symptomatic meckels is resection followed by primary anastomosis.
- Can be done by open or laparoscopic assisted approach