Meckel's diverticulum: Difference between revisions

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   Image          = Diverticule de Meckel.jpg |
   Image          = Diverticule de Meckel.jpg |
   Caption        = Meckel's diverticulum |
   Caption        = Meckel's diverticulum |
  DiseasesDB    = 7903 |
  ICD10          = {{ICD10|C|17|3|c|15}}, {{ICD10|Q|43|0|q|38}} |
  ICD9          = {{ICD9|152.3}}, {{ICD9|751.0}} |
  ICDO          = |
  OMIM          = 155140 |
  MedlinePlus    = |
  MeshID        = D008467 |
}}
}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''.
{{Meckel's diverticulum}}
{{SI}}
{{CMG}} {{AE}} {{Cherry}}<br>
{{CMG}}
{{SK}}Meckel diverticulum, persistent intestinal end of vitelline duct, persistent omphalomesenteric duct, persistent vitelline duct
==Overview==
A '''Meckel's diverticulum''', a true [[congenital]] [[diverticulum]], is a small bulge in the small intestine present at birth. It is a [[vestigial]] remnant of the [[omphalomesenteric duct]] (also called the vitelline duct), and is the most frequent malformation of the [[gastrointestinal tract]]. It is present in approximately 2% of the population, with males more frequently experiencing symptoms.


It is named after [[Johann Friedrich Meckel]], who first described this type of diverticulum in 1809.<ref>{{WhoNamedIt|synd|2050}}</ref><ref>J. F. Meckel. Über die Divertikel am Darmkanal. Archiv für die Physiologie, Halle, 1809, 9: 421-453.</ref>
==[[Meckel's diverticulum overview|Overview]]==


==Presentation==
==[[Meckel's diverticulum historical perspective|Historical Perspective]]==
Meckel's diverticulum is located in the distal [[ileum]], usually within about 60-100 cm of the [[ileocecal valve]]. It is typically 3-5 cm long, runs antimesenterically and has its own blood supply. It's left over from the umbilical cord and intestines from our embryonic life.


A memory aid is the rule of 2's: '''2%'''  (of the population) - '''2''' feet (from the ileocecal valve) - '''2''' inches (in length) - '''2%''' are symptomatic, there are '''2''' types of common ectopic tissue (gastric and pancreatic), the most common age at clinical presentation is '''2''', and males are '''2 times''' as likely to be affected.
==[[Meckel's diverticulum classification|Classification]]==


It can also be present as an indirect hernia, where it is known as  a "'''Hernia of Littre'''." Furthermore, it 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. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, [[ischemia]], and [[necrosis]].
==[[Meckel's diverticulum pathophysiology|Pathophysiology]]==


===Natural History, Complications and Prognosis===
==[[Meckel's diverticulum causes|Causes]]==
'''Meckel diverticulitis''''


Meckel diverticulitis is acute inflammation of a Meckel diverticulum.
==[[Meckel's diverticulum differential diagnosis|Differentiating Meckel's Diverticulum from other Diseases]]==


* CT will demonstrate a blind-ending, tubular, round or oval structure in the right lower quadrant or periumbilical region with surrounding inflammation.
==[[Meckel's diverticulum epidemiology and demographics|Epidemiology and Demographics]]==
* The wall of the diverticulum may show inflammatory changes such as mural thickening and contrast material enhancement.
* Soft-tissue stranding and adjacent fluid collections are also helpful features of diverticulitis.
* Occasionally an enteroliths will be present within the inflamed diverticulum.


<gallery>
==[[Meckel's diverticulum risk factors|Risk Factors]]==
Image:


Meckel's-diverticulitis-001.jpg
==[[Meckel's diverticulum screening|Screening]]==


Image:
==[[Meckel's diverticulum natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
Meckel's-diverticulitis-002.jpg
 
Image:
 
Meckel's-diverticulitis-003.jpg
 
Image:
 
Meckel's-diverticulitis-004.jpg
 
</gallery>
 
==Symptoms==
Approximately 98% of people afflicted with Meckel's diverticulum are [[asymptomatic]]. If symptoms do occur, they typically appear before the age of two. 
 
The most common presenting symptom is painless [[rectal bleeding]], followed by [[intestinal obstruction]], [[volvulus]] and [[intussusception (medical disorder)|intussusception]]. Occasionally, Meckel's diverticulitis may present with all the features of [[acute appendicitis]].  Also, severe pain in the upper abdomen is experienced by the patient along with bloating of the stomach region.  At times, the symptoms are so painful such that they may cause sleepless nights with extreme pain in the abdominal area.


==Diagnosis==
==Diagnosis==
A [[technetium-99m]] (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects [[gastric mucosa]]; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric ([[stomach]]) cells contained within them, this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence. Other tests such as [[colonoscopy]] and screenings for [[bleeding disorder]]s should be performed, and [[angiography]] can assist in determining the location and severity of bleeding.
[[Meckel's diverticulum history and symptoms| History and Symptoms]] | [[Meckel's diverticulum physical examination | Physical Examination]] |  [[Meckel's diverticulum laboratory findings | Laboratory Findings]] | [[Meckel's diverticulum  x ray|X Ray]] | [[Meckel's diverticulum CT|CT]] | [[Meckel's diverticulum MRI|MRI]] | [[Meckel's diverticulum ultrasound|Ultrasound]] | [[Meckel's diverticulum other imaging findings|Other Imaging Findings]] | [[Meckel's diverticulum other diagnostic studies|Other Diagnostic Studies]]
 
'''Positive Technetium-99m pertechnetate scan'''
 
<gallery>
Image:
 
Positive-meckels-scan-001.jpg
 
</gallery>
 
===Imaging Findings===
 
* Meckel diverticulum is identified as a saccular, blind-ending structure located on the antimesenteric border of the ileum.
* Meckel diverticulum is usually found in the right lower quadrant and pelvic region.
* The junction of the diverticulum with the ileum may show a mucosal triangular plateau or triradiate fold pattern (represents the site of omphalomesenteric duct attachment to the ileum).
* Filling defects within the diverticulum may represent enteroliths, fecoliths, or foreign bodies.
* Technetium-99m pertechnetate scintigraphy is the modality of choice for evaluating pediatric patients with gastrointestinal hemorrhage and a suspected Meckel diverticulum.
* A Meckel diverticulum containing gastric mucosa will manifest as a small rounded area of increased activity in the right lower quadrant.
* Normal activity will simultaneously appear in the stomach.


==Treatment==
==Treatment==
Treatment is surgical, consisting of a [[resection]] of the affected portion of the bowel.
[[Meckel's diverticulum medical therapy|Medical Therapy]] | [[Meckel's diverticulum surgery|Surgery]] | [[Meckel's diverticulum primary prevention|Primary Prevention]] | [[Meckel's diverticulum secondary prevention|Secondary Prevention]] | [[Meckel's diverticulum cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Meckel's diverticulum future or investigational therapies|Future or Investigational Therapies]]
 
 
 
==References==
{{reflist|2}}


==Case Studies==
[[Meckel's diverticulum case study one|Case #1]]


{{Congenital malformations and deformations of digestive system}}
{{Congenital malformations and deformations of digestive system}}
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{{WikiDoc Sources}}
{{WikiDoc Sources}}


[[Category:Gastroenterology]]
[[Category:Congenital disorders]]
[[Category:Congenital disorders]]
[[Category:Digestive system]]
[[Category:Pediatrics]]
[[Category:Gastroenterology]]
[[Category:Mature chapter]]
[[Category:Disease]]
[[Category:Disease]]

Latest revision as of 15:07, 10 January 2018

Meckel's diverticulum
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Synonyms and keywords:Meckel diverticulum, persistent intestinal end of vitelline duct, persistent omphalomesenteric duct, persistent vitelline duct

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Meckel's Diverticulum from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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