MECKEL'S DIVERTICULUM



I. Pathophysiology and epidemiology
  1. Caused by a failure of regression of the omphalomesenteric (vitelline) duct (normally occurs during embryonic week 5-7)
  2. Consists of an outpouching of small intestine (on anti-mesenteric border)
  3. In about 50% of cases contains gastric mucosa, which can ulcerate and bleed
  4. 10% become symptomatic, typically prior to 2yo
    1. Most commonly with occult hematochezia in childhood (usually painless)
    2. In rarer cases can see intestinal obstruction due to volvulus or intussusception
    3. Diverticulitis of Meckel's diverticula can occur
  5. Male:Female ratio about 2:1
  6. In adults with no prior history of symptoms from a Meckel's diverticulum, risk of becoming symtpomatic is about 2%
II. Diagnosis
  1. "Meckel's scan"
    1. Radionucleide scan with technetium-99M pertechnetate
    2. Has affinity for oxyntic cells and identifies ectopic gastric mucosa
    3. Sensitivity 90%; specificity 95%
  2. Other imaging modalities are generally inferior
III. Management
  1. If symptomatic, surgical resection is generally performed
  2. Incidentally-discovered Meckel's diverticula in children are often resected as well
(Sources include Core Content Review of Family Medicine, 2012)