Epidemiology

• Prevalence: most common congenital gastrointestinal tract anomaly
• Rule of 2s for Meckel’s Diverticulum
  • 2% of the population
  • 2 feet from the ileocecal valve
  • 2 inches in length
  • 2 years is the most common age for symptomatic presentation
  • 2 types of heterotopic mucosa (gastric and pancreatic)

Etiology

• The omphalomesenteric duct (vitelline or vitellointestinal) is a patent tubular structure connecting the yolk sac to the alimentary tract in the embryo.
• The duct is normally obliterated by the 6�?th week of intrauterine life.
• Incomplete obliteration of the omphalomesenteric duct �?persistence of the proximal (intestinal) segment of the duct �?Meckel diverticulum
• There may be two types of mucosal lining
  • Native ileal mucosa
  • Ectopic mucosa
    • Most common: acid-producing gastric mucosa (�?60%)
    • Other types include pancreatic, colonic, and duodenal mucosa.

Pathophysiology

Clinical features

• Asymptomatic
  • Most common manifestation
• Symptomatic
  • Lower gastrointestinal bleeding (most common feature)
    • Presence of ectopic gastric mucosa or pancreatic tissue �?acid or enzyme secretion within the diverticulum �?ileal ulceration �?bleeding
    • Can manifest as:
      • Hematochezia
        • Indicates a brisk hemorrhage
      • Tarry stools
        • Indicate a slow hemorrhage
      • Currant jelly stools
        • Indicate intussusception with bowel ischemia

Diagnostics

Meckel scintigraphy scan (Meckel scan): a noninvasive nuclear medicine imaging technique using radiolabelled technetium (^99mTc), which is preferentially absorbed by the gastric mucosa and can identify ectopic gastric mucosa

Treatment

Complications

• Bowel obstruction (usually affects terminal ileum) due to
  • Intussusception
  • Volvulus