Meckels Diverticulum

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Cause

-  Congenitally incomplete obliteration of the vitelline duct forming diverticulum in small bowel

-  Usually disappears by 7 weeks gestation

-  97% Meckels, other path possible

 

Meckels

 

Features

-  Most common congenital abnormality of small intestine

-  Associated w enterocystomas, umbilical sinuses and omphaloileal fistulas

-  Ectopic gastric mucosa

-  Rule of 2s

-  2% of the population

-  2 inches in length

-  Found 2 feet proximal to ileocaecal valve

-  Massive painless rectal bleeding if < 2 years old --> shock

 

Associated S/S

-  Asymptomatic unless complicated

 

Complications

-  4% +/- complication rate

-  Bowel obstruction

-  35% on presentation

-  Abdominal pain

-  Omphalomesenteric band (most common), internal hernia, volvulus, intussusception

-  Haemorrhage

-  From PUD in ectopic mucosa

-  Usually presents as painless rectal bleeding

-  Inflammation --> Diverticulitis

-  Typically older patients

-  Abdominal pain: periumbilical --> RLQ

-  DDx Appendicits: PR bleeding prior

 

Ix

-  FBE: anaemia

-  AXR: enteroliths, obstruction, exclude other causes

-  Meckel Scan (technitium)

-  60% sensitivity in adults

-  85-90% sensitivity in children

-  Barium: Small bowel studies/Enteroclysis/Enema

 

Mx

-  Haemodyanimc stabilisation as required

-  Complicated Meckels

-  Surgical incision of diverticulum & adjacent ileum: laparatomy or laparscopy

-  Uncomplicated Meckels

-  Controvesrial, risk of surgery vs risk of complications