MECKEL’S DIVERTICULUM

·         Due to incomplete closure of Vitellointestinal duct/ Omphalomesentric duct.

·         True Diverticulum (i.e. containing all the layers of bowel wall)

·         Location at antimesentric border around 60 cms prior to ileo-caecal junction.

·         Incidence:- Male=Female

·         Cells lining the vitellointestinal duct are ‘pleuripotent’, ∴ heterotopic tissue is often present. [Gastric Mucosa(50%) >> Pancreatic Mucosa(5%)  > Colonic Mucosa]

·         Clinical features-

o   Majority- Asymptomatic

o   In symptomatic cases-

§  Gastrointestinal bleed/hemorrhage

·         Most common presentation

·         Source- chronic acid induced ulcer in ileum adjacent to ‘gastric mucosa containing’ Meckel’s diverticulum

§  Intestinal obstruction

·         Volvulus of small intestine around diverticulum attached to abdominal wall with a fibrous band

·         Intussusception of diverticulum into ileum/colon (may cause acute obstruction)

·         Incarceration in Littre’s hernia

§  Diverticulitis

·         More common in adults

·         Clinically indistinguishable from appendicitis

§  Neoplasms

·         Benign- leomyoma, lipoma, angioma

·         Malignant- adenocarcinoma, carcinoid, sarcoid

·         Diagnosis- Scintigraphy

·         Treatment-

o   Asymptomatic-

§  Children- prophylactic resection

§  Adults- prophylactic resection done in selected patients

o   Symptomatic-

§  Resection anastomosis