dr.Mahyono,Sp.B, Sp.

BA

first described by its namesake, the German anatomist Johann Meckel,in 1809. It is the most common congenital anomaly of the gastrointestinal tract. a remnant of the vitelline (omphalomesenteric) duct. These anomalies may be asymptomatic or the cause of a number of complications

Diverticulum = sac-like protrusion of the colonic wall Diverticulosis = describes the presence of diverticuli Diverticulitis = inflammation of diverticuli

its true incidence is unknown. Most studies report the incidence to be around 2%. increased incidence in patients with certain congenital anomalies of the umbilicus. The male : female is about 3:1, 50% to 60% of all cases of a symptomatic Meckels diverticulum are discovered in the first 2 years of life.

50% to 60% of all cases of a symptomatic Meckels diverticulum are in the first 2 years of life Only about 15% of children are older than 4 years of age.

the classic description is MD is found on the antimesenteric border of the ileum : 1) 2 feet proximal to the ileocecal valve, 2) 2 cm in diameter, 3) 2 inches in length, and not attached to the abdominal wall

heterotopic tissue can act as a lead point for an intussusception, a bowel obstruction. Also, intestinal obstruction may be caused by a MD that is attached to the umbilicus by a mesodiverticular band. Similarly, a persistent vitelline artery may cause obstruction and/or volvulus.

it had been suggested that the gastritis and ulceration/bleeding of MDmay be due to colonization with H.pylori. the MD also may contain a wide variety of tumors, such as carcinoid, leiomyoma, gastrointestinal stromal tumor, angioma, and neurofibroma.

This laparoscopic view shows a long MD emanating from the antimesenteric border of the ileum. This is a true diverticulum and contains ectopic mucosa at the tip of the diverticulum (arrow).

A to F, Drawings illustrating MD and other remnants of the yolk sac. (From Moore KL: The Developing Human. Philadelphia, WB Saunders, 1988.)

The clinical presentation in symptomatic patients with a MD is quite varied. The 3 main forms of presentation are : 1. hemorrhage (40%-60%), 2. Obstruction (25%), 3. and diverticulitis (10%-20%).

The classic presentation of a child with a bleeding MD is a preschool patient with painless rectal bleeding.

The hemorrhage is episodic and usually ceases without treatment. A young child with hemoglobin positive stools and a chronic iron deficiency anemia must be investigated for a bleeding MD. Patients with diverticulitis often have symptoms that resemble appendicitis.

The diagnosis is dependent on the anatomic configuration and its presentation, signs, and symptoms. For example, patients with lower gastrointestinal bleeding need a complete description of the quality and frequency of the bloody stools. Rectal examination, and occasionally lower endoscopy, is useful in identifying other causes of lower gastrointestinal bleeding

Technetium-99m (99mTc) pertechnetate scintigraphy of the abdomen is commonly used to help detect ectopic gastric tissue in a MD. Noninvasive technique that may aid in the diagnosis of MD is wireless capsule endoscopy. Sometimes a combination of USG, computed tomography, and contrast enema the diagnosis of complicated, scintigraphy negative MD.

Technetium-99m pertechnetate scan of a patient with a Meckels diverticulum. Note the blush (arrow) above the bladder. (Courtesy of Kyo Lee, MD.)

Obstruction Bleeding Inflammation itis

Fistula Sepsis Perforation

May co-exist with IBD

Specimen showing blood in diverticulae

begins with adequate resuscitation. Resection can be accomplished by either a simple diverticulectomy or by a partial ileal resection. Most authors suggest that important to resect the ulcer if present , caused by the gastric secretions.

Appendicitis Bowel obstruction Colorectal cancer Gynaecological disease Inflammatory bowel disease Irritable bowel syndrome Ischemic colitis Pyelonephritis