From the Archives of the AFIP

Abstract

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2%-3% of the population. It results from improper closure and absorption of the omphalomesenteric duct. Meckel diverticulum is the most common end result of the spectrum of omphalomesenteric duct anomalies, which also include umbilicoileal fistula, umbilical sinus, umbilical cyst, and a fibrous cord connecting the ileum to the umbilicus. The formation of Meckel diverticulum occurs with equal frequency in both sexes, but symptoms from complications are more common in male patients. Sixty percent of patients come to medical attention before 10 years of age, with the remainder of cases manifesting in adolescence and adulthood. Heterotopic gastric and pancreatic mucosa are frequently found histologically within the diverticula of symptomatic patients. The most common complications are hemorrhage from peptic ulceration, small intestinal obstruction, and diverticulitis. Although the clinical, pathologic, and radiologic features of the complications of Meckel diverticulum are well known, the diagnosis of Meckel diverticulum is difficult to establish preoperatively.

Perforated Meckel’s Diverticulum in an Adult

“…The majority of MD cases remain clinically silent during the entire lifetime, and their presence may be discovered incidentally during surgery, autopsy, or when performing small gastrointestinal studies [10,11]. On CT, MD may appear as a fluid-or air-filled blind-ending pouch that arises from the antimesenteric side of the distal ileum.…”

CT diagnosis of a post-embolization ischemic diverticulitis of Meckel

“…The bleeding is most often caused by the formation of a peptic ulcer in the wall of the ileum after the prolonged exposure of its mucosa to the acid secretions of ectopic stomach mucosa in the pit of the Meckel diverticulum. Hemorrhage is the most common complication of a diverticulum of Meckel with a broad clinical spectrum ranging from a slow and occult bleeding to a more dramatic manifestation of bright red rectal blood loss associated with hemodynamic instability (5). Catheter-based angiography is a powerful tool to trace the bleeding point and subsequent transcatheter embolization can stop the bleeding (6).…”

Diagnostic errors of right lower quadrant pain in children: beyond appendicitis

“…The most common clinical presentation is painless rectal bleeding. The incidence of gastric mucosa within bleeding Meckel's diverticula is estimated at 23%-80% [16,17]. Heterotopic pancreatic tissue is found in 5%-16% of cases [16].…”

“…The incidence of gastric mucosa within bleeding Meckel's diverticula is estimated at 23%-80% [16,17]. Heterotopic pancreatic tissue is found in 5%-16% of cases [16]. Gastric and pancreatic mucosa can also lead to inflammation of the diverticulum, with the abdominal pain mimicking appendicitis.…”