- Meckel's diverticulum
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Meckel's diverticulum Classification and external resources 
Meckel's diverticulumICD-10 C17.3, Q43.0 ICD-9 152.3, 751.0 OMIM 155140 DiseasesDB 7903 eMedicine med/2797 ped/1389 rad/425 MeSH D008467 A Meckel's diverticulum, a true congenital diverticulum, is a small bulge in the small intestine present at birth. It is a vestigial remnant of the omphalomesenteric duct (also called the vitelline duct or yolk stalk), and is the most frequent malformation of the gastrointestinal tract. It is present in approximately 2% of the population,[1] with males more frequently experiencing symptoms.
It was first described by Fabricius Hildanus in the sixteenth century and later named after Johann Friedrich Meckel, who described the embryological origin of this type of diverticulum in 1809.[2][3]
Contents
Presentation
Meckel's diverticulum is located in the distal ileum, usually within about 60–100 cm (2 feet) of the ileocecal valve. It is typically 3–5 cm long, runs antimesenterically and has its own blood supply. It is a remnant of the connection from the yolk-sac to the small intestine present during embryonic development.
A memory aid is the rule of 2s: 2% (of the population). 2 feet (from the ileocecal valve). 2 inches (in length). 2% are symptomatic. 2 types of common ectopic tissue (gastric and pancreatic). 2 years is the most common age at clinical presentation. 2 times more boys are affected.
However, the exact value for the above criteria range from 0.2-5 (for example, prevalence is probably 0.2-4%).
It can also be present as an indirect hernia, typically on the right side, where it is known as a "Hernia of Littre". A case report of strangulated umbilical hernia with Meckel's diverticulum has also been published in the literature.[4] Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, ischemia, and necrosis.
Symptoms
The majority of people afflicted with Meckel's diverticulum are asymptomatic.[5] If symptoms do occur, they typically appear before the age of two.
The most common presenting symptom is painless rectal bleeding such as melaena-like black offensive stools, followed by intestinal obstruction, volvulus and intussusception. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis. Also, severe pain in the epigastric region is experienced by the patient along with bloating in the epigastric and umbilical regions. At times, the symptoms are so painful such that they may cause sleepless nights with acute pain felt in the foregut region, specifically in the epigastric and umbilical regions.
Most of the time, bleeding occurs without warning and stops spontaneously. The symptoms can be extremely painful, often mistaken as just belly pain resulting from not eating or constipation.
Diagnosis
A technetium-99m (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them,[6] this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence. Other tests such as colonoscopy and screenings for bleeding disorders should be performed, and angiography can assist in determining the location and severity of bleeding. Meckel's occurs more often in males than females.
Treatment
Treatment is surgical. In patients with bleeding, strangulation of bowel, bowel perforation or bowel obstruction, treatment involves surgical resection of both the Meckel's diverticulum itself along with the adjacent bowel segment. In patients without any of the aforementioned complications, treatment involves surgical resection of the Meckel's diverticulum only.
Asymptomatic Meckel's diverticulum, some recommend that a search for Meckel's diverticulum in every case of appendicectomy/ laparotomy done for acute abdomen should be conducted, and if found, Meckel's diverticulectomy or resection should be performed to avoid secondary complications arising from it[7]
Notable patients
Major League Baseball player Chan Ho Park, then a pitcher with the San Diego Padres (currently with the Pittsburgh Pirates), suffered multiple episodes during the 2006 season in which mysterious internal bleeding caused him to lose a significant fraction of his blood volume. He was finally diagnosed with Meckel's diverticulum, which was surgically removed August 23, 2006.[8] Nirvana lead-singer Kurt Cobain is thought to have suffered from it as well as Samuel Cooper and George Washington.[citation needed]
External links
- Meckel Diverticulum at eMedicine
- Meckel's Diverticulum Scan — Children's Hospital Boston
- Meckel diverticulum (Image)
- Tutorials and intra-operative image of Meckel's (Weblink)
- Meckel's Diverticulum Technetium Scan Results (Image)
References
- ^ Elsayes KM, Menias CO, Harvin HJ, Francis IR (July 2007). "Imaging manifestations of Meckel's diverticulum". AJR Am J Roentgenol 189 (1): 81–8. doi:10.2214/AJR.06.1257. PMID 17579156. http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=17579156.
- ^ Meckel's diverticulum at Who Named It?
- ^ J. F. Meckel. Über die Divertikel am Darmkanal. Archiv für die Physiologie, Halle, 1809, 9: 421-453.
- ^ Tiu A, Lee D (2006). "An unusual manifestation of Meckel's diverticulum: strangulated paraumbilical hernia". N. Z. Med. J. 119 (1236): U2034. PMID 16807577.
- ^ Thurley PD, Halliday KE, Somers JM, Al-Daraji WI, Ilyas M, Broderick NJ (February 2009). "Radiological features of Meckel's diverticulum and its complications". Clin Radiol 64 (2): 109–18. doi:10.1016/j.crad.2008.07.012. PMID 19103339. http://linkinghub.elsevier.com/retrieve/pii/S0009-9260(08)00332-2.
- ^ Martin JP, Connor PD, Charles K (February 2000). "Meckel's diverticulum". Am Fam Physician 61 (4): 1037–42, 1044. PMID 10706156. http://www.aafp.org/afp/20000215/1037.html.
- ^ Tauro LF, George C, Rao BS, Martis JJ, Menezes LT, Shenoy HD (2010). "Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated?". Saudi J Gastroenterol 16 (3): 198–202. doi:10.4103/1319-3767.65199. PMC 3003224. PMID 20616416. http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2010;volume=16;issue=3;spage=198;epage=202;aulast=Tauro.
- ^ "Padres P Park undergoes surgery, will miss four weeks". ESPN.com. http://sports.espn.go.com/mlb/news/story?id=2559300. Retrieved 2007-07-25.
Congenital malformations and deformations of digestive system (Q35–Q45, 749–751) Upper GI tract EA/TEF (Esophageal atresia: types A, B, C, and D, Tracheoesophageal fistula: types B, C, D and E)
esophageal rings (Esophageal web · upper, Schatzki ring · lower)Lower GI tract Intestinal atresia (Duodenal atresia) · Meckel's diverticulum · Hirschsprung's disease · Intestinal malrotation · Dolichocolon · Enteric duplication cystAccessory Categories:- Congenital disorders of digestive system
- GI tract disorders
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