Makindo Medical Notes

Related Subjects: |Testicular Torsion |Paraphimosis |Meckel's diverticulum

📖 About

• Meckel’s Diverticulum = congenital true diverticulum of the ileum, due to incomplete obliteration of the vitelline (omphalomesenteric) duct.
• Located on the antimesenteric border of the ileum, usually within 2 feet of the ileocaecal valve.
• May contain ectopic gastric or pancreatic tissue → risk of ulceration and bleeding.

📏 Rule of 2s

• Occurs in ~2% of the population.
• 2:1 male predominance.
• Within 2 feet of the ileocaecal valve.
• ~2 inches long.
• Only 2% symptomatic.
• Often presents before age 2.

🔬 Histology

• True diverticulum (all intestinal wall layers present).
• Frequently contains ectopic gastric mucosa → acid secretion → ulceration.
• Occasional pancreatic tissue.

🩺 Clinical Presentation

• Children: Painless rectal bleeding (bright red or “currant jelly”), anaemia.
• Adults: Small bowel obstruction, diverticulitis (appendicitis mimic), abdominal pain.
• Rare: volvulus, intussusception, perforation.

📷 Intraoperative Pictures

🧪 Investigations

• Technetium-99m Pertechnetate Scan (“Meckel’s scan”): highlights ectopic gastric mucosa.
• H2 blockers (e.g. ranitidine) ↑ sensitivity by improving uptake.
• CT/MRI/Ultrasound → detect complications (obstruction, intussusception) but not specific.

⚕️ Management

• Symptomatic cases: Surgical resection (diverticulectomy ± segmental ileal resection).
• Incidental finding: Resect in children (prevent complications). In adults → case-by-case.
• Laparoscopic resection is preferred if feasible.

⚠️ Complications

• Bleeding – most common in children (from ectopic gastric mucosa).
• Obstruction – fibrous bands, intussusception, volvulus.
• Diverticulitis – mimics appendicitis.
• Perforation → peritonitis, urgent surgery.

🌟 Prognosis

• Excellent outcome if resected when symptomatic.
• Most asymptomatic diverticula remain undetected lifelong.
• Prophylactic resection in adults remains controversial.

💡 Teaching Pearl: Meckel’s diverticulum is the most common congenital GI anomaly. Think of it in a child with painless rectal bleeding + normal colonoscopy → order a Meckel’s scan.

📚 References

• Meckel's Diverticulum: Pathophysiology & Management
• Mayo Clinic: Clinical Manifestations
• Medscape Overview

Case – Meckel’s diverticulum (bleeding child)

A 5-year-old boy presents with sudden, painless maroon rectal bleeding and mild pallor; no diarrhoea, fever, or abdominal pain. Vitals: HR 118, BP normal; abdomen soft, non-tender. Hb 9.6 g/dL, CRP normal. After IV access and fluid resuscitation, a Technetium-99m pertechnetate “Meckel scan” shows focal uptake in the right lower quadrant, consistent with ectopic gastric mucosa in a Meckel’s diverticulum. Differential considered: intussusception, juvenile polyp, and infectious colitis (less likely given afebrile, painless bleed). Managed with crossmatch ± transfusion if needed, then laparoscopic diverticulectomy (or segmental resection if broad base/ulceration). Post-op recovery is uncomplicated; parents counselled on the “rule of twos” (2% prevalence, 2 feet from ileocaecal valve, 2 inches long, often symptomatic before age 2, 2 types of ectopic mucosa—gastric/pancreatic).