Meckel Diverticulum

A Meckel diverticulum results from an incomplete obliteration of the vitelline duct and is situated near the ileocaecal valve on the antimesenteric border of

the ileum. It is usually about 2 cm long, located about 2 cm from the ileocecal valve. It is the most common form of congenital abnormality of the small intestine, occurring in about 2% of all infants, but mostly causes no clinical complaints. It contains all layers of the intestinal wall but the mucosa is (ectopic) gastric in origin in about 15%-20% of cases (Carty et al. 2005; Parker 2003; Berrooal et al. 1999).

In half of the patients with complaints clinical signs manifest in the first 2 years of life. Ulceration occurs only in those that contain ectopic gastric mucosa and thus is rare, but can cause occult fecal blood or frank blood in stool and anemia. Adhesions and formation of scar tissue can lead to obstructive ileus. The diverticulum can act as a lead point for ileocolic or ileoileal intussusception.

The visualization of a Meckel diverticulum is often unsuccessful. Plain films show only the complications caused by a Meckel diverticulum.

Plain film is indicated if obstruction or perforation is suspected. Meckel diverticulum is incidentally found by US (Fig. 5.14a), which may show cystic diverticula, and by enteroclysis. Small bowel or colon enemas can show the rather bigger diverticula. Scintigraphy may identify a Meckel diverticulum if it has gastric mucosa as a hot spot (Fig. 5.14b).

Fig. 5.14. a Meckel diverticulum as a lead point for an ileo-ileo-colic intussusception. Note the surrounding of diverticulum by intraluminal intestinal fluid. b Radioisotope uptake in gastric mucosa in a Meckel diverticulum (arrow)

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