Meckels Diverticulum

Meckel's diverticulum is a remnant of the ompha-lomesenteric duct. It is located in the antimesen-

teric side of the ileum, usually within 60 cm of the ileocecal valve. This anomaly occurs in 0.5%-4% of the population, and is generally asymptomatic. Meckel's diverticulum can present clinically with rectal bleeding, inflammation, or obstruction. Obstruction can be produced by small bowel volvulus around an associated omphalomesenteric band (Fig. 1.70), incarceration in a hernia, hernia-tion of other bowel loops through the mesentery of the diverticulum or also the diverticulum may act as a lead point in intussusception. The most frequent form of presentation is painless hemorrhage in children under 5 years old. Bleeding is related to ulceration of heterotopic gastric mucosa, present in less than 25% of cases. The 99m-Tc pertechnetate scan has demonstrated high accuracy in detecting a diverticulum when isotope is taken up by ectopic gastric mucosa (Hayes 2004). It is difficult to prospectively diagnose a Meckel's diverticulum causing abdominal pain despite the wide variety of imaging techniques available, particularly if symptoms regress and diverticula bowel walls return to the normal appearance of any adjacent bowel loop. Radiographic findings are nonspecific in most cases of obstruction. Sonography is useful showing a pir-iform cystic or echogenic everted Meckel's diver-ticulum acting as a lead point in the apex of intussusception cases. US may also show an inflamed or torsioned diverticulum mimicking appendicitis. In these cases, localization of the lesion far from b a a c

Fig. 1.70a-d. Intestinal obstruction due to Meckel's diverticulum. a Plain radiograph showing multiple dilated bowel loops consistent with small bowel obstruction. Sagittal (b) and axial (c) US scan showing a subhepatic cystic, ovoid-shaped lesion with mural stratification of the wall ("gut signature") (arrows). d Surgical gross specimen of the same patient showing normal appendix and the volvulated Meck-el's diverticulum around an associated omphalomesenteric band [From Gallegq (1998)]

Fig. 1.70a-d. Intestinal obstruction due to Meckel's diverticulum. a Plain radiograph showing multiple dilated bowel loops consistent with small bowel obstruction. Sagittal (b) and axial (c) US scan showing a subhepatic cystic, ovoid-shaped lesion with mural stratification of the wall ("gut signature") (arrows). d Surgical gross specimen of the same patient showing normal appendix and the volvulated Meck-el's diverticulum around an associated omphalomesenteric band [From Gallegq (1998)]

the cecum, as well as an anteroposterior diameter superior to 2.5 cm, can help to make an accurate diagnosis (Gallego et al. 1998) (Fig. 1.70). As with the appendix, enteroliths may produce obstruction of the diverticulum and inflammation.

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