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Meckel Diverticulum

Updated : January 9, 2024





Background

Meckel Diverticulum is a congenital anomaly that involves a pouch or diverticulum in the small intestine, specifically the ileum. Named after the German anatomist Johann Friedrich Meckel who first described it in the early 19th century, this condition results from incomplete closure of the omphalomesenteric duct during embryonic development.

The omphalomesenteric duct normally connects the developing gut to the yolk sac but typically regresses by the 7th week of gestation. When this regression is incomplete, a Meckel Diverticulum may persist. 

This diverticulum is usually on the antimesenteric border of the ileum, around 2 feet from the ileocecal valve. While many individuals with Meckel Diverticulum remain asymptomatic, it can lead to complications, particularly when it exhibits pathological features. Complications may include inflammation, bleeding, intestinal obstruction, or the formation of gastric or pancreatic tissue within the diverticulum. 

Meckel Diverticulum is noteworthy for its potential to mimic other gastrointestinal conditions, making diagnosis challenging. Nuclear medicine scans, such as Technetium-99m pertechnetate scintigraphy, are often employed for accurate identification.

Surgical intervention may be necessary if complications arise or if the diverticulum is suspected to be the cause of abdominal symptoms. Given its congenital nature, Meckel Diverticulum is a condition that typically becomes evident in childhood or early adulthood. Awareness of its potential presence and complications is essential for timely diagnosis and management. 

 

Epidemiology

  • Prevalence: Meckel Diverticulum is a common congenital anomaly of gastrointestinal tract, with a prevalence ranging from 2% to 4% in the general population. It is more frequently observed in males than females, with a male-to-female ratio typically ranging from 2:1 to 3:1. 
  • Age Distribution: This congenital anomaly is often diagnosed in childhood or early adulthood. The majority of cases become clinically apparent before the age of 10, with a peak incidence in the first two years of life. However, Meckel Diverticulum can also be discovered incidentally later in life, especially when it remains asymptomatic. 
  • Racial and Ethnic Variations: Meckel Diverticulum’s prevalence shows variations among different racial and ethnic groups. While comprehensive data on these variations are limited, studies have suggested potential differences in occurrence among diverse populations. 
  • Association with Symptomatic Cases: Symptomatic cases, where Meckel Diverticulum leads to complications such as bleeding, inflammation, or obstruction, are less common. These complications tend to be more prevalent in adults than in children. 
  • Incidence of Complications: The lifetime risk of experiencing complications from Meckel Diverticulum is estimated to be around 4-6%. Complications such as gastrointestinal bleeding and inflammation are more likely to manifest in individuals with symptomatic Meckel Diverticulum. 
  • Diagnostic Challenges: Due to its often-asymptomatic nature and the potential to mimic other gastrointestinal conditions, Meckel Diverticulum can be challenging to diagnose. Nuclear medicine scans, especially Technetium-99m pertechnetate scintigraphy, play a crucial role in identifying and confirming the presence of Meckel Diverticulum. 

 

Anatomy

Pathophysiology

  • Persistence of Omphalomesenteric Duct: Meckel Diverticulum occurs when the omphalomesenteric duct persists, creating a small outpouching from the wall of the small intestine. This outpouching represents the diverticulum. 
  • Location: Meckel Diverticulum is most located on antimesenteric border of the ileum, approximately 2 feet proximal to the ileocecal valve. It is often found on the side of the intestine opposite the mesentery. 
  • Heterotopic Tissue: The diverticulum may contain heterotopic tissue, such as gastric, pancreatic, or duodenal mucosa. This tissue can lead to complications like peptic ulcers or bleeding if it produces acid. 
  • Complications: Meckel Diverticulum is usually asymptomatic, but complications can arise. Gastrointestinal bleeding, inflammation (diverticulitis), and obstruction are common complications. Bleeding often results from acid secretion by gastric mucosa in the diverticulum, leading to erosions and ulcerations. 
  • Gastrointestinal Bleeding: The acid-producing gastric tissue within the diverticulum can irritate the adjacent ileal mucosa, leading to ulcer formation and subsequent bleeding. This bleeding is often painless and can manifest as melena (black, tarry stools) or hematochezia (bright red blood in stools). 
  • Inflammation: Inflammatory changes in Meckel Diverticulum may result from bacterial overgrowth, causing diverticulitis. This may lead to localized pain, tenderness, and fever. 
  • Obstruction: Obstruction may occur if the diverticulum causes intussusception or if it becomes trapped in a hernia sac, leading to bowel obstruction. 
  • Technetium-99m Pertechnetate Scintigraphy: Diagnostic imaging, such as technetium-99m pertechnetate scintigraphy, can help identify Meckel Diverticulum by detecting ectopic gastric mucosa in the diverticulum. 

Etiology

  • Incomplete Closure of Omphalomesenteric Duct: The primary cause of Meckel Diverticulum is the failure of the omphalomesenteric duct to completely close during embryonic development. In a normal course of development, this duct obliterates, leaving no remnants. However, if remnants persist, they can form a pouch-like diverticulum. 
  • Timing of Developmental Anomaly: The critical period for the formation of Meckel Diverticulum is during the early weeks of gestation when the embryo is developing its gastrointestinal tract. The omphalomesenteric duct should ideally close by the 7th week. 
  • Heterotopic Tissue Inclusion: In addition to the anatomical pouch formation, Meckel Diverticulum may also include heterotopic tissue, such as gastric or pancreatic cells. This inclusion of different tissue types can contribute to complications and symptoms associated with Meckel Diverticulum. 
  • Congenital Nature: Meckel Diverticulum is considered a congenital anomaly, meaning it is present at birth. The diverticulum persists throughout an individual’s life unless removed surgically. 
  • Genetic and Familial Factors: There is no strong evidence to suggest a clear genetic basis for Meckel Diverticulum. However, there may be a slightly increased risk in individuals with a family history of the condition. 
  • Sexual Predilection: Meckel Diverticulum is more common in males than females, with a male-to-female ratio ranging from 2:1 to 3:1. 

 

Genetics

Prognostic Factors

  • Age at Presentation: The age at which Meckel Diverticulum presents can impact the prognosis. Complications are more commonly observed in older individuals, and symptomatic cases often become apparent in childhood or early adulthood. 
  • Complications: The development of complications, such as gastrointestinal bleeding, inflammation, or obstruction, can influence the prognosis. Gastrointestinal bleeding, especially if severe or recurrent, may require medical intervention. 
  • Symptomatic vs. Asymptomatic Cases: Asymptomatic cases often have a better prognosis as they may not require medical attention. Symptomatic cases, particularly those with complications, may require surgical intervention, influencing the overall prognosis. 
  • Type and Severity of Complications: The type and severity of complications, such as the extent of gastrointestinal bleeding or the degree of inflammation, can impact the prognosis. Severe complications may necessitate more aggressive management. 
  • Prompt Diagnosis and Treatment: Early diagnosis and appropriate management of complications contribute to a better prognosis. Timely surgical intervention may be required in cases of severe bleeding, inflammation, or obstruction. 
  • Presence of Heterotopic Tissue: The presence of heterotopic tissue within the Meckel Diverticulum, such as gastric or pancreatic cells, can contribute to complications. Complications related to acid secretion or inflammation may influence the prognosis. 
  • Surgical Intervention: The need for surgical intervention, either to address complications or as a prophylactic measure, can impact the overall prognosis. Surgical removal of Meckel Diverticulum is often curative and improves the prognosis for individuals with symptomatic or complicated cases. 
  • Individual Health Status: The overall health and medical conditions of the individual can influence the ability to tolerate and recover from complications. 
  •  

Clinical History

  • Age of Presentation: Meckel Diverticulum is most diagnosed in childhood or early adulthood. Symptomatic cases often become apparent before the age of 10, with a peak incidence in the first two years of life. 
  • Asymptomatic Cases: Many individuals with Meckel Diverticulum remain asymptomatic throughout their lives. Asymptomatic cases may be discovered incidentally during imaging studies for unrelated issues. 
  • Symptomatic Cases: Symptomatic cases may present with complications such as gastrointestinal bleeding, inflammation, or obstruction.  
  • Gastrointestinal Bleeding: Gastrointestinal bleeding is a common presentation, often manifested as painless rectal bleeding. Blood may be bright red and typically occurs without an obvious cause. 
  • Anemia: Chronic or recurrent gastrointestinal bleeding may lead to iron-deficiency anemia, which can be a presenting feature. Symptoms of anemia, like fatigue and weakness, may be reported. 
  • Abdominal Pain: In cases of inflammation or obstruction, abdominal pain may be a prominent symptom. The pain may be crampy and localized to the lower abdomen. 
  • Changes in Bowel Habits: Obstruction caused by Meckel Diverticulum may result in changes in bowel habits, including abdominal distension and constipation. 
  • Associated Comorbidities: Meckel Diverticulum is typically not associated with specific comorbidities. However, the presence of heterotopic tissue within the diverticulum, such as gastric or pancreatic cells, may contribute to complications. 
  • Acuity of Presentation: Acuity of presentation varies depending on the nature and severity of complications. Gastrointestinal bleeding may present acutely with sudden onset of rectal bleeding. Inflammatory complications may present with acute abdominal pain. 

Physical Examination

  • Abdominal Inspection: Inspect the abdomen for any signs of distension or asymmetry. Note any visible pulsations or masses. 
  • Palpation: Perform gentle palpation to assess for tenderness, especially in the lower abdomen. Look for signs of guarding or rigidity, which may indicate inflammation. 
  • Deep Palpation: Perform deep palpation to assess for any palpable masses or areas of tenderness. Pay attention to the presence of rebound tenderness, which may suggest peritonitis. 
  • Rectal Examination: Conduct a rectal examination to assess for the presence of fresh or occult blood. Note any tenderness or masses felt during the examination. 
  • Vital Signs: Measure vital signs, including blood pressure, heart rate, respiratory rate, and temperature. Evaluate for signs of hemodynamic instability, which may indicate severe gastrointestinal bleeding. 
  • Skin Examination: Examine the skin for pallor, which may be indicative of chronic or acute blood loss. Look for signs of jaundice if heterotopic gastric tissue within the Meckel Diverticulum causes peptic ulcers and bleeding. 
  • Evaluation of Bowel Sounds: Listen to bowel sounds to assess for normal or increased activity. Absence of bowel sounds may indicate bowel obstruction. 
  • Digital Rectal Examination (DRE): Perform a digital rectal examination to assess for melena or occult blood. Note any masses, tenderness, or abnormal findings. 
  • Assessment of Abdominal Rigidity: Evaluate for signs of abdominal rigidity or guarding, which may suggest peritonitis associated with inflammation or perforation. 
  •  

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

  • Appendicitis: Inflammation of the appendix can present abdominal pain, tenderness, and fever, closely resembling symptoms of Meckel Diverticulum. 
  • Gastrointestinal Bleeding: Conditions such as peptic ulcers, inflammatory bowel disease, or angiodysplasia can cause gastrointestinal bleeding, leading to symptoms similar to Meckel Diverticulum. 
  • Inflammatory Bowel Disease (IBD): ulcerative colitis or Crohn’s disease can present with abdominal pain, diarrhea, and rectal bleeding, overlapping with some symptoms of Meckel Diverticulum. 
  • Gastroenteritis: Infections causing inflammation of the gastrointestinal tract may present abdominal pain, diarrhea, and fever, mimicking some symptoms of Meckel Diverticulum. 
  • Intestinal Obstruction: Conditions such as volvulus, hernias, or intussusception can lead to bowel obstruction, presenting with abdominal pain, distension, and vomiting, similar to complications of Meckel Diverticulum. 
  • Peptic Ulcer Disease: Ulcers may cause upper gastrointestinal bleeding, leading to melena or hematemesis, resembling bleeding complications associated with Meckel Diverticulum. 
  • Diverticulitis: Inflammation of colonic diverticula, especially in the sigmoid colon, can present with lower abdominal pain and tenderness, overlapping with symptoms of Meckel Diverticulum. 
  • Intestinal Ischemia: Conditions causing reduced blood supply to the intestines, such as mesenteric ischemia, can lead to abdominal pain and potentially mimic some complications of Meckel Diverticulum. 
  • Gastrointestinal Tumors: Tumors, such as gastrointestinal stromal tumors (GISTs) or colorectal cancer, may present with abdominal pain, bleeding, or obstruction, resembling symptoms associated with Meckel Diverticulum. 
  • Hemorrhoids: Hemorrhoids can cause rectal bleeding and discomfort, mimicking some symptoms associated with Meckel Diverticulum. 

 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

  • Asymptomatic Cases: Observation is often recommended for asymptomatic Meckel Diverticulum, especially if discovered incidentally during imaging studies for unrelated issues. 
  • Symptomatic Cases without Complications: Conservative management may be considered for symptomatic cases without complications. Symptomatic treatment of pain and monitoring for any changes in symptoms may be appropriate. 
  • Gastrointestinal Bleeding: In cases of severe or recurrent gastrointestinal bleeding, surgical intervention may be necessary. Surgical options include diverticulectomy or segmental resection of the affected bowel. 
  • Inflammation or Obstruction: In cases of inflammation or obstruction, surgical removal of the Meckel Diverticulum is often indicated. Resection of the affected segment of the small intestine may be performed. 
  • Emergency Surgery for Complications: Emergency surgery may be required for complications such as perforation, peritonitis, or massive gastrointestinal bleeding. Immediate surgical intervention aims to address the specific complication and stabilize the patient. 
  • Heterotopic Tissue Management: If Meckel Diverticulum contains heterotopic tissue (e.g., gastric, or pancreatic cells) causing complications, surgical excision is often recommended. 
  • Preventive Surgery: Prophylactic surgery may be considered in certain high-risk groups, such as those with incidental discovery during other abdominal surgeries or individuals with a history of recurrent symptoms. 
  • Diagnostic Imaging: Technetium-99m pertechnetate scintigraphy is a diagnostic imaging modality commonly used to confirm the presence of Meckel Diverticulum. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

non-pharmacological treatment of Meckel Diverticulum

Lifestyle modifications: 

  • Healthy Diet: A well-balanced diet including vegetables, fruits, whole grains, and lean proteins. Adequate fiber intake can support regular bowel movements and help prevent constipation. 
  • Hydration: Stay hydrated by consuming adequate amount of water throughout the day. Proper hydration can contribute to overall gastrointestinal health. 
  • Avoiding Tobacco and Excessive Alcohol: If applicable, avoiding tobacco use and limiting alcohol consumption. Both tobacco and excessive alcohol intake can have negative effects on gastrointestinal health. 
  • Regular Medical Check-ups: Undergoing regular medical check-ups and follow-up appointments with healthcare providers. Regular monitoring helps to identify & address any emerging health concerns. 
  • Symptom Awareness: Being aware of the symptoms associated with Meckel Diverticulum and seeking prompt medical attention if new or concerning symptoms arise. Prompt medical care can help manage potential complications early. 
  • Adherence to Medical Advice: Adhering to any specific recommendations or restrictions provided by healthcare providers, especially after surgical intervention. Following postoperative care instructions to support recovery. 

 

Use of analgesics or antispasmodic agents in the treatment of Meckel Diverticulum

Meckel diverticulum is a congenital pouch or outpouching of the small intestine, and its treatment typically involves surgical intervention when complications arise, such as inflammation, bleeding, or obstruction.

Analgesics and antispasmodic agents may be used to manage symptoms associated with Meckel diverticulum, especially in cases of abdominal pain or discomfort. However, it is crucial to note that these medications do not address the underlying issue and are considered supportive measures. 

Analgesics (e.g., Ibuprofen): 

  • Ibuprofen and other nonsteroidal anti-inflammatory drugs may be used to alleviate pain associated with Meckel diverticulum. NSAIDs acts by reducing inflammation and blocking pain signals. While NSAIDs can be effective for pain relief, they should be used cautiously, especially in individuals with gastrointestinal bleeding or ulcers, as they may exacerbate these conditions. 

Antispasmodic Agents (e.g., Hyoscyamine, Dicyclomine): 

  • Antispasmodic agents can help relieve abdominal cramps and spasms associated with Meckel diverticulum. These medications work by relaxing smooth muscles in the gastrointestinal tract. It is important to use antispasmodic agents under the guidance of a healthcare professional, and their use may be contraindicated in certain medical conditions. 

 

use of Simple diverticulectomy in the treatment of meckel diverticulum

Simple diverticulectomy is a surgical procedure commonly used in the treatment of Meckel diverticulum when surgical intervention is warranted.

Meckel diverticulum is a congenital pouch or outpouching of the small intestine that may require removal under certain circumstances, such as when complications arise. Here is an overview of the use of simple diverticulectomy in the treatment of Meckel diverticulum: 

Simple Diverticulectomy: 

  • Indications: Simple diverticulectomy is typically performed when Meckel diverticulum causes complications, such as bleeding, inflammation (diverticulitis), obstruction, or the presence of symptomatic gastric or pancreatic tissue within the diverticulum (heterotopic mucosa). 

Surgical Procedure: 

  • Incision: The surgery begins with an abdominal incision to access the affected area. 
  • Identification: The surgeon identifies and isolates the Meckel diverticulum. 
  • Diverticulectomy: The diverticulum is then excised (removed) from the small intestine. This removal includes cutting or suturing the connection to the small intestine to prevent further complications. 
  • Closure: The incisions made during the surgery are closed using sutures or staples. 
  • Postoperative Care: Patients typically undergo a period of postoperative monitoring to ensure proper healing and to manage any potential complications. Pain management and supportive care are provided during the recovery period. 
  • Outcome: Simple diverticulectomy is effective in removing the Meckel diverticulum and addressing complications associated with it. The outcome is often favorable, and patients can experience relief from symptoms and a reduced risk of future complications. 

 

use of Segmental resection in the treatment of meckel diverticulum

Segmental resection is a surgical procedure that involves the removal of a segment of the intestine, and it may be considered in the treatment of Meckel diverticulum under certain circumstances. Meckel diverticulum is a congenital pouch or outpouching of the small intestine that may require surgical intervention in cases of complications. 

Segmental Resection: 

  • Indications: Segmental resection may be indicated when Meckel diverticulum causes complications such as bleeding, inflammation (diverticulitis), obstruction, or the presence of symptomatic gastric or pancreatic tissue within the diverticulum (heterotopic mucosa). If the diverticulum is associated with a significant length of involved intestine or if there is extensive damage to the adjacent bowel, segmental resection may be preferred. 

Surgical Procedure: 

  • Incision: The surgery begins with an abdominal incision to access the affected area. 
  • Identification: The surgeon identifies and isolates the Meckel diverticulum. 
  • Segmental Resection: A portion of the small intestine, including the Meckel diverticulum, is removed. The length of resection depends on the extent of involvement and the surgeon’s judgment. 
  • Intestinal Continuity: The remaining healthy portions of the small intestine are then reconnected (anastomosed) to maintain intestinal continuity. 
  • Closure: The incisions made during the surgery are closed using sutures or staples. 
  • Postoperative Care: Patients undergo a period of postoperative monitoring to ensure proper healing and to manage any potential complications. Pain management and supportive care are provided during the recovery period. 
  • Outcome: Segmental resection is effective in removing the affected portion of the small intestine, including the Meckel diverticulum, and addressing complications. The outcome is often favorable, and patients can experience relief from symptoms and a reduced risk of future complications. 

management of meckel diverticulum

Acute Phase: 

  • Diagnosis and Staging: Accurate diagnosis through imaging studies (e.g., CT scans) and endoscopy. Staging to assess the extent of Meckel diverticulum and associated complications. 
  • Symptomatic Relief: Use of analgesics (e.g., ibuprofen) and antispasmodic agents (e.g., hyoscyamine, dicyclomine) to manage abdominal pain and discomfort. 
  • Fluid and Electrolyte Management: Intravenous fluids may be administered to maintain hydration. Monitoring and correction of electrolyte imbalances. 
  • Antibiotic Therapy: Antibiotics may be prescribed if there is evidence of infection or diverticulitis. 
  • Surgical Intervention: Emergency surgery may be required for complications such as bleeding, perforation, or obstruction. Surgical options include simple diverticulectomy or segmental resection, depending on the severity and nature of complications. 

Chronic Phase: 

  • Postoperative Monitoring: Regular follow-up appointments to monitor postoperative recovery. Imaging studies (e.g., CT scans) assess healing and identify any potential issues. 
  • Adjuvant Therapy: Depending on the specific situation, adjuvant therapies such as antibiotics or further interventions may be recommended. 
  • Symptom Management: Continued use of medications for symptomatic relief, as needed. Monitoring and managing any persistent symptoms. 
  • Complication Prevention: Lifestyle modifications and dietary changes to prevent complications. Education on recognizing and managing symptoms promptly. 
  • Long-Term Surveillance: Periodic monitoring for potential long-term complications or recurrence. 
  • Nutritional Support: Addressing nutritional needs, especially if there were issues such as malabsorption or nutritional deficiencies. 
  • Psychosocial Support: Providing emotional and psychological support to cope with the impact of the condition and surgery. 

 

Medication

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Meckel Diverticulum

Updated : January 9, 2024




Meckel Diverticulum is a congenital anomaly that involves a pouch or diverticulum in the small intestine, specifically the ileum. Named after the German anatomist Johann Friedrich Meckel who first described it in the early 19th century, this condition results from incomplete closure of the omphalomesenteric duct during embryonic development.

The omphalomesenteric duct normally connects the developing gut to the yolk sac but typically regresses by the 7th week of gestation. When this regression is incomplete, a Meckel Diverticulum may persist. 

This diverticulum is usually on the antimesenteric border of the ileum, around 2 feet from the ileocecal valve. While many individuals with Meckel Diverticulum remain asymptomatic, it can lead to complications, particularly when it exhibits pathological features. Complications may include inflammation, bleeding, intestinal obstruction, or the formation of gastric or pancreatic tissue within the diverticulum. 

Meckel Diverticulum is noteworthy for its potential to mimic other gastrointestinal conditions, making diagnosis challenging. Nuclear medicine scans, such as Technetium-99m pertechnetate scintigraphy, are often employed for accurate identification.

Surgical intervention may be necessary if complications arise or if the diverticulum is suspected to be the cause of abdominal symptoms. Given its congenital nature, Meckel Diverticulum is a condition that typically becomes evident in childhood or early adulthood. Awareness of its potential presence and complications is essential for timely diagnosis and management. 

 

  • Prevalence: Meckel Diverticulum is a common congenital anomaly of gastrointestinal tract, with a prevalence ranging from 2% to 4% in the general population. It is more frequently observed in males than females, with a male-to-female ratio typically ranging from 2:1 to 3:1. 
  • Age Distribution: This congenital anomaly is often diagnosed in childhood or early adulthood. The majority of cases become clinically apparent before the age of 10, with a peak incidence in the first two years of life. However, Meckel Diverticulum can also be discovered incidentally later in life, especially when it remains asymptomatic. 
  • Racial and Ethnic Variations: Meckel Diverticulum’s prevalence shows variations among different racial and ethnic groups. While comprehensive data on these variations are limited, studies have suggested potential differences in occurrence among diverse populations. 
  • Association with Symptomatic Cases: Symptomatic cases, where Meckel Diverticulum leads to complications such as bleeding, inflammation, or obstruction, are less common. These complications tend to be more prevalent in adults than in children. 
  • Incidence of Complications: The lifetime risk of experiencing complications from Meckel Diverticulum is estimated to be around 4-6%. Complications such as gastrointestinal bleeding and inflammation are more likely to manifest in individuals with symptomatic Meckel Diverticulum. 
  • Diagnostic Challenges: Due to its often-asymptomatic nature and the potential to mimic other gastrointestinal conditions, Meckel Diverticulum can be challenging to diagnose. Nuclear medicine scans, especially Technetium-99m pertechnetate scintigraphy, play a crucial role in identifying and confirming the presence of Meckel Diverticulum.