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Meckel Diverticulum

Meckel Diverticulum is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Most common congenital abnormality of the GI tract
    • Results from incomplete obliteration of the omphalomesenteric duct
  • True diverticula (contains all layers):
    • 50% contain normal ileal mucosa.
    • 50% contain either gastric (most common), pancreatic, duodenal, colonic, endometrial, or hepatobiliary mucosa.
  • Rule of 2’s:
    • 2% prevalence in general population
    • 2% lifetime risk for complications, decreasing with age
    • Symptoms commonly occur around 2 yr of age:
      • 45% of symptomatic patients <2 yr old
    • Average length 2 in
    • Found within 2 ft of the ileocecal valve
  • Male-to-female ratio approximately equal, but more often symptomatic in males
  • Complications:
    • Obstruction and diverticulitis in adults
    • Hemorrhage and obstruction in children
    • Mean age 10 yr
    • Current mortality rate 0.0001%
    • Occurs more frequently in males
  • Obstruction:
    • Diverticulum attached to the umbilicus, abdominal wall, other viscera, or is free and unattached, leading to:
      • Intussusception: Diverticulum is the leading edge.
      • Volvulus: Persistent fibrous band leads to bowel rotation.
  • Diverticulitis:
    • Opening obstructed
    • Bacterial infection follows.
    • Presents like appendicitis (most common preoperative diagnosis with Meckel diverticulum)

Pediatric Considerations
  • Most common cause of significant lower GI bleeding in children.
  • Presents at age <5 yr with episodic painless, brisk, and bright-red rectal bleeding.

Etiology

Remnant of the omphalomesenteric duct that typically regresses by week 7 of gestation.

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Citation

Rosen, Peter, et al., editors. "Meckel Diverticulum." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307182/all/Meckel_Diverticulum.
Meckel Diverticulum. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307182/all/Meckel_Diverticulum. Accessed April 25, 2019.
Meckel Diverticulum. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307182/all/Meckel_Diverticulum
Meckel Diverticulum [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307182/all/Meckel_Diverticulum.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Meckel Diverticulum ID - 307182 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307182/all/Meckel_Diverticulum PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -