Meckel Diverticulum
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Basics
Description
- Most common congenital abnormality of the GI tract
- Results from incomplete obliteration of the omphalomesenteric duct in distal ileum
- 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%
- Occur 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
- Diverticulum attached to the umbilicus, abdominal wall, other viscera, or is free and unattached, leading to:
- Diverticulitis:
- Opening obstructed, leading to bacterial infection
- 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. The ectopic gastric mucosa can secrete gastric enzymes, leading to erosion of the mucosal wall, resulting in bleeding.
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Most common congenital abnormality of the GI tract
- Results from incomplete obliteration of the omphalomesenteric duct in distal ileum
- 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%
- Occur 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
- Diverticulum attached to the umbilicus, abdominal wall, other viscera, or is free and unattached, leading to:
- Diverticulitis:
- Opening obstructed, leading to bacterial infection
- 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. The ectopic gastric mucosa can secrete gastric enzymes, leading to erosion of the mucosal wall, resulting in bleeding.
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