Fabricius hildanus first described the birth defect in 1598, but the condition is named for johann f. Meckel s diverticulum md is the most common gastrointestinal congenital malformation approximately 2% in the overall population. Meckels diverticulum an overview sciencedirect topics. A meckel diverticulum is tissue left over from when the babys digestive tract was forming before birth. Meckels diverticulum surgical treatment ncbi bookshelf. Meckel diverticulum childrens health issues msd manual. If it causes symptoms, meckel s diverticulum can be repaired with surgery. Patients with suspected intestinal obstruction should be explored through a generous laparotomy incision. Meckel diverticulum msd manual professional edition. Meckel s diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. Meckels diverticulum occurs in approximately 1%3% of the population with a maletofemale ratio of 2. Meckel s diverticulum is a congenital present at birth outpouching or bulge in the lower part of the small intestine. The meckel scan is a valuable diagnostic procedure in nuclear medicine.
Meckel s diverticulum is the most common congenital anomaly of the gastrointestinal tract. Meckel scan special instructions at the discretion of the referring clinician, patients may be pretreated with an h 2blocker or proton pump inhibitor. The most common presenting symptom is painless rectal bleeding, followed by intestinal obstruction, volvulus and intussusception. Rule of 2s in meckel diverticulum radiology reference. The patient must fast from midnight prior to the scan in babies and small children omitting one feed prior to the scan will suffice. It results from incomplete obliteration of the vitelline duct leading to the formation of a true diverticulum of the small intestine 1. A meckel s diverticulum, a true congenital diverticulum, is a slight bulge in the small intestine present at birth and a vestigial remnant of the omphalomesenteric duct also called the vitelline duct or yolk stalk. A systematic pubmedmedline database search using the terms meckel and meckel s combined with diverticulum. Having its own blood supply, meckels diverticulum is susceptible to obstruction or infection. Meckel s diverticulum is a common incidental finding at laparotomy.
It is normally located on the antimesenteric border of the terminal ileum within 80100 cm of the ileocecal valve and is on average. The vast majority of those with meckel s diverticulum are asymptomatic. Meckels diverticulum is a congenital condition characterized by the presence of a small sac attached to the intestinal wall, at the junction where the small and large intestines meet. If you have a diverticulum, the fluid will gather around the. Other congenital anomalies occur in about onethird of the cases and it is estimated that meckel s diverticulum is a cause of clinical disease in 15% to 25% of people in whom it occurs.
Peritoneal encapsulation is a rare abnormality of embryonic development and may present with obstruction, although it too is usually asymptomatic. Meckels diverticulum md is the most common congenital abnormality of the gastrointestinal gi tract. Jan 18, 2016 surgical treatment children with meckels diverticulitis or a bleeding meckels diverticulum are operated on by using a transverse appendectomy incision with medial extension if necessary. Of those lesions that are found incidentally, males and females are equally affected.
It was first described in 1809 by the german anatomist johann meckel 1. It is seen in 2% of the population, and it is caused by failure of the omphalomesenteric duct to regress. This lesion is found in 12% of the general population. Meckel s diverticulum is rare and accounts for only 2% of the general population. Final interpretation of a meckel scan, like other scintigraphic procedures, is vitally and directly influenced by the quality with which it is performed and the appropriateness of the imaging parameters for the individual patient. Perforation of the meckels diverticulum with a chicken bone. A meckels diverticulum, a true congenital diverticulum, is a small bulge in the small intestine present at birth. Meckel s diverticulum is an abnormal pouch in the intestine thats present from birth. A meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is caused by an incomplete obliteration of the omphalomesenteric duct. Meckel s diverticulum is the most common congenital malformation of gastrointestinal tract. Two of these cases were apparentiy examples of meckeis diverticulum, unrecognized as such, inasmuch as this report antedated meckels description by ioo years.
The scan procedure consists of injecting into the veins, a liquid with small amounts of radioactive molecules in it, called technetium99m. This blind segment or small pouch is about 36 cm 2 inch long and may have a greater lumen diameter than that of the ileum. Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage. Meckel diverticulum is the most common congenital gastrointestinal malformation, but it is rarely symptomatic. Moreover, symptoms accompanying meckels diverticulum, which include hemorrhage, intestinal obstruction, intussusception, perforation, and diverticulitis, emerge less commonly with age, and more than 70% of symptomatic patients are under the age of 20 years 2. Meckel s diverticulum is a small abnormality in the small intestine that is present at birth. Meckel s diverticulum is the most prevalent congenital anomaly of the gi tract 2% of the general population 2% prevalence, 2. Meckels diverticulum is a congenital gastrointestinal tract malformation mostly in pediatric population but also seen in adults. Despite this, it is an uncommon cause of acute abdomen and is often not correctly diagnosed preoperatively this article focuses on meckel diverticulitis. It is the most common birth defect that occurs in the digestive system. Symptomatic meckels occur disproportionately in male compared to females in a ration of 24. This is most often gastric, but may also be pancreatic, jejunal or colonic mucosa.
Meckel s diverticulum is a developmental anomaly of the intestinal tract which is found in about 2 per cent of all adults. Studies reporting on the epidemiology of meckel s diverticulum were included. Meckel s diverticulum is an embryonic remnant of the vitelloumbilical duct, which fails to atrophy completely and becomes a blind pouch projecting from the antimesenteric border of the ileum. Feb 27, 2019 meckels diverticulum is a common congenital condition characterized by the presence of a small pouch in the intestinal wall, at the junction where the small and large intestines meet. Meckel diverticulum merck manuals professional edition. It is generally about 2 inches long and located 2 feet proximal to the ileocecal valve. It is a vestigial remnant of the omphalomesenteric duct also called the vitelline duct or yolk stalk, and is the most frequent malformation of the gastrointestinal tract. This abnormality sometimes contains gastric mucosa from the stomach, which can cause local ulcers and bleeding. If a meckel s is present but does not contain gastric mucosa the scan will show no uptake. Meckels diverticulum is a common congenital condition characterized by the presence of a small pouch in the intestinal wall, at the junction where the small and large intestines meet. How boston children s hospital approaches meckel s diverticulum scans. Meckels diverticulum definition of meckels diverticulum.
Contact your doctor if you or your child develops symptoms. Learn about the symptoms of this condition and how its diagnosed and treated. Meckels diverticulum scan boston childrens hospital. It can do this by infolding on itself into the passageway of the intestine intussusception. A meckel s diverticulum scan is a nuclear medicine test that detects the abnormallylocated gastric mucosa. Meckel diverticulitis is the inflammation of meckel diverticulum, which is the most common congenital structural abnormality of the gastrointestinal tract 3. Meckel diverticulum knowledge for medical students and. Approximately 98 of people afflicted with meckel s diverticulum are asymptomatic.
The substance is picked up by cells in the diverticulum, which can then be seen using a radiationsensing camera. Meckel diverticulum is a true diverticulum, containing all the normal bowel wall layers. Meckels diverticulum is the most common congenital anomaly of small bowel that occurs in around 2% of population. Snyder, in pediatric surgery seventh edition, 2012. If doctors think bleeding from the rectum is caused by a meckel diverticulum, they do an imaging study called a meckel scan. A meckel s diverticulum containing gastric mucosa 40 50% can be visualised within one hour of intravenous injection. Gastric mucosa is the mucous membrane layer of the stomach. Meckel s diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. Perforation of meckels diverticulum, peritonitis, and.
Most 75% meckel diverticula are found within 60 cm range 40100 cm of the ileocecal valve 2. Meckel s diverticulum, which is the most common congenital anomaly of the gastrointestinal tract, is a true diverticulum that arises from the antimesenteric surface of the midtodistal ileum that results from incomplete obliteration of the vitelline duct. Learn about the symptoms of this condition and how it s diagnosed and treated. Meckel diverticulum is the vestigial remnant of the omphalomesenteric duct and represents the most common congenital anomaly of the gastrointestinal tract, with an incidence of 1%3% in the general population. Acute gastrointestinal obstruction can have a varied spectrum of clinical presentation and etiologies. Meckel s diverticulum is a small pouch in the wall of the lower small intestine. We report the case of an 82yearold male who presented with symptoms and imaging findings consistent. Mar 04, 2020 meckel s diverticulum is a small pouch in the wall of the lower small intestine. Meckel s diverticulum can also cause intestinal obstruction. Meckels diverticulum is rarely diagnosed because most cases remain asymptomatic. It has been studied in detail and the management criteria have been well defined for the most part in our era.
Meckel diverticulum an overview sciencedirect topics. Most 75% meckel s diverticula are found within 100 cm of the ileocecal. Meckel s diverticulum md is the most common congenital malformation of the gastrointestinal tract involving 97% of omphalomesenteric duct malformations. According to anecdotal reports in literature, encountering meckels diverticulum in a patient with crohns disease is not uncommon, but differentiating between the overlapping complications of mickels diverticulum and the natural manifestations of crohns disease can be challenging and may impact lifelong therapy. The pouch is a congenital present at birth abnormality that affects approximately 2% of the population. Meckel s diverticulitis is one of the recognized complications of the condition and is clinically indistinguishable from appendicitis, except that the pain and tenderness typically localized at the periumbilical region. Meckels diverticulum are congenital present at birth pouches in a childs intestine that are leftover tissue from the development of the digestive system. Feb 15, 2000 meckel s diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. A portion of small intestine may also twist around an anchored meckel s diverticulum. Although originally described by fabricius hildanus in 1598, it is named after johann friedrich meckel, who established. Meckel s diverticulum synonyms, meckel s diverticulum pronunciation, meckel s diverticulum translation, english dictionary definition of meckel s diverticulum. Meckel s diverticulum is named in honor of johann friedrich meckel, who, in 1809, described the intrauterine origin of the condition, which is one of the most common inborn defects of the baby s small intestine stipulated by the partial obliteration of the vitelline duct omphalomesenteric duct. This is known as segmental volvulus and is associated with compromised blood supply and intestinal.
Littre herniaincarcerated meckels diverticulum kundoc. It is caused by incomplete obliteration of the vitelline duct and consists of a congenital sacculation of the antimesenteric border of the ileum. It can be as long as 5 cm with diameters up to 2 cm. Meckel s diverticulum is an abnormal pouch in the intestine that s present from birth. In this report, we aimed to represent a case of intestinal perforation, caused by double meckels. In this study, a small amount of a harmless radioactive substance is given by vein intravenously. Additional and relevant useful information for meckels diverticulum. Using the figure of 2 per cent incidence of meckel s diverticulum, we calculated that a meckel s diverticulum has a 4. A pelvic meckel diverticulum mimicking the urinary bladder. Oct 20, 2017 a study of 202 cases of diseased meckel s diverticulum found in king county, washington, over a fifteen year period. Meckels diverticulum is located in the distal ileum, usually within 60100 cm 2 feet of the ileocecal valve. These include gastrointestinal bleeding, obstruction or diverticular inflammation.
Perforation of meckels diverticulum is very rare, and we present a case of perforation by a chicken bone. A small number of people have a meckel diverticulum. Most of the people remain asymptomatic during their lifetime, but some can develop complications such as inflammation, haemorrhage or obstruction. Three fourths of meckel diverticula are unattached to the abdominal wall and freefloating within the peritoneal cavity. It is a true diverticulum with five wall layers and independent blood supply from superior mesenteric artery.
Meckels diverticulum information mount sinai new york. In this report, we present a case of meckels diverticulitis in a. Single incision laparoscopic surgery sils for meckels. English language articles published from january 1, 2000 to july 31, 2017 were considered. Meckels diverticulum occurs due to an abnormality in early fetal development. Meckel s diverticulum is an outpouching or bulge in the lower part of the small intestine. A meckel s scan is a diagnostic imaging procedure that detects the abnormallylocated gastric mucosa. Meckel diverticulum is a true diverticulum and is the most common congenital anomaly of the gi tract, occurring in about 2% of people. On examination, she had only mild abdominal tenderness, but a mass was palpable in her right lower quadrant. The mechanism responsible for the production of this anomaly, as is well known, is failure of the omphalomesenteric duct and its accompanying vessels to become completely obliterated. It is seen in 2% of the general population and is more common in males. Important point meckel diverticulum rule of two occur in 2% of poulation 2 inch long 2 feet from ileocecal valve in child younger than age2 2 type of tissue ectopic stomach or pancerase not attached to the abdominal wall 6.
Although a meckels diverticulum exists at birth, doctors do not test for it. Meckel, a german anatomist who was the first to note that the condition occurred during the. High incidence of symptomatic meckel s diverticulum in patients less than fifty years of age. Meckels diverticulum is the most common congenital anomaly of the gastrointestinal tract. Meckels diverticulum penetrating the mesentery causing. Meckel s diverticulum is the most frequent gastrointestinal anomaly and occurs in approximately 2% of the population. For a general discussion of the uninflamed diverticulum, please refer to the.
The rule of 2s is a useful mnemonic for the features of meckel diverticulum, although the figures do have a broad range. Jan 18, 2014 meckel diverticulum also referred to as meckel s diverticulum is the most common congenital abnormality of the small intestine. The pouch, or diverticulum, seems to be leftover tissue from the development of the digestive system. Meckel s diverticulum is an outpouching or bulge in. It is the most common malformation of the gastrointestinal tract and is present in approximately 2% of the population, with males more frequently experiencing symptoms. Complications are most likely to occur when the diverticulum contains heterotypic tissue. This anomaly is due to the incomplete obliteration ofthe omphalomesenteric duct during the 7th week of gestation and is classically located 2 feet proximal to the ileocecal valve.
Meckel s diverticulum a congenital diverticulum in the ileum resulting from incomplete closure of the yolk sac diverticulum a herniation through. If symptoms do occur, they typically appear before the age of two. For the test, the doctor injects a fluid into your body that can be seen by a special camera. Snmmi and eanm practice guideline for meckel diverticulum. Rare variant of meckels diverticulum on the mesenteric. Learn about meckel s diverticulum, find a doctor, complications, outcomes, recovery and followup care for meckel s diverticulum. Alexis littre, a french surgeon, pubhshed a report on a new form of hernia in 1700 and gave details of three cases. The mucosal lining of the diverticulum may be either native ileal mucosa. With picmonic, get your life back by studying less and remembering more. Intussusception secondary to a meckels diverticulum in an.
Meckel s diverticulum is an abnormality in the small intestine that is present at birth. In patient number 5 figuras 4ad, with acute abdominal pain syndrome, the appendix proved to be normal and meckels diverticulum was identified with peritonitis. Meckel s diverticulum was first described in a paper published in 1809 by the german anatomist, johann friedrich meckel, the younger 17811833, who described it as a remnant of the omphalomesenteric duct, 3 although such an abnormality had been mentioned quite early by fabricius hildamus in 1598 and in 1671 by lavater who did not recognize its embryological. The lifetime risk of related complications is estimated at 4%. A yearold girl presented to the emergency department with vomiting and abdominal pain.
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