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Definition of Diverticulum
A blind pouch that is continuous with lumen of a hollow viscus(gut or urinary bladder)

Meckel's Diverticulum 

  • Persistent patency of the proximal part of the vitellointestinal duct.
  • lt is the most common cause of bleed per rectum in childhood


Incidence(Rule of 2)

(Most prevalent congenital anomaly of the GIT)
  • 2% of people are affected.
  • 2% of affected people may have complicati
  • 2 times more common in males than females.
  • 2 feet (60 cm) from ileocaecaljunction.
  • 2 inches long.

Pathology

  • its true diverticulum which consist of all layers of the bowel and has seperate blood supply from the superior mesentric artery
  • it project from antemesenteric boarder 
  • it may contain ectopic tissues(gastric,duodenal,pancreatic or colonic tissues in 20% of cases)

Clinical picture

  • its may be asymtomatic
  • may present with complications
  • most frequent manifestation is bleeding

Complications

1-Intestinal obstruction(the commonest)
may be due to
  • lntussusception
  • volvulus

2-Peptic ulceration
  • Sometimes the diverticulum contains ectopic gastric epithelium This leads to formation of peptic ulcer on the neighboring epithelium.
  • The ulcer is liable to Perforation →Bleeding  melena or blood per rectum according to the amount of bleeding.

Clinical Picture :
  • Usually a child 8-10 years old.
  • Abdominal pain (around the umbilicus because it is a part of Midgut) following meals
  • Melena
  • Picture of acute peritonitis if the ulcer perforates.

3-Meckel's diverticulitis
  • Clinical picture similar to that of acute appendicitis.
  • At operation, the appendix is found normal (it is the only way to differentiate between acute appendicitis and Meckel's diverticulitis).
  • It is more danqerous than acute appendicitis due to:

            - Easier perforation due to its thin wall.
            - More difficult localization due to its central position & mobility of the small intestine

4-Littre's hernia
  • its hernia in which its content is Meckel's diverticulum
  • May strangulate causing strangulation without obstruction.


Differential diagnosis:

  • Appendicitis.
  • Salpingitis.
  • Perforated peptic ulcer.

Investigations:-

1-Barium meals follow through: may show a diverticulum.

2-Superior mesenteric angiography: extravasation.
3-Tc99 Scan + gamma camera: safer than arteriography can demonstrate gastric mucosa.
4-Angiography: extravasation: weeping meckel's (active blood, 0.5ml / min)

Treatment

1-Symptomatic cases:
  • Wedge resection of the ileum and closure of the defect transversely or segmental resection is indicated.

2-Silent cases and accidentally discovered at laprotomy:
  • indications of resection(if complication is likely)

1-Narrow mouthed (diverticulitis is likely) 
2-The wall of the diverticulum is thickened (contains ectopi gastric tissue) (peptic ulcer is likely).
3-Attached band of adhesions(intestinal obstruction is likely)
4-Young adults and children(different complications are likely) 
  • If not we can leave it


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