Meckel's diverticulum
Encyclopedia
A Meckel's diverticulum, a true congenital diverticulum
, is a small bulge in the small intestine present at birth. 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
. It is present in approximately 2% of the population, with males more frequently experiencing symptoms.
It was first described by Fabricius Hildanus in the sixteenth century and later named after Johann Friedrich Meckel
, who described the embryological origin of this type of diverticulum in 1809.
, usually within about 60–100 cm (2 feet) of the ileocecal valve
. It is typically 3–5 cm long, runs antimesenterically and has its own blood supply. It is a remnant of the connection from the yolk-sac to the small intestine present during embryonic development.
A memory aid is the rule of 2s:
2% (of the population).
2 feet (from the ileocecal valve).
2 inches (in length).
2% are symptomatic.
2 types of common ectopic tissue (gastric and pancreatic).
2 years is the most common age at clinical presentation.
2 times more boys are affected.
However, the exact value for the above criteria range from 0.2-5 (for example, prevalence is probably 0.2-4%).
It can also be present as an indirect hernia, typically on the right side, where it is known as a "Hernia of Littre". A case report of strangulated umbilical hernia
with Meckel's diverticulum has also been published in the literature. Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, ischemia
, and necrosis
.
. If symptoms do occur, they typically appear before the age of two.
The most common presenting symptom is painless rectal bleeding
such as melaena-like black offensive stools, followed by intestinal obstruction, volvulus
and intussusception
. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis. Also, severe pain in the epigastric region is experienced by the patient along with bloating in the epigastric and umbilical regions. At times, the symptoms are so painful such that they may cause sleepless nights with acute pain felt in the foregut region, specifically in the epigastric and umbilical regions.
Most of the time, bleeding occurs without warning and stops spontaneously.
The symptoms can be extremely painful, often mistaken as just belly pain resulting from not eating or constipation.
(99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa
; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them, this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence. Other tests such as colonoscopy
and screenings for bleeding disorders should be performed, and angiography can assist in determining the location and severity of bleeding. Meckel's occurs more often in males than females.
Asymptomatic Meckel's diverticulum, some recommend that a search for Meckel's diverticulum in every case of appendicectomy/ laparotomy done for acute abdomen
should be conducted, and if found, Meckel's diverticulectomy or resection should be performed to avoid secondary complications arising from it
with the San Diego Padres
(currently with the Pittsburgh Pirates
), suffered multiple episodes during the 2006 season in which mysterious internal bleeding caused him to lose a significant fraction of his blood volume. He was finally diagnosed with Meckel's diverticulum, which was surgically removed August 23, 2006.
Nirvana
lead-singer Kurt Cobain
is thought to have suffered from it as well as Samuel Cooper
and George Washington
.
Diverticulum
A diverticulum is medical or biological term for an outpouching of a hollow structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false....
, is a small bulge in the small intestine present at birth. 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
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
. It is present in approximately 2% of the population, with males more frequently experiencing symptoms.
It was first described by Fabricius Hildanus in the sixteenth century and later named after Johann Friedrich Meckel
Johann Friedrich Meckel
Johann Friedrich Meckel , often referred to as Johann Friedrich Meckel, the Younger, was a German anatomist born in Halle...
, who described the embryological origin of this type of diverticulum in 1809.
Presentation
Meckel's diverticulum is located in the distal ileumIleum
The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...
, usually within about 60–100 cm (2 feet) of the ileocecal valve
Ileocecal valve
The ileocecal valve, or ileocaecal valve, is of a bilabial papilla structure with physiological sphincter muscle situated at the junction of the small intestine and the large intestine, with recent evidence indicating an anatomical sphincter may also be present in humans) Its critical function is...
. It is typically 3–5 cm long, runs antimesenterically and has its own blood supply. It is a remnant of the connection from the yolk-sac to the small intestine present during embryonic development.
A memory aid is the rule of 2s:
2% (of the population).
2 feet (from the ileocecal valve).
2 inches (in length).
2% are symptomatic.
2 types of common ectopic tissue (gastric and pancreatic).
2 years is the most common age at clinical presentation.
2 times more boys are affected.
However, the exact value for the above criteria range from 0.2-5 (for example, prevalence is probably 0.2-4%).
It can also be present as an indirect hernia, typically on the right side, where it is known as a "Hernia of Littre". A case report of strangulated umbilical hernia
Umbilical hernia
Congenital umbilical hernia is a congenital malformation, common in infants of African descent. Among adults, it is three times more common in women than in men; among children, the ratio is roughly equal...
with Meckel's diverticulum has also been published in the literature. Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, ischemia
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
, and necrosis
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
.
Symptoms
The majority of people afflicted with Meckel's diverticulum are asymptomaticAsymptomatic
In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...
. If symptoms do occur, they typically appear before the age of two.
The most common presenting symptom is painless rectal bleeding
Rectal bleeding
Rectal bleeding can refer to:* Lower gastrointestinal bleeding* Hematochezia* Fecal occult blood* Melena...
such as melaena-like black offensive stools, followed by intestinal obstruction, volvulus
Volvulus
A volvulus is a bowel obstruction with a loop of bowel whose nose has abnormally twisted on itself.-Types:* Volvulus Neonatorum.* Volvulus Small Intestine.* Volvulus Caecum.* Volvulus Sigmoid Colon .* Gastric volvulus....
and intussusception
Intussusception (medical disorder)
An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another. This can often result in an obstruction...
. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis. Also, severe pain in the epigastric region is experienced by the patient along with bloating in the epigastric and umbilical regions. At times, the symptoms are so painful such that they may cause sleepless nights with acute pain felt in the foregut region, specifically in the epigastric and umbilical regions.
Most of the time, bleeding occurs without warning and stops spontaneously.
The symptoms can be extremely painful, often mistaken as just belly pain resulting from not eating or constipation.
Diagnosis
A technetium-99mTechnetium-99m
Technetium-99m is a metastable nuclear isomer of technetium-99, symbolized as 99mTc. The "m" indicates that this is a metastable nuclear isomer, i.e., that its half-life of 6 hours is considerably longer than most nuclear isomers that undergo gamma decay...
(99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa
Gastric mucosa
The gastric mucosa is the mucous membrane layer of the stomach which contains the glands and the gastric pits. In men it is about 1 mm thick and its surface is smooth, soft, and velvety...
; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them, this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence. Other tests such as colonoscopy
Colonoscopy
Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
and screenings for bleeding disorders should be performed, and angiography can assist in determining the location and severity of bleeding. Meckel's occurs more often in males than females.
Treatment
Treatment is surgical. In patients with bleeding, strangulation of bowel, bowel perforation or bowel obstruction, treatment involves surgical resection of both the Meckel's diverticulum itself along with the adjacent bowel segment. In patients without any of the aforementioned complications, treatment involves surgical resection of the Meckel's diverticulum only.Asymptomatic Meckel's diverticulum, some recommend that a search for Meckel's diverticulum in every case of appendicectomy/ laparotomy done for acute abdomen
Acute abdomen
The term acute abdomen refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. It is in many cases a medical emergency, requiring urgent and specific diagnosis...
should be conducted, and if found, Meckel's diverticulectomy or resection should be performed to avoid secondary complications arising from it
Notable patients
Major League Baseball player Chan Ho Park, then a pitcherPitcher
In baseball, the pitcher is the player who throwsthe baseball from the pitcher's mound toward the catcher to begin each play, with the goal of retiring a batter, who attempts to either make contact with the pitched ball or draw a walk. In the numbering system used to record defensive plays, the...
with the San Diego Padres
San Diego Padres
The San Diego Padres are a Major League Baseball team based in San Diego, California. They play in the National League Western Division. Founded in 1969, the Padres have won the National League Pennant twice, in 1984 and 1998, losing in the World Series both times...
(currently with the Pittsburgh Pirates
Pittsburgh Pirates
The Pittsburgh Pirates are a Major League Baseball club based in Pittsburgh, Pennsylvania. They play in the Central Division of the National League, and are five-time World Series Champions...
), suffered multiple episodes during the 2006 season in which mysterious internal bleeding caused him to lose a significant fraction of his blood volume. He was finally diagnosed with Meckel's diverticulum, which was surgically removed August 23, 2006.
Nirvana
Nirvana (band)
Nirvana was an American rock band that was formed by singer/guitarist Kurt Cobain and bassist Krist Novoselic in Aberdeen, Washington in 1987...
lead-singer Kurt Cobain
Kurt Cobain
Kurt Donald Cobain was an American singer-songwriter, musician and artist, best known as the lead singer and guitarist of the grunge band Nirvana...
is thought to have suffered from it as well as Samuel Cooper
Samuel Cooper
Samuel Cooper was an English miniature painter, and younger brother of Alexander Cooper.He is believed to have been born in London, and was a nephew of John Hoskins, the miniature painter, by whom he was educated. He lived in Henrietta Street, Covent Garden, and frequented the Covent Garden...
and George Washington
George Washington
George Washington was the dominant military and political leader of the new United States of America from 1775 to 1799. He led the American victory over Great Britain in the American Revolutionary War as commander-in-chief of the Continental Army from 1775 to 1783, and presided over the writing of...
.
External links
- Meckel's Diverticulum Scan — Children's Hospital BostonChildren's Hospital BostonChildren's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...
- Meckel diverticulum (Image)
- Tutorials and intra-operative image of Meckel's (Weblink)
- Meckel's Diverticulum Technetium Scan Results (Image)
