MECKEL’S DIVERTICULUM- Pediatric Surgery Dear Viewers, Greetings from “Surgical Educator” Today I have uploaded a video on Meckel’s diverticulum. This is a great imitator because of its varied ways of presentation. It can present as bleeding per rectum, intestinal obstruction, pain abdomen and fecal umbilical discharge. I have discussed the epidemiology, etiology, embryology, clinical features, investigations, differential diagnosis and treatment of Meckel’s diverticulum in this video. Hope you will enjoy the video. You can watch the video in the following links: surgicaleducator.blogspot.com youtube.com/c/surgicaleducator Thank you for watching the video.

1. MECKEL’S DIVERTICULUM
AN OVERVIEW
Dr.B.Selvaraj MS;Mch;FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia

2. Learning Outcomes
• To understand the embryological origin of Meckel’s
diverticulum
•To be familiar with its clinical presentation and
methods of investigation
•To be aware of management options

3. PLAN
• Introduction
• Epidemiology & Etiology
• History & Physical
• Workup
• Differential Diagnosis
• Treatment

4. Introduction
• Meckel’s diverticulum is a true diverticulum arising
from the antimesenteric border of the distal ileum
• It is the remnant of the vestigial vitello-intestinal
duct or omphalo-mesenteric duct or yolk stalk
• The ‘rule of 2s’ is often used for Meckel’s
diverticulum: within 2 feet of the ileocaecal valve, 2
inches in length, occurring in about 2% of the
population, two times more symptomatic in males,
symptomatic by 2 years of age and potentially
containing 2 heterotopic tissues, gastric and
pancreatic.

5. Epidemiology & Etiology
• The first known description of Meckel’s
diverticulum was made in 1598 by Hildanus.
• In 1809, the anatomist and physician Johann
Friedrich Meckel identified the origin of the
diverticulum as the vitellointestinal duct.
• Heterotopic pancreatic tissue in the diverticulum
was identified in 1861 by Zenker and gastric
mucosa in 1904 by Salzer.
• Meckel’s diverticulum is the most common vitelline
duct abnormality and the most common congenital
anomaly of the gastrointestinal tract.

6. Epidemiology & Etiology
• The fetal midgut is attached to the yolk sac via the
vitellointestinal duct, also known as the
omphalomesenteric duct or yolk stalk.
• This duct normally obliterates between 5 and 8
weeks’ gestation. Meckel’s diverticulum results from
failure of the proximal duct to obliterate.

7. History & Physical
• Meckel’s diverticulum has been called the ‘great
imitator’ because of its varied manifestations.
• The common presenting problems of a Meckel’s
diverticulum are bleeding, obstruction, pain
(inflammation) and umbilical discharge
• Bleeding accounts for > 50% of all instances of
lower gastrointestinal bleeding in children, usually
occurring in infants and toddlers.
• The bleeding is due to ulcer formation from the acid
secreted from the ectopic gastric mucosa and can be
severe.

8. History & Physical
• Meckel’s diverticulum can cause intestinal
obstruction by one of the several mechanisms:
-Meckel’s band
-Intussusception
-Volvulus
-Internal herniation
-Prolapse through a patent vitellointestinal duct
• Pain(Inflammation): Mimic like Acute Appendicitis
• Umbilical discharge: When complete patency of
V.I. duct

9. History & Physical

10. History & Physical

11. Timing of various
presentations

12. WORKUP
• Technetium-99m pertechnetate scintigraphy
(Meckel’s scan) is the investigation of choice.
• It is used to detect heterotopic gastric mucosa.
Pentagastrin, histamine blockers and glucagon may
enhance the accuracy of diagnosis.
• Mesenteric Angiography in patients with severe
active bleeding

13. WORKUP
Tch 99 SCAN- Meckel’s Scan Mesenteric Angiogram

14. Differential Diagnosis
• Malrotation
• Acute appendicitis
• Gastroenteritis
• Peptic ulcer disease
• Intestinal duplication
• Cow’s milk protein intolerance/allergy

15. TREATMENT
• In incidentally discovered diverticulum, no need for
surgical excision. However, if there is thickening of
diverticulum suggestive of heterotopic mucosa
elective resection can be done
• The bleeding child should be placed nil by mouth
and appropriately resuscitated.
• In symptomatic patients, the diverticulum is
removed using a laparoscopic, laparoscopic-assisted
or open technique.

16. TREATMENT
• In incidentally discovered diverticulum, no need for
surgical excision. However, if there is thickening of
diverticulum suggestive of heterotopic mucosa
elective resection can be done
• The bleeding child should be placed nil by mouth
and appropriately resuscitated.
• In symptomatic patients, the diverticulum is
removed using a laparoscopic, laparoscopic-assisted
or open technique.

17. TREATMENT
• The technique comprises either a simple resection of
the diverticulum-wedge resection- and transverse
closure across the base or resection of a short
segment of ileum, containing the diverticulum,
followed by end-to-end ileal anastomosis.
• The latter technique is recommended in bleeding
patients because it deals with any ulcer which may
be present in the adjoining 5 cm of distal ileum
• The feeding diverticular artery on the surface of the
ileum should be clearly identified and ligated.

18. TREATMENT

19. TREATMENT

20. TREATMENT