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Meckel’s Diverticulum
Dinoosh De Livera
Group 49
5th course
Oversease Students Training Faculty
Vitebsk State Medical Univ...
Meckel’s Diverticulum
Definition: It is a congenital diverticulum arising
from the antimesenteric border of terminal ileum
• During the eighth w...
Development
• Sometimes this diverticulum can be attached to the
umbilical region by the vitelline ligament, with the
possibility of v...
• Most common congenital abnormality of the
gastrointestinal tract
• Contains all three layers of bowel with
independent b...
Meckel's diverticulum is the most prevalent
congenital anomaly of the GI tract
• 2% of the general population
• 2% prevale...
Rule of 2’s
• 2% of the population
• Usually found 2 feet proximal to the ileocecal valve
• About 2 inches long
• 2 times ...
Clinical presentations
• Majority of Meckel’s diverticuli are clinically
silent (Asymptomatic)
• Symptoms in order of freq...
Pathophysiology
• Severe Hemorrhage
-painless per rectal bleeding, maroon colored
Hemorrhage may be caused by:
• Ectopic g...
Meckel’s Diverticulitis
Inflammation of the diverticulum can mimic symptoms
of appendicitis
Diverticulitis results from-
•...
• During perforation, the symptoms may
resemble those of a perforated duodenal ulcer
• Whether perforated or not, urgent s...
• Intestinal obstruction
Causes—
• Volvulus of the intestine around the fibrous band
attaching the diverticulum to the umb...
Diagonosis
• A technetium-99m (99mTc) pertechnetate scan, also
called Meckel scan.
positive only when the diverticulum con...
A technetium-99m
(99mTc)
pertechnetate scan,
also called Meckel
scan.
positive only when the
diverticulum contains
associa...
1) Intestinal obstruction
2) Hematochezia
3) Appendicitis
4) Intussusception
5) Lower GI bleeding
6) Angiodysplasias
7) Ma...
Complications of Meckel Diverticulum
• Ulceration
• Hemorrhage
• Small intestinal obstruction
• Diverticulitis
• Perforati...
Indication for surgery
Symptomatic Meckel diverticulum
- hemorrhage
- intestinal obstruction
- diverticulitis
- umbilico-i...
Indication for surgery
Incidentally discovered Meckel diverticulum
- Patients younger than 40 years
- Diverticula longer t...
Management
• Meckelian Diverticulectomy:
Meckel’s diverticulum with the broad base should not be amputated and
invaginated...
1. Schwartz’s principles of surgery, 9th
edition. Mc Graw-Hill, 2009.
2. Medscape http://emedicine.medscape.com
References
THANK YOU!
Merkel's diverticulum
Merkel's diverticulum
Merkel's diverticulum
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Merkel's diverticulum

  1. 1. Meckel’s Diverticulum Dinoosh De Livera Group 49 5th course Oversease Students Training Faculty Vitebsk State Medical University Paediatric Surgery
  2. 2. Meckel’s Diverticulum
  3. 3. Definition: It is a congenital diverticulum arising from the antimesenteric border of terminal ileum • During the eighth week of gestation, the omphalomesenteric (vitelline) duct normally undergoes obliteration • Failure or incomplete obliteration of vitelline duct results in some congenital abnormalities, the most common of which is Meckel's diverticulum.
  4. 4. Development
  5. 5. • Sometimes this diverticulum 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
  6. 6. • Most common congenital abnormality of the gastrointestinal tract • Contains all three layers of bowel with independent blood supply • Often contains heterotropic tissue- gastric, occasionally pancreatic • If the Meckel’s Diverticulum is found in an inguinal or femoral sac – Littre’s hernia
  7. 7. Meckel's diverticulum is the most prevalent congenital anomaly of the GI tract • 2% of the general population • 2% prevalence, 2:1 male predominance • 2 ft proximal to the ileocecal valve in adults • 50% symptomatic under 2 years • Heterotropic tissue  Gastric mucosa  Pancreatic acini Epidemiology
  8. 8. Rule of 2’s • 2% of the population • Usually found 2 feet proximal to the ileocecal valve • About 2 inches long • 2 times more common in males than females • Symptomatic mostly before 2 years of age • In adult patients it symptomatic in only about 2%
  9. 9. Clinical presentations • Majority of Meckel’s diverticuli are clinically silent (Asymptomatic) • Symptoms in order of frequencies— a) Severe haemorrhage b) Intussuception c) Meckel’s Diverticulitis d) Chronic peptic ulceration e) Intestinal obstruction
  10. 10. Pathophysiology • Severe Hemorrhage -painless per rectal bleeding, maroon colored Hemorrhage may be caused by: • Ectopic gastric or pancreatic mucosa: When diverticulum contains embryonic remnants of mucosa of other tissue types. • Secretion of gastric acid or alkaline pancreatic juice from the ectopic mucosa leads to ulceration in the adjacent ileal mucosa i.e. peptic or pancreatic ulcer • Perforation and bleeding from ulcer
  11. 11. Meckel’s Diverticulitis Inflammation of the diverticulum can mimic symptoms of appendicitis Diverticulitis results from- • Peptic ulceration resulting from ectopic gastric mucosa of the diverticulum • Following perforation by trauma or ingested food residue • Luminal obstruction due to tumors, foreign body, causing stasis or bacterial infection
  12. 12. • During perforation, the symptoms may resemble those of a perforated duodenal ulcer • Whether perforated or not, urgent surgery is required • In non perforated cases, an inflamed diverticulum should be sought as soon as it has been demonstrated that the appendix and fallopian tubes are not at fault
  13. 13. • Intestinal obstruction Causes— • Volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus • Entrapment of intestine by a mesodiverticular band • Intussusception with the diverticulum acting as a lead point • Stricture secondary to chronic diverticulitis • Tumors e.g. Carcinoid, adenocarcinoma, GIST arising in the diverticulum
  14. 14. Diagonosis • A technetium-99m (99mTc) pertechnetate scan, also called Meckel scan. positive only when the diverticulum contains associated ectopic gastric mucosa that is capable of uptake of the tracer • Laparoscopy • Enteroclysis/ small bowel enema under fluoroscopy • CT scan • Angiography
  15. 15. A technetium-99m (99mTc) pertechnetate scan, also called Meckel scan. positive only when the diverticulum contains associated ectopic gastric mucosa that is capable of uptake of the tracer
  16. 16. 1) Intestinal obstruction 2) Hematochezia 3) Appendicitis 4) Intussusception 5) Lower GI bleeding 6) Angiodysplasias 7) Malignancy 8) Arteriovenous malformations Differential diagnosis
  17. 17. Complications of Meckel Diverticulum • Ulceration • Hemorrhage • Small intestinal obstruction • Diverticulitis • Perforation
  18. 18. Indication for surgery Symptomatic Meckel diverticulum - hemorrhage - intestinal obstruction - diverticulitis - umbilico-ileal fistulas
  19. 19. Indication for surgery Incidentally discovered Meckel diverticulum - Patients younger than 40 years - Diverticula longer than 2cm - Diverticula with narrow necks - Diverticula with fibrous bands - Suspected ectopic gastric tissue - Inflamed, thickened diverticula
  20. 20. Management • Meckelian Diverticulectomy: Meckel’s diverticulum with the broad base should not be amputated and invaginated A linear stapler device may be used. If induration of base, hetrotropic gastric tissue extending to adjacent ileum is present then- short segment of ileum is resected and end to end anastomosis is done restoring the continuity
  21. 21. 1. Schwartz’s principles of surgery, 9th edition. Mc Graw-Hill, 2009. 2. Medscape http://emedicine.medscape.com References
  22. 22. THANK YOU!

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