Meckel diverticulum

Overview

The commonest congenital GI anomaly - a true diverticulum from a persistent vitellointestinal (omphalomesenteric) duct, often containing ectopic GASTRIC or pancreatic mucosa. The RULE OF 2s: 2% of people, 2 feet from the ileocaecal valve, 2 inches long, often presents under age 2, 2 types of ectopic mucosa. Classically PAINLESS rectal bleeding in a child (ectopic gastric mucosa ulcerates the ileum); can also cause obstruction (lead point for intussusception/volvulus) or mimic appendicitis.

Recognise

• Often asymptomatic; classic presentation = PAINLESS lower GI bleeding (per rectum) in a young child (ectopic gastric mucosa -> ileal ulceration)
• Can cause obstruction (lead point for intussusception/volvulus), or inflammation mimicking appendicitis (Meckel diverticulitis)
• Rule of 2s; a vitellointestinal remnant

Differentials & how to tell them apart

Investigations

MECKEL (technetium-99m pertechnetate) SCAN - detects ectopic gastric mucosa (the key test in painless paediatric PR bleeding); CT/laparoscopy for complications.

Management

Surgical resection of the symptomatic/bleeding diverticulum

1. 1Suspect in painless paediatric PR bleeding -> Meckel (technetium) scan to detect ectopic gastric mucosa. Resect symptomatic/complicated diverticula.Gate: Painless rectal bleeding in a young child should prompt a Meckel scan; an incidentally-found asymptomatic diverticulum is usually left alone
2. 2Surgical resection for bleeding/obstruction/diverticulitis; manage intussusception if Meckel is the lead point. (Also a paediatric GI item - cross-reference child health.)

Monitor & prognosis

Post-op; complications.

Excellent after resection.