Meckels diverticulum
Key points
Rule of 2's:
2" long
2 types of heterotopic mucosa
Within 2 feet of the ileocecal valve
2% of the population
Can be associated with other anomalies:
VACTERL
Exomphalos
Duodenal atresia
Congenital diaphragmatic hernia
Malrotation
15% asymptomatic have heterotopic mucosa
Heterotopic mucosa frequency
1. Gastric
2. Pancreatic
3. Colonic, endometrial, pancreatic islets
Complications include bleeding, perforation, acting as lead point for intussusception, if bands attached - obstruction/volvulus/internal hernia
If no ectopic tissue, then perforation should prompt investigation for distal obstruction e.g. Hirschprungs
Can develop carcinoid tumours
Management
Pre-operative Meckels scan is unlikely to change management CT angiogram may help if other causes of GI bleed are suspected
For GI bleed with suspected Meckels:
Perform laparoscopy first
Wedge resection - as this will include heterotopic tissue on mesenteric wall of bowel
If no Meckel's found, perform OGD (do this after, as doing first will inflate the small bowel making laparoscopy difficult. An exception would be if gastric pathology is more likely, then should do OGD first)
Incidental finding of Meckels
Zani et al - Meta-analysis, 3000 patients
Complications from leaving 1.3%
Removing 5%
Conclusion: Leave, unless adverse features
Meckels scan
Technetium 99 - accumulates in Mucous cells
H2 blockers stop secretion of isotope into lumen - keep it in cells
Glucagon also enhances uptake
Half life 6 hours
False negatives in bleeding patients due to dilution
References
An J, Zabbo CP. Meckel Diverticulum. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499960/
Zani A, Eaton S, Rees CM, Pierro A. Incidentally detected Meckel diverticulum: to resect or not to resect? Ann Surg. 2008 Feb;247(2):276-81. doi: 10.1097/SLA.0b013e31815aaaf8. PMID: 18216533.
Titley-Diaz WH, Aziz M. Meckel Scan. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560500/