Meckel's Diverticulum

Investigation of choice if child is haemodynamically stable with less severe or intermittent bleeding

'Meckel's scan' (which uses 99m technetium pertechnetate, which has an affinity for gastric mucosa99m technetium pertechnetate, which has an affinity for gastric mucosa)

Potential other management options for Meckel's diuverticulum

Address the clinical presentation appropriately (e.g. managing obstruction with an NG tube)

Clinical features of Meckel's diverticulum

Abdominal pain minicking appendicitis Passage of bright red blood per rectum (haematochezia) Intractable constipation (obstipation due to intestinal obstruction)

Complications of Meckel's diverticulum

Enterocystomas Umbilical sinuses, and omphaloileal fistulas Typically lined by ileal mucosa but ectopic gastric mucosa can occur, with the risk of peptic ulceration Pancreatic and jejunal mucosa can also occur

Complications of Meckel's diverticulum QUESMED

Intussusception Obstruction Ulceration and perforation (e.g. by foreign body) (can result in a massive haemorrhage)

Investigation of choice if more severe e.g. transfusion required

Mesenteric arteriography

Pathophysiology of Meckel's diverticulum

Normally, there is an attachment between the vitellointestinal duct and the yolk sac This should disappear at 6 weeks gestation If the vitelline duct fails to obliterate during the 5th week of fetal development it leads to an intestinal blind pouch Can be asymptomatic BUT this embryological remnant may cause bleeding, obstruction, inflammation, or perforation NOTE: arterial supply= omphalomesenteric artery

Rules of 2 in Meckel's diverticulum

Occurs in 2% of the population Is 2ft from the ileocaecal valve Is 2 inches long Patient <2

DEFINITIVE management options for Meckel's diverticulum (note only used if patient is symptomatic)

Removal via Wedge excision OR Formal mall bowel resection + anastomosis

What is Meckel's diverticulum?

The commonest congenital malformation of the small bowel. Many people remain asymptomatic for their entire lives and the majority of symptomatic patients will present before the age of 2