Meckel's Diverticulum
if meckel's diverticulum is found during a surgery for another condition, resection is recommended for who?
-children <50 years old adults if meckel's diverticulum is: >2 cm long or palpable abnormalities/fibrous bands are noted >50 years old or with comorbidities: -if there is a palpable abnormality
when do symptoms of meckel's diverticulum commonly present and in who?
males > females (2:1) most commonly present with symptoms in 2-4 years
what is the most common congenital GI tract anomaly
meckel's diverticulum
a omphalomesenteric duct that does not fully involute can give rise to
meckels diverticulum (most common) -omphalomesenteric cyst -omphalomesenteric fistula (drain through umbilicus) -fibrous bands (can cause bowel obstruction)
Surgical Management is emergency if
signs of sepsis, peritonitis, or perforation
symptoms of Meckel's Diverticulitis
similar to acute appendicitis signs of peritoneal irritation if perforated midline abdominal tenderness
what tests do you do to for the diagnosis of Meckel's Diverticulum
tests for GI bleeding -meckel's scan -ateriography -CTA tests for SBO and diverticulitis -CT scan -diagnostic laparoscopy
Describe the Meckel's scan
used 1st line in hemodynamically stable patients if suspicion is high (usually children) nuclear medicine scan utilizing radioactively labeled technetium that binds to gastric mucosa
symptoms of a SBO
-N/V -cramping abdominal pain -abdominal distention in children: most commonly in form of recurrent intussusception
meckel's diverticulum has an increased incidence in children with malformation involving
-umbilicus -GI tract -nervous system -heart
what would be a sign on CXR for a perforation?
free air
what supportive care is done if the patient is symptomatic
-IV hydration and resuscitation -blood transfusions (GI bleed) -bowel rest, gastric decompression (SBO) -IV antibiotics (Meckel's diverticulitis)
no resection of a diverticulum is recommended if
>50 years old and there is no palpable abnormality
what antibiotics can be used for diverticulitis?
Zosyn and metro - kids metro and cipro - adults
what is a sign of an acute and chronic GI bleed?
acute - massive hematochezia chronic - (slow) melena, currant jelly, maroon stools in children
a true diverticulum contains
all layers of the bowel wall
describe the omphalomesenteric duct
connects the midgut to the yolk sac in utero normally involutes between the 5th and 6th weeks of gestation
Where is a Meckel's diverticulum located?
distal ileum
T/F Meckel's Diverticulum is frequently symptomatic
false - frequently asymptomatic -25-50% of symptomatic are <10 years old
T/F a asymptomatic meckel's diverticulum incidentally found on imaging needs treatment
false - no treatment necessary
diagnostic laparoscopy for Meckel's diverticulum if performed when
if imaging studies are equivocal -difficult to distinguish an inflamed diverticulum from appendicitis on imaging can be therapeutic and diagnostic
describe the use of arteriography for Meckel's diverticulum
invasive test when bleeding is brisk enough to necessitate blood transfusion an anomalous branch of the superior mesenteric artery feeding the Meckel's Diverticulum can be identified
describe the use of CTA for Meckel's diverticulum
more sensitive than arteriography for less-brisk hemorrhage
clinical presentation of Meckel's Diverticulum
painless lower GI bleeding (most common) SBO Meckel's Diverticulitis
What is Meckel's diverticulum?
persistent remnant of embryonic structure known as omphalomesenteric (vitelline) duct
what is done during surgery
resection of the Meckel's diverticulum segmented bowel resection -include all ulcerated bleeding mucosa -if adjacent small bowel is severely inflamed/ischemic
describe the use of CT scan for Meckel's diverticulum
will identify -SBO -inflammatory changes -perforation
why do you get a CT for a SBO and Diverticulitis?
you cannot rule out a diverticulitis on a Xray