Meckel's diverticulum

Meckel's diverticulum is a congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa

Rule of 2's

• occurs in 2% of the population
• is 2 feet from the ileocaecal valve
• is 2 inches long

Presentation (usually asymptomatic)

• abdominal pain mimicking appendicitis
• rectal bleeding
• intestinal obstruction: secondary to an omphalomesenteric band (most commonly), volvulus and intussusception

Management

• removal if narrow neck or symptomatic. Options are between wedge excision or formal small bowel resection and anastomosis.

Pathophysiology

• normally, in the foetus, there is an attachment between the vitellointestinal duct and the yolk sac.This disappears at 6 weeks gestation
• the tip is free in the majority of cases
• associated with enterocystomas, umbilical sinuses, and omphaloileal fistulas.
• arterial supply: omphalomesenteric artery.
• typically lined by ileal mucosa but ectopic gastric mucosa can occur, with the risk of peptic ulceration. Pancreatic and jejunal mucosa can also occur.