Meckel's Diverticulum - Presentation

Presentation

Meckel's diverticulum is located in the distal ileum, usually within about 60–100 cm (2 feet) of the ileocecal valve. This blind segment or small pouch is about 3–6 cm long and may have a greater lumen diameter than that of the ileum. It runs antimesenterically and has its own blood supply. It is a remnant of the connection from the yolk-sac to the small intestine present during embryonic development. It is a true diverticulum, consisting of all 3 layers of the bowel wall with mucosa, submucosa and muscularis propria.

As the vitelline duct consists of pluripotent cell lining, Mekel’s diverticulum may harbor abnormal tissues, containing embryonic remnants of other tissue types. Jejunal, duodenal mucosa or Brunner tissue were each found in 2% of ectopic cases. Heterotopic rests of gastric mucosa and pancreatic tissue are seen in 60% and 6% of cases respectively. Heterotopic means the displacement of an organ from its normal anatomic location.

A memory aid is the rule of 2s: 2% (of the population). 2 feet (from the ileocecal valve). 2 inches (in length). 2% are symptomatic. 2 types of common ectopic tissue (gastric and pancreatic). 2 years is the most common age at clinical presentation. 2 times more boys are affected.

However, the exact value for the above criteria range from 0.2-5 (for example, prevalence is probably 0.2-4%).

It can also be present as an indirect hernia, typically on the right side, where it is known as a "Hernia of Littré". A case report of strangulated umbilical hernia with Meckel's diverticulum has also been published in the literature. Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, ischemia, and necrosis.