MEckel's Diverticulum
Gastroenterology
Pathogenesis: embryological failure of closure of the vitelline duct (aka omphalomesenteric duct)
2% of population, 2:1 M:F, presents 2yo (typically but can be any age)
2 inches long, 2 feet before ileocaecal valve
Presentation
Acute painless rectal bleeding +/- shock
Pain or Obstruction
- intussusception
- volvulus around its fibrous cord
- diverticulitis
- Littre's Hernia (Meckel's through umbi, ing or fem)
- diverticular torsion
anaemia
Ix
Meckel's scan: IV 99m technetium pertechnetate radioisotope has an affinity for gastric mucosa (so stomach will also light up)
85-97% sensitivity (higher than adults as meckels with gastric mucosa present earlier than those with pancreatic
95% specificity (False negs: intus, duplication cyst, IBD)
Aluminium hydroxide in antacids impairs localisation of tracer, Ranitidine enhances by retaining tracer in mucosa
Pathogenesis: embryological failure of closure of the vitelline duct (aka omphalomesenteric duct)
2% of population, 2:1 M:F, presents 2yo (typically but can be any age)
2 inches long, 2 feet before ileocaecal valve
Presentation
Acute painless rectal bleeding +/- shock
Pain or Obstruction
- intussusception
- volvulus around its fibrous cord
- diverticulitis
- Littre's Hernia (Meckel's through umbi, ing or fem)
- diverticular torsion
anaemia
Ix
Meckel's scan: IV 99m technetium pertechnetate radioisotope has an affinity for gastric mucosa (so stomach will also light up)
85-97% sensitivity (higher than adults as meckels with gastric mucosa present earlier than those with pancreatic
95% specificity (False negs: intus, duplication cyst, IBD)
Aluminium hydroxide in antacids impairs localisation of tracer, Ranitidine enhances by retaining tracer in mucosa