May 25, 2009

Meckel's Diverticulum

Introduction: Meckel's diverticulum is the diverticulum present on the antimesenteric border of terminal part of small intestine also called as ileum. It does not present in all individuals. It is a presistence of vitellointestinal duct in the abdomen.

There is unique 'The rule of two' i.e. Meckel's diverticulum is present in 2% of population, it is 2" long and it is 2 feet away from ileocaecal junction (junction where small intestine joins large intestine).

Clinical presentation:
1. Bleeding per rectum- profuse & painless bleeding
2. Intestinal obstruction- leadiing to vomiting, pain & abdominal distension
3. Infection- symtoms mimicking appendicitis

In majority of cases it is diagnosed at exploration when the child is being operated for appendicitis. When it presents as bleeding per rectum then Meckel's scan or RBC tagged scan is useful. Barium meal follow through can also sometimes diagnoses Meckel's Diverticulum.

Managment: Laparoscopic or open Meckel's diverticulectomy is the standard of care. In case of appendicectomy, it is worthwhile to trace aprroximately 2 feet of ileum from ileocaecal junction to rule out uncomplicated Meckel's diverticulum.