Meckel's diverticulum

Carlos FernandezGroup 4

NMT 1713

Objectives

• What is Meckel’s• Symptoms of

Meckel’s• Diagnosing Meckel’s• Treatment of

Meckle’s

What is Meckel’s• A Meckel's diverticulum is a small bulge in the

small intestine present at birth• It is a vestigial remnant of the omphalomesenteric

duct, and is the most frequent malformation of the gastrointestinal tract

• It is present in approximately 2% of the population, found twice as frequently in males as females, although males more frequently experience symptoms

• It is named after Johann Friedrich Meckel, who first described this type of diverticulum in 1809

What is Meckel’s

• It can usually be found within about 60-100 cm of the ileocecal valve. It is typically 3-5 cm long, runs antimesenterically and has its own blood supply

• Can be present in an indirect hernia, where it is known as Hernia of Littre. Furthermore, it can be attached to the umbilicus, with the possibility of local cysts, torsions of intestine around the intestinal stalk, leading to obstruction, ischemia, and necrosis

Symptoms of Meckel’s• Approximately 98% of people afflicted with Meckel's diverticulum

are asymptomatic. If symptoms do occur, they typically appear before the age of two.

• The most common presenting symptom is painless rectal bleeding, followed by intestinal obstruction, volvulus and intussusception.

• Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis. Also, severe pain in the upper abdomen is experienced by the patient along with bloating of the stomach region.

• At times, the symptoms are so painful such that they may cause sleepless nights with extreme pain in the abdominal area.

Diagnosing Meckel’s

• Perfrom Meckel’s Scan– Iindications:

• Detection and localization of a Meckels diverticulum containing functioning (bleeding) gastric mucosa.

• Detection of Barrett's esophagus

Diagnosing Meckel’s• PATIENT PREPARATION:Patient's G.I. tract should be barium free.

(Optional) Administer cimetidine prior to injecting the radiopharmaceutical:

Give 300 mg intravenously 30 minutes prior to the study. (Dilute to 20 mL and infuse over 5 minutes. or

Give 300 mg orally 60 minutes prior to the study.)

Tc-99m-sodium pertechnetate is given by standard intravenous injection. An adult dose of 5 mCi is administered.

SCANNING TIME:30 minutes to 1 hour.

Diagnosing Meckel’s

• OTHER CONSIDERATIONS/RATIONALE:– The radiopharmaceutical is actively secreted by

gastric mucosa. Although all Meckel's diverticula do not contain functioning gastric mucosa, most that bleed do

– Patient's with active hemorrhage can also be studied with tagged red blood cells. While only 20% of Meckel's Diverticula contain ectopic mucosa, greater than 90% of diverticula that bleed do.

Treatment of Meckle’s

• Treatment is surgical, consisting of a resection of the affected portion of the bowel.

Refrences

• WWW.google.com for images• www.wikipedia.com• Merck Manual second home edition