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Meckel’s Diverticulum

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Overview

Meckel’s diverticulum (MD) describes a congenital diverticulum (outpouching) of the small intestine. It is a vestigial remnant of the omphalomesenteric duct.

It follows ‘the rule of 2s’:

  • Present in 2% of the population
  • Symptomatic in 2% of those with it
  • Children are <2 years old
  • Males are 2 times as common as female patients
  • It is around 2 feet proximal to the ileocaecal valve
  • It is 2 inches long or less
  • It has 2 types of mucosal lining

Epidemiology

  • Children are generally <2 years old
  • Male patients are twice as likely to be affected than female patients

Presentation

Most patients are asymptomatic, however, some patients may present with:

  • Rectal bleeding – MD is the most common cause of painless massive gastrointestinal bleeding (requiring transfusion) in children aged 1-2 years
  • Inflammation of the diverticula (diverticulitis):
  • Intestinal obstruction – due to volvulus and intussusception
    • May present with severe/complete constipation and vomiting 

Investigations

Overview

  • Full blood count (FBC):
    • May show anaemia if bleeding is present
    • May show leukocytosis if an infection is present
  • Technetium-99m scan (‘Meckel’s scan’) – diagnostic
    • Performed if the patient is haemodynamically stable
  • Mesenteric angiography
    • May be performed in unstable patients to localise the haemorrhage

Differential Diagnoses

Appendicitis

  • Appendicitis starts with central abdominal pain that localises to the right iliac fossa
  • There may be associated fever, anorexia, nausea, and vomiting
  • Leukocytosis may be present
  • May be difficult to distinguish from MD

Intussusception (non-Meckel’s diverticulum-related)

  • Intussusception tends to present with crampy, progressive abdominal pain and inconsolable crying
  • During episodes of pain, the infant may draw their knees up and turn pale
  • There may be a sausage-shaped abdominal mass
  • There may be bloodstained stool similar to ‘red-currant jelly’ – a late sign

Management

Overview

If MD is detected incidentally and causes no problems, then watching and waiting may be appropriate. Otherwise, surgical excision may be considered.

Complications

  • Diverticulitis
  • Bowel obstruction
  • Haemorrhage

Prognosis

  • If diagnosed and treated early, the prognosis is good
  • The lifetime risk of incidental MD becoming symptomatic is around 6%

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