Which of the following is not a feature of meckels diverticulum –
Correct Answer: It is found on the mesenteric side of the ileum
Description: Ans. is 'b' i.e., It is found on the mesenteric side of the ileum Meckel's diverticulum:* A Meckel's diverticulum is a persistent remnant of the vitellointestinal duct and is present in about 2 per cent of the population.* It is found on the antimesenteric side of the ileum, commonly at 60 cm from the ileocaecal valve and is classically 5 cm long.* A Meckel's diverticulum contains all three coats of the bowel wall and has its own blood supply.* It is vulnerable to obstruction and inflammation in the same way as the appendix; indeed, when a normal appendix is found at surgery for suspected appendicitis, a Meckel's diverticulum should be looked for by examining the small bowel particularly if free fluid or pus is found.* In around 20 per cent of cases, the mucosa of a MeckeVs diverticulum contains heterotopic epithelium of gastric, colonic or pancreatic type. A Meckel's diverticulum can present clinically in the following ways:i) Haemorrhage: If gastric mucosa is present, peptic ulceration can occur and present as painless maroon rectal bleeding or melaena. If the stomach, duodenum and colon are cleared by endoscopy, radioisotope scanning with technetium-99m may demonstrate a Meckel's. (A Meckel's is notoriously difficult to see with contrast radiology.)ii) Diverticulitis: Meckel's diverticulitis presents like appendicitis, although if perforation occurs the presentation may resemble a perforated duodenal ulcer.iii) Intussusception: A Meckel's can be the lead point for ileoileal or ileocolic intussusception.iv) Chronic ulceration: Pain is felt around the umbilicus, as the site of the diverticulum is midgut in origin.v) Intestinal obstruction: A band between the apex of the diverticulum and the umbilicus (also part of the vitellointestinal duct) may cause obstruction directly or by a volvulus around it.vi) Perforation* The vast majority of Meckel's are asymptomatic. When found in the course of abdominal surgery, a Meckel's can safely be left alone provided it has a wide mouth and is not thickened.* When there is doubt, it can be resected.* The finding of a Meckel's diverticulum in an inguinal or femoral hernia has been described as Littre's hernia.
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