All the following are true about Meckel’s diverticulum except-
Correct Answer: Arises at the mesentric border
Description: Meckel's diverticulum is situated at the anti-mesenteric border of the small intestine.
Meckel's diverticulum is a true diverticulum as it has all the 3 layers of the intestine.
It's the most common congenital anomaly of the gastrointestinal tract.
Male to female ratio is 3 : 2.
Approximately 60% of Meckel's diverticula contain heterotopic mucosa, of which more than 60% consists of gastric mucosa. Second most common ectopic mucosa is that of Pancreas (Pancreatic acini). Other mucosa are colonic mucosa, Brunner's gland, pancreatic islets, endometriosis and hepatobiliary tissue.
A useful but crude Mnemonic used traditionally for describing Meckel's diverticula is
Rule of two: i.e.
2% prevalence
2 inch in length
2 feet proximal to the ilcocecal valve.
half of these who are symptomatic are younger than 2 yrs of age
Meckel's diverticula are asymptomatic. Symptoms arise only when any complication occurs.
Complications
Most common complication
in children & young adults (< 18 yrs of age) → bleeding
in adults → intestinal obstruction
overall → bleeding
Following complications are noted in Meckel's diverticulum.
Bleeding
bleeding in Meckel's diverticulum is usually the result of ulceration in ileal mucosa adjacent to the diverticulum caused by the acid secreted by heterotopic gastric mucosa within the diverticulum.
Intestinal obstruction
Intestinal obstruction associated with Meckel's diverticulum can result from several mechanisms.
Volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus
Intussusception with the diverticulum acting as the lead point.
Entrapment of intestine by a mesodiverticular band (the Mesodiverticular band is a remnant of the left vitelline artery, it tethers the Meckel's diverticulum to the ileal mesentery.)
Stricture secondary to chronic diverticulitis.
Diverticulitis
clinical picture is similar to appendicitis.
diverticulitis may lead to perforation.
Littre's hernia - rarely Meckel's diverticulum is found in an inguinal or a femoral hernia. This is known as Littre's hernia.
Diagnostic studies
Meckel's diverticulum in the absence of bleeding can be rarely diagnosed before surgical intervention.
Barium meal follows through can rarely demonstrate the diverticulum. Barium enteroclysis can demonstrate the diverticula in 75% of cases but is avoided during the acute presentation of complication.
If repeated episodes of lower GI bleed occur and an ectopic gastric mucosa in the Meckel's diverticulum is suspected, it can be demonstrated by Technetium99 pertechnate radionuclide scan. It demonstrates the ectopic gastric mucosa and localizes the Meckel's diverticulum. Angiography can localize the site of bleeding during acute hemorrhage related to Meckel's diverticula.
Category:
Surgery
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