What is false about Meckel’s diverticulitis?
Correct Answer: Present in 3% of the population
Description: Ans. a. Present in 3% of the population (Ref: Sabiston 19/e p1268-1270; Schwartz 9/e p1002-1004, 1435; Bailey 26/e p1169-1170, 25/e p1158-1159; Shackelford 7/e p695-698)Meckel's diverticulum is present in 2% of the population and not 3%."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 alt three coats of the bowel wall and has its own blood supply. " - Bailey 26/e p1169Meckel's diverticulumMost commonly encountered congenital anomaly of the small intestineQOccur 2% of the populationQ.Rule of two in Meckel's diverticulum* 2% prevalenceQ* 2 inch in lengthQ* 2 feet proximal to ileocecal valveQ* Half of these who are symptomatic are <2 yearsQ of ageTrueQ diverticulum as it has all the 3 layers of the intestineQ.Located on the antimesenteric border of the ileum 45 to 60 cm proximal to the ileocecal valveResults from incomplete closure of omphalomesenteric or vitellointestinal ductQ.An equal incidence among men & womenQ.MC heterotopic tissue: Gastric mucosa (50%)Q >Pancreatic mucosa (5%) >colonic mucosa (rarely)Clinical Features:Most are entirely benign & incidentally discovered during autopsy, laparotomy, or barium studiesMC clinical presentation is GI bleeding (25-50%)QHemorrhage: MC symptomatic presentation in children <2 yearsQHemorrhage is manifested as painless bright red blood from the rectum, with intermittent episodesQ persisting without treatment.Source of the bleeding is a chronic acid-induced ulcer in the ileum adjacent to a Meckel's diverticulum that contains gastric mucosa.Intestinal obstruction (31%): Due to volvulus, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia (Littre's hernia) QComplications of Meckel's diverticulumMC complication in children & young adults: BleedingQMC complication in adults: Intestinal obstructionQDiverticulitis (10-20%) is more common in adult patients.Progression of the diverticulitis may lead to perforation and peritonitis.When the appendix is found to be normal during exploration for suspected appendicitis, the distal ileum should be inspected for the presence of an inflamed Meckel's diverticulumQ.Diagnosis:Most accurate diagnostic test in children: Scintigraphy with sodium 99mTc-pertechnetateQ.99mTc-pertechnetateQ ScanThe 99mTc-pertechnetate is preferentially taken up by the mucus-secreting cells of gastric mucosa & ectopic gastric tissue in the diverticulumQ.(Sensitivity-85%. specificity-95% and an accuracy-90% in the pediatric age group)Less accurate in adults because of the reduced prevalence of ectopic gastric mucosaQ 1 The sensitivity & specificity can be improved by pentagastrin and glucagon or H2-receptor antagonists (cimetidine)Q.In adults with normal nuclear medicine findings, barium studies should be performed.Treatment:Symptomatic Meckel's diverticulum: Diverticulectomy or resection of the segment of ileumQ bearing the diverticulum.Segmental intestinal resection is required for bleeding because the bleeding site usually is in the ileum adjacent to the diverticulumQ.Asymptomatic diverticula found in children during laparotomy should be resectedQ.Incidentally found Meckel's diverticulum should be removed at any age up to 80 years as long as no additional conditions (e.g., peritonitis) made removal hazardousQ.
Category:
Surgery
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