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    Meckel Diverticulum

    Meckel Diverticulum is a topic covered in the Select 5-Minute Pediatrics Topics.

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    Basics

    Description

    • Meckel diverticulum (MD) is the most common congenital abnormality of the GI tract.
    • Derives from the omphalomesenteric duct remnants
    • The most common clinical presentation in children of MD is painless rectal bleeding.
    • Classically characterized by “Rule of 2’s”
      • Present in approximately 2% of the population
      • Male-to-female ratio 2:1
      • Within 2 feet of the ileocecal valve
      • Can be up to 2 inches in length
      • Symptoms usually present by 2 years of age.

    Epidemiology

    • MD as an anomaly occurs in ~2% of the population, but only ~4% of patients with MD develop symptoms over their lifetime.
    • MD is more common in patients with other malformations including anorectal atresia, esophageal atresia, omphalocele, and cardiac abnormalities.
    • MD is considered to be more common in males, with a male/female ratio of 2:1.
    • Males are also more likely to have symptomatic diverticula.

    Pathophysiology

    • Diverticula with ectopic tissue are more likely to be symptomatic.
    • Ectopic tissue in MD is often of gastric origin; can also be comprised pancreatic, duodenal, or colonic tissue as well
    • Bleeding occurs when gastric mucosa is present, resulting in peptic ulcerations of the small bowel downstream from the diverticulum (90% of cases).
    • Alkaline secretions from ectopic pancreatic tissue can also cause ulcerations with bleeding.
    • Obstruction can occur when the diverticulum acts as a lead point for intussusception, when the diverticulum becomes inflamed with subsequent lumen narrowing, or when the diverticulum induces a volvulus.

    Etiology

    • True diverticulum (contains all 3 layers of the bowel wall)
    • Originates from the antimesenteric border of the bowel in the region of the terminal ileum and proximal to the ileocecal valve
    • Remnant of the omphalomesenteric (vitelline) duct which fails to involute completely during the 5th–6th week of gestation as the placenta replaces the yolk sac as the source of fetal nutrition
    • MD accounts for 90% of the vitelline duct anomalies. Other anomalies include the following:
      • Omphalomesenteric fistula
      • Omphalomesenteric cyst
      • Fibrous band

    Commonly Associated Conditions

    • MD has also been associated with several other congenital anomalies that include the following:
      • Anorectal atresia (affects 11% of patients with MD)
      • Esophageal atresia (12%)
      • Minor omphalocele (25%)
      • Cardiac malformations
      • Exophthalmos
      • Cleft palate
      • Annular pancreas
      • Some central nervous system malformations
    • Malignancies have also been reported in association with MD.
      • Can be present within the diverticulum and can cause obstructive symptoms or can be found incidentally
      • Sarcomas are the most common malignancy associated with MD, followed by carcinoids and adenocarcinomas.

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    Citation

    Cabana, Michael D., editor. "Meckel Diverticulum." Select 5-Minute Pediatrics Topics, 7th ed., Wolters Kluwer Health, 2015. Medicine Central, im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14113/all/Meckel_Diverticulum.
    Meckel Diverticulum. In: Cabana MD, ed. Select 5-Minute Pediatrics Topics. 7th ed. Wolters Kluwer Health; 2015. https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14113/all/Meckel_Diverticulum. Accessed April 25, 2019.
    Meckel Diverticulum. (2015). In Cabana, M. D. (Ed.), Select 5-Minute Pediatrics Topics. Available from https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14113/all/Meckel_Diverticulum
    Meckel Diverticulum [Internet]. In: Cabana MD, editors. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14113/all/Meckel_Diverticulum.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Meckel Diverticulum ID - 14113 ED - Cabana,Michael D, BT - Select 5-Minute Pediatrics Topics UR - https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14113/all/Meckel_Diverticulum PB - Wolters Kluwer Health ET - 7 DB - Medicine Central DP - Unbound Medicine ER -