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Meckel's diverticulum (MD) is the most common congenital malformation of the digestive tract
.
This article summarizes
the key points related to MD.
Epidemiology.
MD was first proposed by German anatomist Johnn Friedric Meckel in 1809, with an incidence of about 2%, and the male-female incidence ratio is 2:1~7.
5:1
.
About 56.
4%
of children under 5 years of age.
MD formation MD formation
is caused by incomplete degeneration of the yolk duct, often occurring in the mesangial limbus at the end of the ileum, belonging to true diverticula, which often contain ectopic tissue, the most common is the gastric mucosa, followed by pancreatic tissue
.
MD is often located within 100 cm of the ileocecal valve, and ectopic gastric tissue in the diverticulum secretes acidic fluid, which may be the cause of ulceration and acute gastrointestinal bleeding, and is the most common cause
of small bowel bleeding in patients younger than 25 years of age.
Clinical manifestations of MD itself are often asymptomatic, and the corresponding manifestations
usually occur when complications occur.
The morphological structure of diverticulum is often an important factor in causing complications and producing clinical symptoms, and male children, diverticulum length greater than 2 cm, and diverticulum containing ectopic tissue are more likely to have complications
.
Common complications of MD include gastrointestinal bleeding, intestinal obstruction, Merkel's diverticulitis, and intestinal perforation
.
The clinical features of lower gastrointestinal bleeding caused by Meckel's diverticulum in adults are closely related to the location of the diverticulum, the bleeding rate and the amount of bleeding, namely: high diverticulum position, slow bleeding rate, small bleeding volume are mostly manifested as black stool, diverticulum position is low, bleeding speed, large bleeding volume is manifested as blood stool, and in between the two is usually manifested as dark red blood stool, but some patients can also present black stool, dark red blood stool and blood stool alternating performance
。 Diverticular haemorrhage and diverticular inflammation are two pathologic states, so diverticular haemorrhage often presents as painless bleeding, and large diverticular bleeding is often accompanied by haemodynamic changes
.
When Merkel's diverticulitis or ulcer is complicated by infection, fever, abdominal pain, and blood in the stool may be present
.
Because lesions tend to occur distal to the ileum, they may usually be accompanied by right lower quadrant tenderness, even rebound tenderness and abdominal muscle tension
.
Patients with symptoms similar to acute appendicitis with blood in the stool should be on high alert for Merkel's diverticulitis or ulceration
.
is the gold standard for diagnosing MD, but MD itself and its complications lack specificity, so preoperative examinations are often required to assist in diagnosis
.
Commonly used auxiliary examination methods include nuclear scanning, abdominal radiograph, ultrasound, endoscopy, barium angiography, CT examination, angiography, etc
.
(1) MD (short arrow) is connected to the ileum (long arrow)
(2) The wall of the diverticulum is thickened, the fluid accumulation in the lumen is accompanied by gas accumulation, and the surrounding inflammatory exudation
Image source: Reference 3
Barium contrast (right abdomen prone and supine position), x-rays showing the terminal small intestine and MD (arrows)
Image credit: Medscape
References:
1.
JIANG Jianxia,JIANG Liuqin.
Investigation of Doubts in Digestion-A Collection of Difficult Diseases in Gastroenterology[M].
Nanjing:Southeast University Press,2020.
2.
LI Qin, LI Zhongyue.
Advances in the diagnosis of Meckel's diverticulum[J] .
Chinese Journal of Practical Pediatrics, 2015, 30 (19): 1518-1520
3.
Wang Chao, Tian Ying, Qiu Xiaohui, et al.
Meckel's diverticulum torsion with perforation: 1 case [J/OL] .
Journal of Practical Radiology,
2021, 37(10) : 1736-1737.
4.
Ali
Nawaz Khan, Meckel Diverticulum Imaging.
Medscape.
