Overview

• Congenital diverticulum of the small intestine.
  • Remnant of the omphalomesenteric duct (aka vitellointestinal duct), which orginally would disappear around 6th week of gestation.
• Rule of 2s → occurs in 2% of the population, is 2 feet from the ileocaecal valve, and is 2 inches long.

Making Diagnosis

Clinical Features

• Usually asymptomatic (may be discovered during surgery).
• Abdominal pain mimicking appendicitis.
• Rectal bleeding → most common cause of PAINLESS massive GI bleeding requiring a transfusion in children 1-2 years.
• Intestinal obstruction → secondary to an omphalomesenteric band (most commonly), volvulus and intussusception
• Recurrent intussusception.

Investigations

• ‘Meckel’s Scan’ → uses 99m technetium pertechnetate (99mTC) to identify ectopic gastric mucosa.

Management Plan

• Asymptomatic
  • Incidental imaging finding → no treatment required. Regular monitoring for complications.
  • Detected during surgery for other reasons → prophylactic excisions.
• Symptomatic
  • Bleeding → excision of diverticulum with blood transfusion.
  • Obstruction → excision of diverticulum and lysis of adhesions.
  • Perforation/Peritonitis → excision of diverticulum or small bowel segmental resection with perioperative antibiotics.