Meckel's diverticulum pathophysiology: Difference between revisions

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Revision as of 17:06, 5 January 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

During embryonic life, the vitelline duct or the omphalomesenteric duct is the connection between the midgut and the yolk sac responsible for providing nutrition to the midgut.
In the period between the fifth and the sixth weeks of gestation, the vitelline duct involutes and disappears, while the bowel is rapidly pulled into the abdominal cavity.
Failure of duct involution may lead to persistence of the omphalomesenteric duct with variable morphology:
- Vitelline fistulae draining through the umbilicus
- Vitelline cysts
- Fibrous bands connecting the umbilicus to the diverticulum that may twist to cause intestinal obstruction
- Meckel’s diverticulum:
  - True diverticulum (comprising of all layers of intestinal wall i.e. mucosa, submucosa and muscularis propria)
  - Arises from the antimesenteric border of the ileum , extends into the umblical cord
  - Supplied by the vitelline artery, branch of SMA, prone to torsion and subsequent ischemia, infarction and obstruction
  - Bears ectopic tissue due to the following reasons:
    - Presence of a pluripotent cell lining
    - Faulty association between endodermal and neural crest cells
    - Absence of inhibitory effect of the mesoderm on the local endoderm may also be responsible
  - Types of ectopic tissue:
    - Jejunal mucosa
    - Duodenal mucosa or Brunner's tissue
    - Gastric mucosa
    - Pancreatic tissue

References

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 ==Overview==
 ==Pathophysiology==
-===Presentation===
+* During embryonic life, the vitelline duct or the omphalomesenteric duct is the connection between the midgut and the yolk sac responsible for providing nutrition to the midgut.
+* In the period between the fifth and the sixth weeks of gestation, the vitelline duct involutes and disappears, while the bowel is rapidly pulled into the abdominal cavity.
-Meckel's diverticulum is located in the distal [[ileum]], usually within about 60-100 cm of the [[ileocecal valve]]. It is typically 3-5 cm long, runs antimesenterically and has its own blood supply. It's left over from the umbilical cord and intestines from our embryonic life.
+* Failure of duct involution may lead to persistence of the omphalomesenteric duct with variable morphology:
+** Vitelline fistulae draining through the umbilicus
-A memory aid is the rule of 2's: '''2%'''  (of the population) - '''2''' feet (from the ileocecal valve) - '''2''' inches (in length) - '''2%''' are symptomatic, there are '''2''' types of common ectopic tissue (gastric and pancreatic), the most common age at clinical presentation is '''2''', and males are '''2 times''' as likely to be affected.
+** Vitelline cysts
+** Fibrous bands connecting the umbilicus to the diverticulum that may twist to cause intestinal obstruction
-It can also be present as an indirect hernia, where it is known as  a Hernia of Littre. Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, [[ischemia]], and [[necrosis]].
+** Meckel’s diverticulum:
+*** True diverticulum (comprising of all layers of intestinal wall i.e. mucosa, submucosa and muscularis propria)
+*** Arises from the antimesenteric border of the ileum , extends into the umblical cord
+*** Supplied by the vitelline artery, branch of SMA, prone to torsion and subsequent ischemia, infarction and obstruction
+*** Bears ectopic tissue due to the following reasons:
+**** Presence of a pluripotent cell lining
+**** Faulty association between endodermal and neural crest cells
+**** Absence of inhibitory effect of the mesoderm on the local endoderm may also be responsible
+*** Types of ectopic tissue:
+**** Jejunal mucosa
+**** Duodenal mucosa or Brunner's tissue
+**** Gastric mucosa
+**** Pancreatic tissue
 ==References==

Meckel's diverticulum pathophysiology: Difference between revisions

Revision as of 17:06, 5 January 2018

Overview

Pathophysiology

References

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