Meckel's diverticulum
| Meckel's diverticulum | |
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| Meckel's diverticulum |
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American Roentgen Ray Society Images of Meckel's diverticulum |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Natural History, Complications and Prognosis
Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, ischemia, and necrosis.
Meckel diverticulitis
Meckel diverticulitis is acute inflammation of a Meckel diverticulum.
- CT will demonstrate a blind-ending, tubular, round or oval structure in the right lower quadrant or periumbilical region with surrounding inflammation.
- The wall of the diverticulum may show inflammatory changes such as mural thickening and contrast material enhancement.
- Soft-tissue stranding and adjacent fluid collections are also helpful features of diverticulitis.
- Occasionally an enteroliths will be present within the inflamed diverticulum.
Diagnosis
A technetium-99m (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric (stomach) cells contained within them, this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence. Other tests such as colonoscopy and screenings for bleeding disorders should be performed, and angiography can assist in determining the location and severity of bleeding.
Positive Technetium-99m pertechnetate scan
Imaging Findings
- Meckel diverticulum is identified as a saccular, blind-ending structure located on the antimesenteric border of the ileum.
- Meckel diverticulum is usually found in the right lower quadrant and pelvic region.
- The junction of the diverticulum with the ileum may show a mucosal triangular plateau or triradiate fold pattern (represents the site of omphalomesenteric duct attachment to the ileum).
- Filling defects within the diverticulum may represent enteroliths, fecoliths, or foreign bodies.
- Technetium-99m pertechnetate scintigraphy is the modality of choice for evaluating pediatric patients with gastrointestinal hemorrhage and a suspected Meckel diverticulum.
- A Meckel diverticulum containing gastric mucosa will manifest as a small rounded area of increased activity in the right lower quadrant.
- Normal activity will simultaneously appear in the stomach.
Treatment
Treatment is surgical, consisting of a resection of the affected portion of the bowel.
References
Template:Congenital malformations and deformations of digestive system
de:Meckel-Divertikel
it:Diverticolo di Meckel