Meckel's diverticulum pathophysiology
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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