Type:
Educational Exhibit
Keywords:
Diverticula, Congenital, Acute, Education, Diagnostic procedure, Ultrasound, Nuclear medicine conventional, Paediatric, Emergency, Abdomen
Authors:
N. Pérez Peláez1, C. Gallego2, D. Coca Robinot2, G. del Pozo Garcia2, M. Rasero Ponferrada2, E. Aguirre Pascual2; 1Madrid, Madrid/ES, 2Madrid/ES
DOI:
10.1594/ecr2018/C-1809
Background
Meckel’s diverticulum is the most common malformation of the gastrointestinal tract.
It is a remnant of the omphalomesenteric duct,
the embryological communication between the yolk sac and the developing midgut,
which obliterates by the 10th-12th week of gestation.
Incomplete obliteration of the omphalomesenteric duct may lead to a Meckel’s diverticulum,
omphalomesenteric sinus or cyst or fibrous cord.
Meckel’s diverticulum is by far the most common malformation of the omphalomesenteric duct remnants (nearly 98% of all omphalomesenteric anomalies).
It is a true diverticulum,
length up to 5 cm,
located at the antimesenteric side of the distal ileum,
classically within 60 -90 cm from the ileocecal valve in children.
Heterotopic mucosa frequently lines its lumen,
being gastric mucosa the most common tissue.
With a prevalence of 2-3% in general population,
Meckel’s diverticulum is generally asymptomatic.
Clinical manifestation is more frequent in children than in adults,
because of a lower prevalence of heterotopic gastric mucosa in adults.
The most common clinical presentation in children less than 5 years is painless rectal bleeding,
secondary to the presence of ectopic gastric mucosa,
which leads to ulcer formation in the diverticulum or adjacent ileum.
Bowell obstruction or pain and infectious symptoms are less common clinical manifestations.
Complication rate is about 5%,
including haemorrhage; diverticulitis; small bowel obstruction due to intussusception diverticulum herniation,
torsion and inversion; perforation; enterolith formation and neoplastic transformation.