Diverticulum gastric

Fig. 4.28. Abnormal areae gastricae. The pattern is disturbed in this patient with a carcinoma of the fundus not noted at endoscopy (also note the gastric diverticulum)...

Peptic ulceration occurs as an acute or chronic non-traumatic epithelial breach typically in the gastric or duodenal mucosa, but also in the oesophagus (see above) and occasionally in the small intestine with the Zollinger-Ellison syndrome of gastrin overproduction or with an acid-secreting Meckel s diverticulum. Symptoms overlap with those of non-ulcer dyspepsia and cancer and the diagnostic cornerstone is endoscopy. Biopsy may be necessary to distinguish ulcer from cancer. 

To diagnose ectopic gastric mucosa (Meckel s diverticulum)... 

Meckel diverticulum is the most common congenital anomaly of the GI tract and is the most common site for ectopic gastric mucosa. GI duplications (non-communicating or more rarely communicating) are less common and 20%-30% of these will contain ectopic gastric mucosa. It is also more commonly seen in tubular duplications (in contrast to cystic). 

Fig. 3.7. A 2-year old boy with bright red blood per rectum and a normal UGI study ectopic gastric muscosa (Meckel diverticulum) (arrow)...

In half of the patients with complaints dinical signs manifest in the first 2 years of life. Ulceration occurs only in those that contain ectopic gastric mucosa and thus is rare, but can cause occult fecal blood or frank blood in stool and anemia. Adhesions and formation of scar tissue can lead to obstructive ileus. The diverticulum can act as a lead point for ileocolic or ileoileal intussusception. 

Plain film is indicated if obstruction or perforation is suspected. Meckel diverticulum is incidentally found by US (Fig. 5.14a), which may show cystic diverticula, andby enteroclysis. Small bowel or colon enemas can show the rather bigger diverticula. Scintigraphy may identify a Meckel diverticulum if it has gastric mucosa as a hot spot (Fig. 5.14b). 

Fig. 5.14. a Meckel diverticulum as a lead point for an ileo-ileo-colic intussusception. Note the surrounding of diverticulum by intraluminal intestinal fluid, b Radioisotope uptake in gastric mucosa in a Meckel diverticulum (arrow)... 

In children, localized gastrointestinal bleeding is usually secondary to duodenal ulcer and less frequently to gastric ulcer, Meckel s diverticulum, and vascular malformations. Diffuse bleeding can occur in vasculitis and coagulopathy. 

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