Meckel diverticulum

Most childhood cases of intussusception are idiopathic. Intussusception lead points such as a Meckel diverticulum, duplication cyst, polyp, or tumor (e.g. lymphoma) are uncommon in infants (<5% of cases). Intussusception lead points are more common in neonates, older children (> 5 years old), and cases restricted to the small intestine. For example, intussusception of the small intestine is common in Peutz-Jeghers syndrome, Schonlein-Henoch purpura, and after surgery. US allows... 

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)...

Congenital Diseases in the Infant 177 Volvulus 177 Meckel Diverticulum 177 Duplication Cysts 178 Intraperitoneal Cysts 179... 

A Meckel diverticulum results from an incomplete obliteration of the vitelline duct and is situated near the ileocaecal valve on the antimesenteric border of... 

The visualization of a Meckel diverticulum is often unsuccessful. Plain films show only the complications caused by a Meckel diverticulum. 

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)... 

Gl obstruction (Concerts only) Because the Concerts tablet is nondeformable and does not appreciably change shape in the Gl tract, do not administer to patients with pre-existing severe Gl narrowing (eg, small bowel inflammatory disease, short gut syndrome because of adhesions or decreased transit time, history of peritonitis, cystic fibrosis, chronic intestinal pseudo-obstruction, Meckel s 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. 

Burrull-Madero MA, Del-Villar-Ruiz A, Grau-Cerrato S, Andreu-Garcia M, Goday-Arno A. Digestive hemorrhage caused by a Meckel s diverticulum in a metformin-treated patient is there any connection Pharm World Sci 2001 23(3) 120-1. 

Bleeding from a Meckel s diverticulum has been described with oral ibuprofen (SEDA-17,110). 

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

Meckel s diverticulum scintigraphy should commence immediately after intravenous injection and at regular intervals up to 30 min. 

Meckel s diverticulum nuclear scan MUGA scan Octreotide scan Oncoscint scan... 

Types of Enema Therapies 43 Appendicitis 46 Appendicitis Imaging 47 Small Bowel Obstruction 56 Midgut Volvulus 58 Meckel s Diverticulum 59 Enteritis 60... 

Besides perforated appendicitis and intussusception, the most common causes of small howel obstruction are incarcerated hernias and adhesions. Other causes of small bowel obstruction comprise a miscellaneous group of rare conditions, such as midgut volvulus, Meckel s diverticulum, advanced stages of Crohn s disease, and bezoars. Adhesions usually result from prior surgery and are often multiple. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. 

Meckel s diverticulum is a remnant of the omphalomesenteric duct. It is located in the antimesen-... 

Ectopic pancreas is described as the presence of pancreatic tissue without an anatomic or vascular connection with the pancreatic body. This ectopic tissue maybe localized anywhere in or outside of the gastrointestinal tract. Common sites in the gastrointestinal tract are the stomach, duodenum, and the proximal jejunum, and less commonly in the appendix, the diverticulum of Meckel in 5% of cases, or the ileum in just 1% of cases. Extraintestinal localization, such as in the wall of the gallbladder, the bile ducts in the liver, the hilum of the spleen, the omentum, the perigastric or periduodenal area, may be seen in only 4% of cases (Gazelle et al. 1998). 

Fig. 5.13. Lead-point lesion in intussusception, a Adenomatous polyp, b Inflammatory polyp, c Inverted Meckel s diverticulum seen as cystic mass...

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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