| 19. Meckel's
Diverticulum |
page 255 |
Meckel's diverticulum, an
omphalomesenteric duct remnant, is a congenital outpouching usually located in the distal
100 cm of the ileum. Such diverticula are present in 1-3% of the general population. Of
these, 30-40% are asymptomatic. Complications of Meckel's diverticulum include hemorrhage,
intestinal obstruction, diverticulitis, umbilical discharge, perforation and peritonitis.
Bleeding is the most common complication, resulting from ulceration of the ileal mucosa
adjacent to ectopic gastric mucosa located within the diverticulum. (However, in the
patients with a Meckel's diverticulum but without ectopic gastric mucosa, bleeding does
not usually occur.) This bleeding is often painless and is usually encountered in children
and young adults. Meckel's diverticulum accounts for nearly 50% of all lower
gastrointestinal bleeding in children. Technetium-99m pertechnetate is normally taken by
the ectopic gastric mucosa, providing the basis for the Meckel scan. Since only 60% of
Meckel's diverticula contain ectopic gastric mucosa, false negative results occur. If the
scan is positive, increased sensitivity can be achieved by repeating the scan after a
short course of an H2-RA: the H2-RA releases acid secretion by the ectopic parietal cells
in the Meckel's diverticulum and may thereby convert a positive into a negative scan. |