31st July 2023

Meckel’s Diverticulum

Meckel’s diverticulum are congenital diverticulum due to embryonic remnants of the vitelline duct in the distal ileum, made up of gastric and pancreatic tissue. The remnant tissue may secrete gastric acid, leading to ulceration and bleeding, and it is an important differential for occult GI bleeding in adults.

The majority of those with this condition are asymptomatic. Those with symptoms typically present early in life to paediatrics (<2 years), but symptoms can potentially arise at any age. Clinical features may include fresh PR bleeding (or melaena) and those of bowel obstruction. Rarely, it can present with severe right iliac fossa pain and mimic acute appendicitis. Other complications include diverticulitis, perforation and the formation of a Littre hernia.

The rule of 2s may be used as a memory aid to remember some clinical features:

• 2% of the population affected
• 2 inches in length
• 2 feet proximal to the ileocaecal valve
• 2 types of ectopic tissue
• 2 years old – peak age for presentation
• 2:1 male to female ratio

The diagnosis is usually made with a radionuclide scan (technetium-99m pertechnetate) which will accumulate in ectopic gastric tissue. In asymptomatic patients, it is often found incidentally during laparoscopy or laparotomy.

Patients with a symptomatic Meckel’s diverticulum should be referred to the general surgery team for resection. For those with an incidental Meckel’s diverticulum, the decision regarding whether to operate is made depending on age, comorbidities and size of diverticulum.

A surgical specimen of Meckel’s diverticulum. 

Image Source: Wikimedia Commons (2010). Meckel’s Diverticulum AFIP, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Meckel%27s_Diverticulum_AFIP.jpg (Accessed: 12 May 2022).