Advertisement

Meckel's diverticulum

  • Charles K. Brown
    Correspondence
    Address reprint requests to Dr. Brown: c/o Clinical Investigation Department, Naval Hospital, San Diego, CA 92134-5000.
    Affiliations
    Department of Emergency Medicine, Naval Hospital, San Diego, CaliforniaUSA.

    Department of Clinical Investigation, Naval Hospital, San Diego, CaliforniaUSA.
    Search for articles by this author
  • Jonathan S. Olshaker
    Affiliations
    Department of Emergency Medicine, Naval Hospital, San Diego, CaliforniaUSA.

    Department of Clinical Investigation, Naval Hospital, San Diego, CaliforniaUSA.
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Meckel's diverticulum is a cause of significant morbidity and mortality. Often this is related to the delay in diagnosis. Based on a US population of 200 million people and a 2% incidence, there are 4 million Meckel's diverticula present waiting to cause symptoms. Considering that most Meckel's diverticula are asymptomatic and that many authors have described the condition as a great mimic, the diagnosis is often quite elusive. Therefore, a high index of suspicion is needed to diagnose Meckel's diverticulum correctly and expeditiously as the source of disease in the patient with an often unclear abdominal presentation. The difficulty with diagnosis should be lessened if one considers that Meckel's diverticulum presents largely in the male and younger age groups with the three major symptom complexes of bowel obstruction, gastrointestinal bleeding, and inflammation. Use of 99mTc pertechnetate scintigraphy appears to be the diagnostic study of choice if Meckel's diverticulum is suspected and the patient is clinically stable. When one considers the potential for bad outcome if Meckel's diverticulum is missed in the setting of possible obstruction or hemorrhage (i.e., bowel infarction or exsanguination), a high index of suspicion and diagnostic aggressiveness is warranted. Lastly, if one thought is to be left behind, it should be: “Meckel's is a great mimic that must be considered in all cases of intra-abdominal disease in which the cause is not readily apparent.”7

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Castleden WM
        Meckel's diverticulum in an umbilical hernia.
        Br J Surg. 1970; 57: 932-933
        • Gentile A
        The incidence of hernia in the United States.
        Ind Med Surg. 1962; 31: 19-21
        • Lichtenstein MD
        Meckel's diverticulum: intestinal obstruction due to invagination and intussusception: peritonitis due to perforation by fish bone. 1941; 15: 296-300
        • Curd HH
        Histiologic study of Meckel's diverticulum with special reference to heterotopic tissue.
        Arch Surg. 1936; 32: 506-523
        • Ruysch F
        ed 8. Thesarus Anatomicusis. vol 7. J Wotters, Amsterdam1701: 44
        • Meckel JF
        Meckel's diverticulum: clinical and histologic study.
        Acta Chir Scand. 1959; 248 (quoted by Soderlund S) (Suppl): 1-233
        • Weinstein EC
        • Cain JC
        • ReMine WH
        Meckel's diverticulum: fifty-five years of clinical and surgical experience.
        JAMA. 1962; 182: 131-133
        • Leijonmarck CE
        • Bonman-Sandelin K
        • Frisell J
        • et al.
        Meckel's diverticulum in the adult.
        Br J Surg. 1986; 73: 146-149
        • Winzelberg GG
        Radionuclide detection of gastrointestinal bleeding.
        Am Fam Physician. 1982; 25: 191-194
        • Rutherford RB
        • Akers DR
        Meckel's diverticulum: a review of 148 pediatric patients, with special reference to the pattern of bleeding and to mesodiverticular vascular bands.
        Surgery. 1966; 59: 618-626
        • Savino JA
        Malabsorption secondary to Meckel's diverticulum.
        Am J Surg. 1982; 144: 588-592
        • Tisdall FF
        Unusual Meckel's diverticulum as a cause of intestinal hemorrhage.
        Am J Dis Child. 1928; 36: 1218-1223
        • Chaffin L
        Surgical emergencies during childhood caused by Meckel's diverticulum.
        Ann Surg. 1941; 113: 47-56
        • Moll HH
        Giant Meckel's diverticulum, Math Eq inches long.
        Br J Surg. 1926; 14: 176-179
        • Goldstein M
        • Cragg RW
        Elongated Meckel's diverticulum in a child.
        Am J Dis Child. 1938; 55: 128-134
        • Mackey WC
        • Dineen P
        A fifty year experience with Meckel's diverticulum.
        Surg Gynecol Obstet. 1983; 156: 56-64
        • Deetz D
        Perforationsperitonitis von einem darmdivertikel mit magenschleimhautbau ausgehend.
        Dtsch Z Chir. 1907; 88: 482-493
        • Bird WE
        Littre's umbilical hernia.
        Am J Surg. 1943; 60: 81-87
        • Brookes VS
        Meckel's diverticulum in children: a report of 43 cases.
        Br J Surg. 1954; 42: 57-68
        • Dowse JLA
        Meckel's diverticulum.
        Br J Surg. 1961; 48: 392-399
        • Kabbani SS
        • Lewis JE
        Strangulated hernia of Meckel's diverticulum in an infant.
        J Pediatr Surg. 1966; 1: 579-582
        • Soltero MJ
        • Bill AH
        The natural history of Meckel's diverticulum and its relation to incidental removal: a study of 202 cases of diseased Meckel's diverticulum found in King County, Washington, over a fifteen year period.
        Am J Surg. 1976; 132: 168-173
        • Yamaguchi M
        • Takeuchi S
        • Awazu S
        Meckel's diverticulum: investigation of 600 patients in the Japanese literature.
        Am J Surg. 1978; 136: 247-249
        • Moore T
        • Johnston AOB
        Complications of Meckel's diverticulum.
        Br J Surg. 1976; 63: 453-454
        • Stevenson RJ
        Gastrointestinal bleeding in children.
        Surg Clin North Am. 1985; 65: 1455-1481
        • Boley SJ
        • Brandt LJ
        • Frank MS
        Severe lower intestinal bleeding: diagnosis and treatment.
        Clin Gastroenterol. 1981; 10: 65-91
        • Frederick PL
        • Johnson ET
        Meckel's diverticulum in childhood: a review of 73 cases.
        Postgrad Med. 1963; (Oct:): 341-348
        • Littre A
        Das Meckelsche divertikel.
        Ergeb Chir Orthop. 1937; 30 (quoted by Neff G): 227-315
        • Moses WR
        Meckel's diverticulum, a report of two unusual cases.
        N Engl J Med. 1947; 237: 118-122
        • Weinstein EC
        • Dockerty MB
        • Waugh JM
        Neoplasms of Meckel's diverticulum.
        Int Abstracts Surg. 1963; 116: 103-111
        • Farris JM
        The natural history of Meckel's diverticulum and its relation to incidental removal.
        Am J Surg. 1976; 132 (in discussion of Soltero MJ, Bill AH): 168-173
        • Deneke
        Über die entzündung des meckelschen divertikels und die gangrän desselben.
        Dtsch Z Chir. 1902; 62: 523-547
        • Brenneman J
        Some acute abdominal conditions in childhood.
        Miss Doctor. 1938; 15: 43-50
        • Shaunak S
        • O[Donohue J
        Massive hematemesis and melaena from a Meckel's diverticulum.
        Postgrad Med J. 1983; 59: 786-787
        • Bergquist TH
        • Nolan NG
        • Stephens DH
        • et al.
        Specificity of 99mTc pertechnetate in scintigraphic diagnosis of Meckel's diverticulum: review of 100 cases.
        J Nucl Med. 1976; 17: 465-469
        • Rosenthall L
        • Henry J
        • Murphy D
        • et al.
        Radiopertechnetate imaging of the Meckel's diverticulum.
        Radiology. 1972; 105: 371-373
        • Kilburn E
        • Gilday D
        • Ash J
        Meckel's diverticulum: serial view imaging.
        J Nucl Med. 1976; 17: 553
        • Conway J
        The sensitivity, specificity and accuracy of radionuclide imaging of Meckel's diverticulum.
        J Nucl Med. 1976; 17: 553
        • Fletcher P
        • Andrews J
        Abdominal scanning for bleeding Meckel's diverticulum using 99mTc pertechnetate.
        Aust Paediatr J. 1978; 14: 244-247
        • Gelfand M
        • Silberstein E
        • Cox J
        Radionuclide imaging of Meckel's diverticulum in children.
        Clin Nucl Med. 1978; 3: 4-8
        • Sfakianakis G
        • Haase G
        Abdominal scintigraphy for ectopic gastric mucosa: a retrospective analysis of 143 studies.
        AJR. 1982; 138: 7-12
        • Fries M
        • Mortensson W
        • Robertson B
        Technetium pertechnetate scintigraphy to detect ectopic gastric mucosa in Meckel's diverticulum.
        Acta Radiol (Diagn) (Stockh). 1984; 25: 417-422
        • Goel V
        Meckel's diverticulum.
        Semin Nucl Med. 1982; 12: 97-98
        • Treves S
        • Grand RJ
        • Eraklis AJ
        Pentagastrin stimulation of Tc 99m uptake by ectopic gastric mucosa in a Meckel's diverticulum.
        Radiology. 1978; 128: 711-712
        • Holder LE
        • Ashare AB
        • Smith W
        • et al.
        Pentagastrin: a new drug for stimulating gastric secretion of pertechnetate.
        J Nucl Med. 1975; 16: 535-536
        • Khettery J
        • Efmann E
        • Grand RJ
        • et al.
        Effect of pentagastrin, histalog, glucagon, secretion and perchlorate on the gastric handling of 99m Tc pertechnetate in mice.
        Radiology. 1976; 120: 629-631
        • Petrokubi RJ
        • Baum S
        • Rohrer GIV
        Cimetidine administration resulting in improved pertechnetate imaging of Meckel's diverticulum.
        Clin Nucl Med. 1978; 3: 385-388