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  • • Most jejunoileal diverticula are acquired true diverticula

    • -Meckel diverticulum is congenital

    • May be asymptomatic or associated with obstruction, bleeding, or inflammation (diverticulitis)

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Epidemiology

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  • Acquired diverticula in 1.3% of the population

    • Most contain all layers of the intestinal wall (true diverticula)

    • Often multiple, they diminish in frequency from the ligament of Treitz to the ileocecal valve

    Meckel diverticulum is a congenital, true diverticulum that results from persistence of the vitelline duct and occurs on the antimesenteric border of the ileum

    • Heterotrophic gastric or pancreatic tissue may be present in the diverticulum

    • Follow the rule of 2:

    • -Occur in males twice as often as females

      -Occur in 2% of the population

      -Become symptomatic in 2% of cases

      -Occur 2 ft proximal to the ileocecal valve

      -May extend over 2 inches in length

      -Can cause 2 symptoms: Bleeding and obstruction

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Symptoms and Signs

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  • • Most are asymptomatic

    • Symptoms may be due to obstruction, inflammation, bleeding, or bacterial overgrowth

    • Abdominal pain

    • GI hemorrhage

    • Diarrhea and malabsorption

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Laboratory Findings

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  • • Elevated WBC count (inflammation)

    • Anemia (bleeding)

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Imaging Findings

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  • Upper GI contrast radiography: May outline the diverticula and any associated obstruction

    CT scan: May reveal the diverticula as well as associated inflammation or obstruction

    Meckel diverticulum: 99technetium-pertechnate scan can identify ectopic gastric mucosa in the diverticulum

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  • • Jejunoileal diverticula may be associated with disturbed motility

    • Blind loop syndrome is caused by chronic partial obstruction or bacterial overgrowth in large diverticula

    • Obstruction in Meckel diverticulum may be due to volvulus around a persistent omphalomesenteric band or intussusception

    • Bleeding in Meckel diverticulum is due to ulceration from acid secreted by heterotopic gastric mucosa

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Rule Out

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  • • Other causes of GI bleeding, small bowel obstruction, or small bowel inflammation

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  • • Upper GI contrast radiography or CT scan

    99Technetium-pertechnate scan in suspected cases of Meckel diverticulum

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When to Admit

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  • • Complications

    • -Obstruction

      -Bleeding

      -Inflammation

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  • • Asymptomatic diverticula require no treatment

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Surgery

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  • • Small bowel resection and anastomosis required for complications

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Indications

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  • • Inflammation (diverticulitis)

    • Bleeding

    • Obstruction

    • Perforation

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Complications

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  • • Inflammation (diverticulitis)

    • Perforation

    • Bleeding

    • Obstruction

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Prognosis

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  • • Diverticula are treated completely by segmental small bowel resection

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References

Woods K et al: Acquired jejunoileal diverticulosis and its complications: a review of the literature. Am Surg 2008;74:849.  [PubMed: 18807676]

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