Skip to Main Content

+

  • • Most jejunoileal diverticula are acquired true diverticula

    • -Meckel diverticulum is congenital

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

++

Epidemiology

+

  • 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

++

Symptoms and Signs

+

  • • Most are asymptomatic

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

    • Abdominal pain

    • GI hemorrhage

    • Diarrhea and malabsorption

++

Laboratory Findings

+

  • • Elevated WBC count (inflammation)

    • Anemia (bleeding)

++

Imaging Findings

+

  • 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

+

  • • 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

++

Rule Out

+

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

+

  • • Upper GI contrast radiography or CT scan

    99Technetium-pertechnate scan in suspected cases of Meckel diverticulum

++

When to Admit

+

  • • Complications

    • -Obstruction

      -Bleeding

      -Inflammation

+

  • • Asymptomatic diverticula require no treatment

++

Surgery

+

  • • Small bowel resection and anastomosis required for complications

++

Indications

+

  • • Inflammation (diverticulitis)

    • Bleeding

    • Obstruction

    • Perforation

++

Complications

+

  • • Inflammation (diverticulitis)

    • Perforation

    • Bleeding

    • Obstruction

++

Prognosis

+

  • • Diverticula are treated completely by segmental small bowel resection

++

References

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

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.