MECKELS DIVERTICULUM

 

Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract occurring in approximately 2-3% of the population (1).

It develops at the fifth week of life from the vestigial remnant of the omphalomesenteric duct or yolk stalk of the embryo.

It is located arising from the distal ileum as a 1-12 cm pouch protruding from the wall.

It usually contains all layers of the bowel but may conatin heterotopic tissue within it in 50% of cases (gastric or pancreatic tissue0.
Asymptomatic diverticuli are usually found incidentally.
Giant Meckel's diverticuli occur in less than 0.5% of all omphalomesenteric duct remnants.

Features suggesting that they are at risk for complications are:

 

ULTRASOUND

 

Scan at 26 weeks of gestation

Cystic mass in mid-abdomen and right lower quadrant (arising from the pelvis and extending into the

right upper quadrant of the fetus).

No connection to bowel or stomach.

No connection to gallbladder or hepatobiliary system.

Mass is separate from the urinary bladder

Avascular on color doppler

 

 

DIFFERENTIAL DIAGNOSIS

1.      Enteric duplication cysts.

2.      Mesenteric cyst.

3.      Choledochal cysts.

4.      Displaced ovarian cysts (in a female fetus).

5.      Distended appendix.

6.      Bowel obstruction and volvulus less likely.

 

REFERENCES

  1. Mackey WC, Dineen P. A fifty-year experience with Meckel's diverticulum. Surg Gynecol Obstet 1983;156:56-64.
  2. Aultman CJ, Samples TL. In utero appearance of a giant Meckel's diverticulum. Pediatr Radiol 1996;26:398-401.