Meckels Diverticulum

Meckel's diverticulum is the most common congenital anomaly of the small intestine, occurring in 1-3% of the population. It is mostly asymptomatic. One of the most common complications is lower gastrointestinal bleeding, which may be acute, life-threatening, chronic or intermittent, and is mostly due to ectopic gastric mucosa and peptic ulceration. Ectopic gastric mucosa is found in 15-20% of cases, in almost 90% of those who present with bleeding of the pediatric age group, but in only 7% of similar cases in adults.

Pre-operative radiological diagnosis of Meckel's diver-ticulum ranges from difficult to very difficult. Radionuclide imaging, the Meckel's scan, based on the affinity of the isotope technetium-99m pertechnetate for functioning ectopic gastric mucosa, has long been con sidered a most sensitive study. However, sensitivity varies with technique and age, and it is estimated to be around 60% for adults. False positive results do occur, at a disturbing frequency, in a number of conditions, whereas false negative results usually occur with symptomatic di-verticula without ectopic gastric mucosa or acutely hem-orrhaging diverticula.

Enteroclysis has been also suggested as a most reliable imaging technique for the pre-operative diagnosis of a Meckel's diverticulum. It usually shows a blindly ending sac of variable size, arising from the antimesenteric border of ileum. Additional characteristic findings include a gastric rugal pattern or a triangular fold pattern, at the base of the diverticulum. Careful fluoroscopy with compression is essential.

However, unsuccessful demonstration of a Meckel's di-verticulum on enteroclysis despite a detailed examination is not unusual. The reasons for this include stenosis of the ostium, filling with intestinal contents, rapid emptying, or small size. CT has been reported to be of value in Meckel's diverticulitis and infracted Meckel's diverticulum.

Selective angiography is a well-established method for both non-hemorrhaging-negative scintigraphic, and for massively bleeding, diverticula. Extravasation of contrast into the bowel lumen is an expected angiographic finding in a patient with active bleeding. Very recently the importance of visualization and identification of the vitelline artery for the diagnosis of a Meckel's diverticulum itself, with or without active hemorrhage, has again been stressed.

Characteristic angiographic findings of selective or su-perselective catheterization will include: a) an abnormal elongated vessel, originating from the ileal artery, without anastomotic branches to the ileal artery branches; and b) a group of dilated tortuous vessels at the distal portion of this artery, without branches.

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