Meckel´s diverticulum, brings you back to embryologic issue.
First and foremost, what you have to have memorized
is that this is the remnant of the vitelline duct.
And where your Meckel diverticulum would be is the rule of two´s.
It is 2 inches long, it is from 2 feet from the IC valve, which stands for ileocecal valve,
2% of the population and 2x greater in boys. Rule of two´s, Meckel´s diverticulum.
At the remnant.
Now you are 2 feet from the ileocecal valve you are nowhere near the stomach.
Why do I bring that to your attention, because in our discussion of neoplasia,
where we discussed was the fact that there is a course tumor heterotropic rest
that you want to pay attention to.
There is every possibility that you might find parietal cells
that are normally located in the stomach down the Meckel diverticulum.
That is the definition of a choristoma or heterotropic rest. Do not forget that.
This is in fact the two diverticulum and then may contain the gastric mucosa,
that of course referring to, once again a heterotropic rest.
With Meckel´s diverticulum, you are worried about hemorrhage, well the leading edge,
this might be the handle in which it is then going through fold upon each other.
So let us think about where you are.
Ileocecal valve, and when you fold upon each other, what did you just form?
You feel this, and it feels like a sausage like structure
and now you have a child that is complaining about abdominal pain
and there is currant jelly stool. This is intussusception.
In addition, you are also worried about this being the handle, would complication of volvulus.
Twisting of the mesentery and with Meckel diverticulum
there is every possibility of incarceration and perforation taking place
as well with Meckel´s diverticulum. Remember, you could have accumulation of substance
within the diverticulum and there might be inflammation,
behave very much like a diverticular disease, right? Same concept.
Three different places where we might see a diverticula that is extremely high yield for you.
Zenker´s diverticulum up in the esophagus, diverticular disease down in the colon,
most likely in the sigmoid colon of the elderly patient. Low fiber, high fat diet.
Number three, in a boy congenitally, may then be a remnant of the vitelline duct
resulting in Meckel diverticulum.
Meckel´s diverticulum. Take a look at this beautiful picture.
You find that there is the diverticulum at down at the bottom there,
2 feet from the ileocecal valve were the two diverticulum at the remnant of your vitelline duct,
you made and accumulate feces like substance, fecalith made them behave like a diverticulitis.
Then for diagnostic purposes, you take a look at a Meckel´s scan.
Initially 2-3 minutes, not much going on, 5 minutes later a little bit more,
10 minutes and then 25 minutes respectively, what you are waiting for here
is accumulation of that particular dye within your Meckel diverticulum.
At this point, it is wonderful that you even know the Meckel scan even exist
and the time that then goes by will then give you an idea as to what actually your patient has,
is Meckel´s diverticulum. Now do not forget about the complications including intussusception.
An example, this would be perhaps an example of a heterotropic rest
and there is every possibility, a twisting taking place with valvulus.