Add page for Meckel Diverticulum

Author: caufieldjh

kb/disorders/Meckel_Diverticulum.yaml

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+name: Meckel Diverticulum
+category: Congenital
+parents:
+- Gastrointestinal Disease
+synonyms:
+- Meckel's diverticulum
+- MD
+description: Meckel diverticulum is the most common congenital malformation of the gastrointestinal tract, resulting from incomplete obliteration of the vitelline duct. It is a true diverticulum containing all layers of the intestinal wall and is typically located on the antimesenteric border of the ileum.
+prevalence:
+- population: Global
+  percentage: 2
+  notes: Occurs in approximately 2-3% of the general population. Males and females have equal frequency of formation, but complications are more common in males.
+  evidence:
+  - reference: PMID:27492813
+    supports: SUPPORT
+    snippet: "Meckel's diverticulum is the most frequent congenital malformation of the gastrointestinal tract, occurring in 2% of the general population."
+    explanation: This confirms the 2% prevalence rate in the general population.
+  - reference: PMID:15026601
+    supports: SUPPORT
+    snippet: "Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2%-3% of the population."
+    explanation: This confirms the 2-3% prevalence range.
+  - reference: PMID:15026601
+    supports: SUPPORT
+    snippet: "The formation of Meckel diverticulum occurs with equal frequency in both sexes, but symptoms from complications are more common in male patients."
+    explanation: This documents the sex-specific differences in complication rates despite equal occurrence.
+progression:
+- phase: Lifetime Risk
+  notes: Most cases remain asymptomatic throughout life. Lifetime risk of complications is 4-40%, with complications more common in childhood. 60% of patients present before age 10, with the remainder manifesting in adolescence and adulthood.
+  evidence:
+  - reference: PMID:27492813
+    supports: SUPPORT
+    snippet: "Meckel's diverticulum is usually asymptomatic and found incidentally. However, the lifetime risk of complications is 4-40%."
+    explanation: This describes the natural history and complication rates.
+  - reference: PMID:8506491
+    supports: SUPPORT
+    snippet: "It is generally believed that less than 5% of them become symptomatic, the frequency decreasing with age."
+    explanation: This indicates that most cases remain asymptomatic and complications decrease with age.
+  - reference: PMID:15026601
+    supports: SUPPORT
+    snippet: "Sixty percent of patients come to medical attention before 10 years of age, with the remainder of cases manifesting in adolescence and adulthood."
+    explanation: This documents the age distribution of symptomatic presentations.
+pathophysiology:
+- name: Incomplete Vitelline Duct Obliteration
+  description: Meckel diverticulum results from failure of complete obliteration of the vitelline duct during embryonic development, leading to a persistent outpouching of the ileum.
+  consequence: Formation of a true diverticulum containing all layers of the intestinal wall, typically located on the antimesenteric border of the distal ileum.
+  evidence:
+  - reference: PMID:8506491
+    supports: SUPPORT
+    snippet: "Meckel's diverticula are the result of incomplete degeneration of the vitelline duct."
+    explanation: This explains the embryological origin of Meckel diverticulum.
+  - reference: PMID:15026601
+    supports: SUPPORT
+    snippet: "It results from improper closure and absorption of the omphalomesenteric duct."
+    explanation: This describes the embryological mechanism as failure of omphalomesenteric duct closure.
+phenotypes:
+- category: Gastrointestinal
+  name: Gastrointestinal Bleeding
+  frequency: COMMON
+  notes: Painless lower gastrointestinal bleeding is the most common presentation in children, often due to peptic ulceration from ectopic gastric mucosa.
+  phenotype_term:
+    preferred_term: Gastrointestinal hemorrhage
+    term:
+      id: HP:0002239
+      label: Gastrointestinal hemorrhage
+  evidence:
+  - reference: PMID:8506491
+    supports: SUPPORT
+    snippet: "Meckel's diverticula are most commonly manifested in children by painless lower gastrointestinal bleeding and in adults, as an inflammatory process or obstruction."
+    explanation: This describes the age-specific manifestations of Meckel diverticulum complications.
+  - reference: PMID:17021300
+    supports: SUPPORT
+    snippet: "It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours."
+    explanation: This systematic review identifies hemorrhage as a major complication of Meckel diverticulum.
+  - reference: PMID:15026601
+    supports: SUPPORT
+    snippet: "The most common complications are hemorrhage from peptic ulceration, small intestinal obstruction, and diverticulitis."
+    explanation: This identifies hemorrhage from peptic ulceration as the most common complication.
+  - reference: PMID:19444035
+    supports: SUPPORT
+    snippet: "Our first patient presented with massive bleeding per rectum in the first week of life, which is the only case reported so far."
+    explanation: This documents rare neonatal presentation with massive rectal bleeding in the first week of life.
+- category: Gastrointestinal
+  name: Intestinal Obstruction
+  frequency: COMMON
+  notes: Bowel obstruction is a common complication in adults, often due to intussusception, volvulus, or band formation.
+  phenotype_term:
+    preferred_term: Intestinal obstruction
+    term:
+      id: HP:0005214
+      label: Intestinal obstruction
+  evidence:
+  - reference: PMID:8506491
+    supports: SUPPORT
+    snippet: "Meckel's diverticula are most commonly manifested in children by painless lower gastrointestinal bleeding and in adults, as an inflammatory process or obstruction."
+    explanation: This describes intestinal obstruction as a common adult presentation.
+  - reference: PMID:17021300
+    supports: SUPPORT
+    snippet: "It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours."
+    explanation: This systematic review identifies intestinal obstruction as a major complication.
+  - reference: PMID:27492813
+    supports: SUPPORT
+    snippet: "The major complications of Meckel's diverticulum include gastrointestinal bleeding, bowel obstruction, perforation and inflammation."
+    explanation: This identifies bowel obstruction as one of the major complications of Meckel diverticulum.
+  - reference: PMID:1084202
+    supports: SUPPORT
+    snippet: "In particular, the possiblity of an attached mesodiverticular band leading to obstruction must be stressed."
+    explanation: This highlights mesodiverticular bands as an important cause of intestinal obstruction.
+  - reference: PMID:15026601
+    supports: SUPPORT
+    snippet: "The most common complications are hemorrhage from peptic ulceration, small intestinal obstruction, and diverticulitis."
+    explanation: This identifies small intestinal obstruction as one of the three most common complications.
+- category: Gastrointestinal
+  name: Diverticulitis
+  frequency: OCCASIONAL
+  notes: Inflammation of the diverticulum (diverticulitis) may present similarly to appendicitis.
+  evidence:
+  - reference: PMID:8506491
+    supports: SUPPORT
+    snippet: "Meckel's diverticula are most commonly manifested in children by painless lower gastrointestinal bleeding and in adults, as an inflammatory process or obstruction."
+    explanation: This describes inflammatory presentations in adults.
+  - reference: PMID:27492813
+    supports: SUPPORT
+    snippet: "The major complications of Meckel's diverticulum include gastrointestinal bleeding, bowel obstruction, perforation and inflammation."
+    explanation: This identifies inflammation as a major complication.
+  - reference: PMID:37769709
+    supports: SUPPORT
+    snippet: "Diverticulitis in Meckel's diverticulum."
+    explanation: This is a case report specifically documenting diverticulitis in Meckel's diverticulum.
+- category: Gastrointestinal
+  name: Intestinal Perforation
+  frequency: OCCASIONAL
+  notes: Perforation of the diverticulum can occur, leading to peritonitis and acute abdomen.
+  evidence:
+  - reference: PMID:17021300
+    supports: SUPPORT
+    snippet: "It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours."
+    explanation: This systematic review identifies perforation as a complication of Meckel diverticulum.
+  - reference: PMID:27492813
+    supports: SUPPORT
+    snippet: "The major complications of Meckel's diverticulum include gastrointestinal bleeding, bowel obstruction, perforation and inflammation."
+    explanation: This identifies perforation as a major complication.
+  - reference: PMID:41044867
+    supports: SUPPORT
+    snippet: "Perforated Meckel Diverticulum Caused by Vegetal Food Entrapment: A Rare Case Report and Literature Review."
+    explanation: This case report documents perforation of Meckel diverticulum.
+- category: Gastrointestinal
+  name: Intussusception
+  frequency: OCCASIONAL
+  notes: Meckel diverticulum can serve as a lead point for intussusception.
+  evidence:
+  - reference: PMID:17021300
+    supports: SUPPORT
+    snippet: "It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours."
+    explanation: This systematic review identifies intussusception as a complication of Meckel diverticulum.
+  - reference: PMID:37099684
+    supports: SUPPORT
+    snippet: "There are few cases of a Meckel's diverticulum having been identified as the lead point for adult intussusception."
+    explanation: This notes that Meckel diverticulum as a lead point for intussusception is uncommon in adults.
+- category: Gastrointestinal
+  name: Ectopic Gastric Mucosa
+  frequency: COMMON
+  notes: Approximately 50-60% of symptomatic Meckel diverticula contain heterotopic gastric or pancreatic tissue, with gastric mucosa being more common.
+  evidence:
+  - reference: PMID:27064958
+    supports: SUPPORT
+    snippet: "Our review shows 58 cases containing gastric and/or pancreatic heterotopic tissue, including two unique cases."
+    explanation: This large series of 208 pediatric cases documents heterotopic tissue in Meckel diverticulum.
+  - reference: PMID:15026601
+    supports: SUPPORT
+    snippet: "Heterotopic gastric and pancreatic mucosa are frequently found histologically within the diverticula of symptomatic patients."
+    explanation: This confirms that heterotopic gastric and pancreatic mucosa are frequently found in symptomatic cases.
+treatments:
+- name: Surgical Resection for Symptomatic Cases
+  description: All symptomatic Meckel diverticula should be surgically removed, typically with a segment of adjacent ileum.
+  treatment_term:
+    preferred_term: surgical procedure
+    term:
+      id: MAXO:0000004
+      label: surgical procedure
+  evidence:
+  - reference: PMID:8506491
+    supports: SUPPORT
+    snippet: "All symptomatic and pathologic Meckel's diverticula should be removed with a segment of ileum."
+    explanation: This provides guidance on surgical management of symptomatic Meckel diverticula.
+  - reference: PMID:31930430
+    supports: SUPPORT
+    snippet: "Complicated Meckel's diverticulum is treated by resection."
+    explanation: This confirms resection as the treatment for complicated cases.
+- name: Incidental Diverticulectomy with Stapling Devices
+  description: For incidentally discovered Meckel diverticula during surgery, removal using stapling devices is reasonable if the diverticulum easily fits in the device.
+  treatment_term:
+    preferred_term: surgical procedure
+    term:
+      id: MAXO:0000004
+      label: surgical procedure
+  evidence:
+  - reference: PMID:8506491
+    supports: SUPPORT
+    snippet: "The use of stapling devices, with their ease of use and low complication rate, make it reasonable to remove any Meckel's diverticulum that easily fits in the device. If a diverticulum found incidentally is so broad-based or short that stapling cannot be done without difficulty, it is unlikely to become symptomatic and should be left undisturbed."
+    explanation: This provides specific guidance on management of incidentally discovered Meckel diverticula using stapling devices.

references_cache/PMID_1084202.md

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+---
+reference_id: "PMID:1084202"
+title: "Complications of Meckel's diverticulum."
+authors:
+- Moore T
+- Johnston AO
+journal: Br J Surg
+year: '1976'
+doi: 10.1002/bjs.1800630612
+content_type: abstract_only
+---
+
+# Complications of Meckel's diverticulum.
+**Authors:** Moore T, Johnston AO
+**Journal:** Br J Surg (1976)
+**DOI:** [10.1002/bjs.1800630612](https://doi.org/10.1002/bjs.1800630612)
+
+## Content
+
+1. Br J Surg. 1976 Jun;63(6):453-4. doi: 10.1002/bjs.1800630612.
+
+Complications of Meckel's diverticulum.
+
+Moore T, Johnston AO.
+
+This paper reviews the presentation and surgical pathology of 50 Meckel's 
+diverticula encountered in one hospital in a 20-year period. It is concluded 
+that in children with intestinal bleeding or a "raspberry tumour" of the 
+umbilicus a Meckel's diverticulum is usually suspected. In adults with an acute 
+surgical emergency Meckel's diverticulum is unlikely to be considered. However, 
+a Meckel's diverticulum can give rise to surgical problems in many ways and at 
+any age. In particular, the possiblity of an attached mesodiverticular band 
+leading to obstruction must be stressed.
+
+DOI: 10.1002/bjs.1800630612
+PMID: 1084202 [Indexed for MEDLINE]

references_cache/PMID_1113949.md

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+---
+reference_id: "PMID:1113949"
+title: "Meckel's diverticulum."
+authors:
+- Buchsbaum HJ
+journal: Obstet Gynecol
+year: '1975'
+content_type: abstract_only
+---
+
+# Meckel's diverticulum.
+**Authors:** Buchsbaum HJ
+**Journal:** Obstet Gynecol (1975)
+
+## Content
+
+1. Obstet Gynecol. 1975 Mar;45(3):311-4.
+
+Meckel's diverticulum.
+
+Buchsbaum HJ.
+
+The embryology and clinical implications of Meckel's diverticulum, the most 
+common gastrointestinal anomaly, are presented from the viewpoint of the 
+obstetrician-gynecologist. The complications and clinical management are 
+discussed.
+
+PMID: 1113949 [Indexed for MEDLINE]

references_cache/PMID_11333103.md

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+---
+reference_id: "PMID:11333103"
+title: "Meckel's diverticulum."
+authors:
+- Yahchouchy EK
+- Marano AF
+- Etienne JC
+- Fingerhut AL
+journal: J Am Coll Surg
+year: '2001'
+doi: 10.1016/s1072-7515(01)00817-1
+content_type: abstract_only
+---
+
+# Meckel's diverticulum.
+**Authors:** Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL
+**Journal:** J Am Coll Surg (2001)
+**DOI:** [10.1016/s1072-7515(01)00817-1](https://doi.org/10.1016/s1072-7515(01)00817-1)
+
+## Content
+
+1. J Am Coll Surg. 2001 May;192(5):658-62. doi: 10.1016/s1072-7515(01)00817-1.
+
+Meckel's diverticulum.
+
+Yahchouchy EK(1), Marano AF, Etienne JC, Fingerhut AL.
+
+Author information:
+(1)Digestive Surgery Department, Centre Hospitalier Intercommunal de 
+Poissy-Saint Germain, France.
+
+DOI: 10.1016/s1072-7515(01)00817-1
+PMID: 11333103 [Indexed for MEDLINE]

references_cache/PMID_1247297.md

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+---
+reference_id: "PMID:1247297"
+title: "Meckel's diverticulum."
+authors:
+- DeBartolo HM Jr
+- van Heerden JA
+journal: Ann Surg
+year: '1976'
+doi: 10.1097/00000658-197601000-00006
+content_type: abstract_only
+---
+
+# Meckel's diverticulum.
+**Authors:** DeBartolo HM Jr, van Heerden JA
+**Journal:** Ann Surg (1976)
+**DOI:** [10.1097/00000658-197601000-00006](https://doi.org/10.1097/00000658-197601000-00006)
+
+## Content
+
+1. Ann Surg. 1976 Jan;183(1):30-3. doi: 10.1097/00000658-197601000-00006.
+
+Meckel's diverticulum.
+
+DeBartolo HM Jr, van Heerden JA.
+
+One hundred and ninety surgically documented cases of Meckel's diverticulum 
+encountered at the Mayo Clinic during a 51-year period, 1920 through 1971, are 
+reviewed. In 39 patients, the diverticulum was left undisturbed. In 51 patients, 
+the diverticulum was the primary surgical disease, and, in 100 patients, the 
+diverticulum was removed incidentally. The clinical features are presented as 
+well as the surgical considerations. Meckel's diverticulum is a relatively 
+frequent development anomaly with eccentric manifestations, and its surgical 
+management has intrigued physicians for over 350 years. Dr. Charles W. Mayo 
+stated, "Meckel's diverticulum is frequently suspected, often looked for, and 
+seldom found."
+
+DOI: 10.1097/00000658-197601000-00006
+PMCID: PMC1344177
+PMID: 1247297 [Indexed for MEDLINE]

references_cache/PMID_15026601.md

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+---
+reference_id: "PMID:15026601"
+title: "From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation."
+authors:
+- Levy AD
+- Hobbs CM
+journal: Radiographics
+year: '2004'
+doi: 10.1148/rg.242035187
+content_type: abstract_only
+---
+
+# From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation.
+**Authors:** Levy AD, Hobbs CM
+**Journal:** Radiographics (2004)
+**DOI:** [10.1148/rg.242035187](https://doi.org/10.1148/rg.242035187)
+
+## Content
+
+1. Radiographics. 2004 Mar-Apr;24(2):565-87. doi: 10.1148/rg.242035187.
+
+From the archives of the AFIP. Meckel diverticulum: radiologic features with 
+pathologic Correlation.
+
+Levy AD(1), Hobbs CM.
+
+Author information:
+(1)Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 
+16th St NW, Washington, DC 20306-6000, USA. levya@afip.osd.mil
+
+Comment in
+    N Z Med J. 2004 Oct 22;117(1204):U1133.
+
+Meckel diverticulum is the most common congenital anomaly of the 
+gastrointestinal tract, occurring in 2%-3% of the population. It results from 
+improper closure and absorption of the omphalomesenteric duct. Meckel 
+diverticulum is the most common end result of the spectrum of omphalomesenteric 
+duct anomalies, which also include umbilicoileal fistula, umbilical sinus, 
+umbilical cyst, and a fibrous cord connecting the ileum to the umbilicus. The 
+formation of Meckel diverticulum occurs with equal frequency in both sexes, but 
+symptoms from complications are more common in male patients. Sixty percent of 
+patients come to medical attention before 10 years of age, with the remainder of 
+cases manifesting in adolescence and adulthood. Heterotopic gastric and 
+pancreatic mucosa are frequently found histologically within the diverticula of 
+symptomatic patients. The most common complications are hemorrhage from peptic 
+ulceration, small intestinal obstruction, and diverticulitis. Although the 
+clinical, pathologic, and radiologic features of the complications of Meckel 
+diverticulum are well known, the diagnosis of Meckel diverticulum is difficult 
+to establish preoperatively.
+
+DOI: 10.1148/rg.242035187
+PMID: 15026601 [Indexed for MEDLINE]