Meckels divertikulum
A Meckels diverticulum is a bulging part of the small bowel. It is a remnant of the embryonal situation in which there is a connection between the bowel and the umbilical cord. Normally this connection disappears totally, but in about 2% a remnant remains. Johan Friedrich Meckel (1781-1833) described this fenomenon and gave it his name.
The diverticulum is about 2-5cm long and is positioned within 50cm of the large bowel. It is twice as frequent in the male and it may contain apart from smallbowelmucosa also stomachmucosa and pancreatic tissue.
In case of complaints, which is not necessary the case, it appears in 80% of the cases in the first 15 years of life. Complaints are caused by inflammation, bleeding or perforation. Less frequent is obstuction of the bowel, due to torsion (volvulus, see example below), invagination or strangulation.
The complaints can mimic appendicitis. This is the reason that in case of an operation for appendicitis in which the appendix appears to be normal, one always has to look for a Meckels diverticulum.
The treatment consists of removing the diverticulum. Resection of small bowel is not necessary in most cases.
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In this example the patient is a 9 year old boy with abdominal complaints for several days and obvious signs of peritonitis. Decided is to operate under the diagnosis of appendicitis. However, the appendix proved to be rather normal. It was removed anyway because sometimes in microscopic examination there is prove of inflammation. Routinely performed examination of the small bowel showed a large Meckels diverticulum (1). The pincet shows the stump of the removed appendix (in detail in 2). The red bowel part is the strangulated but still viable small bowel and the Meckels diverticulum was gangrenous because of torsion, leading to the black color.
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In 3 it can clearly be seen that the diverticulum is indeed a protrusion of the small bowel. In 4 the adhesion is seen that was responsible for the strangulation and torsion of the bowel.
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With a special device the diverticulum is removed (5,6,7). After this the row of staples can be seen. For safetyreasons this is hidden under stitches (9).