Image Based Question-70052

A 54-year-old male, presented with persistent anemia and occult blood per rectum. Upper and capsule endoscopy, colonoscopy, enteroclysis, Meckel scan, and tagged nuclear red blood cell scan failed to localize the source.

An abdominal computed tomography scan showed a possible intussusception and intraluminal mass. During the abdominal exploration, pathological part was resected.

The resected part is shown in the image.Regarding this pathology:Which part of the gastrointestinal tract is most commonly involved?

A. Ileum

B. Jejunum

C. Duodenum

D. Descending colon

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Correct Answer » A Explanation

Ans:A. Ileum

Image shows:Gross specimen of the inverted Meckel’s diverticulum arising in the segmental resection of the small bowel.A small area of erythema was seen at the tip and appeared grossly consistent with an area of hemorrhage.

MECKEL’S DIVERTICULUM

• Meckel’s diverticulum is the most common congenital abnormality in the  astrointestinal tract.

• It is more common in males.

• The anomaly is commonly situated on the antimesenteric border of the ileum, about 1 meter above the ileocaecal valve.

• Like other true diverticula, Meckel’s diverticulum is an outpouching containing all the layers of the intestinal wall in their normal orientation.

• It is almost always lined by small intestinal type of epithelium; rarely it may contain islands of gastric mucosa and ectopic pancreatic tissue.

• Embryologic origin of Meckel’s diverticulum is from incomplete obliteration of vitellointestinal duct.

• It is usually asymptomatic.

• When symptomatic it may present with hemorrhage in association with ectopic gastric and/or pancreatic mucosa, intestinal obstruction, intussusceptions, or inflammation.

• This abnormality can also present in the setting of an inverted diverticulum causing a lower gastrointestinal bleed.