Meckel’s Diverticulum

MECKEL’S DIVERTICULUM

Q. 1

An old man presented with fever and abdominal pain. Diverticulitis is suspected. If it is Meckel’s diverticulum is involved, it can be best diagnosed by:

 A

X-ray

 B

Ultrasound

 C

CT Scan

 D

Tc99 pertechnetium scan

Q. 1

An old man presented with fever and abdominal pain. Diverticulitis is suspected. If it is Meckel’s diverticulum is involved, it can be best diagnosed by:

 A

X-ray

 B

Ultrasound

 C

CT Scan

 D

Tc99 pertechnetium scan

Ans. D

Explanation:

Diagnosis of Meckel diverticulum is made with a Meckel scan.

Technetium-99 (99mTc)-pertechnetate is taken up by the heterotopic gastric mucosa in the diverticulum and outlines the diverticulum on a nuclear scan.

Giving pentagastrin or cimetidine before administering the radionuclide increases 99mTc-pertechnetate uptake and retention by the heterotopic gastric mucosa and can increase the sensitivity of the test.

The sensitivity of CT scanning for the detection of Meckel’s diverticula is too low to be clinically useful.

Ref: Sundaram S.S., Hoffenberg E.J., Kramer R.E., Sondheimer J.M., Furuta G.T. (2012). Chapter 21. Gastrointestinal Tract. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.


Q. 2

Meckel’s diverticulum is considered as true diverticula. It arises from:

 A

The foregut

 B

Caecum

 C

Colon

 D

Ileum

Q. 2

Meckel’s diverticulum is considered as true diverticula. It arises from:

 A

The foregut

 B

Caecum

 C

Colon

 D

Ileum

Ans. D

Explanation:

Meckel’s diverticulum:
  • It is the most prevalent congenital anomaly of the GI tract, affecting approximately 2% of the general population.
  • A 3:2 male-to-female prevalence ratio has been reported. Meckel’s diverticula are designated true diverticula because their walls contain all of the layers found in normal small intestine.
  • Their location varies among individual patients, but they are usually found in the ileum within 100 cm of the ileocecal valve.
  • Approximately 60% of Meckel’s diverticula contain heterotopic mucosa, of which over 60% consist of gastric mucosa. Pancreatic acini are the next most common; others include Brunner’s glands, pancreatic islets, colonic mucosa, endometriosis, and hepatobiliary tissues.
 
Must know:
“Rule of twos” of Meckel’s diverticula: 2% prevalence, 2:1 female predominance, location 2 ft proximal to the ileocecal valve in adults, and one half of those who are symptomatic are under 2 years of age.
 

Q. 3

All the following are true about Meckel’s diverticulum except-

 A

Bleeding

 B

Intussusception

 C

Arises at the mesentric border

 D

Located 60 cm from the cecal valve

Q. 3

All the following are true about Meckel’s diverticulum except-

 A

Bleeding

 B

Intussusception

 C

Arises at the mesentric border

 D

Located 60 cm from the cecal valve

Ans. C

Explanation:

Ans is ‘c’ i.e., Arises at the Mesentric border

Meckel’s diverticulum is situated at the anti-mesenteric border of small intestine.

  • Meckel’s diverticulum is a true diverticulum as it has all the 3 layers of the intestine.
  • It’s the most common congenital anomaly of the gastrointestinal tract.
  • Male to female ratio is 3 : 2.
  • Approximately 60% of Meckel’s diverticula contain heterotopic mucosa, of which more than 60% consists of gastric mucosa. Second most common ectopic mucosa is that of Pancreas (Pancreatic acini). Other mucosa are -colonic mucosa, Brunner’s gland, pancreatic islets, endometriosis and hepatobiliary tissue.
  • A useful but crude Mnemonic used traditionally for describing Meckel’s diverticula is

Rule of two : i.e.

– 2% prevalence

– 2 inch in length

2 feet proximal to ilcocecal valve.

half of these who are symptomatic are younger than 2 yrs of age

  • Meckel’s diverticula are asymptomatic. Symptoms arise only when any complication occurs.
  • Complications
  • Most common complication
  • in children & young adults (< 18 yrs of age)           —>            bleeding
  • in adults                                                                           —>            intestinal obstruction
  • overall                                                                              —>            bleeding
  • Following complications are noted in Meckel’s diverticulum.

(1) Bleeding

– bleeding in Meckel’s diverticulum is usually the result of ulceration in ileal mucosa adjacent to the diverticulum caused by the acid secreted by heterotopic gastric mucosa within the diverticulum.

(2) Intestinal obstruction

Intestinal obstruction associated with Meckel’s diverticulum can result from several mechanisms.

a)Volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus

b)Intussusception with the diverticulum acting as the lead point.

c)Entrapment of intestine by a mesodiverticular band (Mesodiverticular band is a remnant of left vitelline artery, it tethers the Meckel’s diverticulum to the ileal mesentry.)

d) Stricture secondary to chronic diverticulitis.

(3) Diverticulitis

-clinical picture is similar to appendicitis.

-diverticulitis may lead to perforation.

  • Littre’s hernia – rarely Meckel’s diverticulum is found in inguinal or femoral hernia. This is known as Littre’s hernia.
  • Diagnostic studies
  • Meckel’s diverticulum in the absence of bleeding can be rarely diagnosed before surgical intervention.
  • Barium meal follow through can rarely demonstrate the diverticulum. Barium enteroclysis can demonstrate the diverticula in 75% of cases but is avoided during acute presentation of complication.
  • If repeated episodes of lower GI bleed occur and an ectopic gastric mucosa in the Meckel’s diverticulum is suspected, it can be demonstrated by Technetium pertechnate radionuclide scan. It demonstrates the ectopic gastric mucosa and localizes the Meckel’s diverticulum. Angiography can localize the site of bleeding during acute hemorrhage related to meckel’s diverticula.

Quiz In Between


Q. 4

All are true statement about Meckel’s diverticulum except:

 A

Occurs in 2% of the population

 B

Common on antimesenteric border

 C

Diarrhea very common

 D

Peroration occurs

Q. 4

All are true statement about Meckel’s diverticulum except:

 A

Occurs in 2% of the population

 B

Common on antimesenteric border

 C

Diarrhea very common

 D

Peroration occurs

Ans. C

Explanation:

Ans is ‘c’ i.e. Diarrhea very common


Q. 5

Which one of the following statements is incorrect regarding Meckel’s diverticulum?

 A

Is found on the anti-mesenteric border of the small intestine

 B

Consists of mucosa without a muscle coat

 C

Heterotopic gastric muscosa can ulcerate and cause a brisk gastrointestinal bleed

 D

A fibrous band between the apex and umbilicus can cause intestinal obstruction

Q. 5

Which one of the following statements is incorrect regarding Meckel’s diverticulum?

 A

Is found on the anti-mesenteric border of the small intestine

 B

Consists of mucosa without a muscle coat

 C

Heterotopic gastric muscosa can ulcerate and cause a brisk gastrointestinal bleed

 D

A fibrous band between the apex and umbilicus can cause intestinal obstruction

Ans. B

Explanation:

Ans. is ‘b’ i.e. Consists of mucosa without a muscle coat 

A diverticulum consisting of mucosa without a muscle coat is a feature of false’ or ‘acquired’ diverticulum, whereas Meckel’s diverticulum is a ‘true’ diverticulum and consists of all the 3 layers of the gut – the mucosa, the muscularis & outer scrosa.


Q. 6

Meckel’s diverticulum, true are A/E :

 A

Has three layers with artery

 B

Heterotopic epithelium in 50-60% cases

 C

Always gastric epithelium

 D

May present with hemorrhage

Q. 6

Meckel’s diverticulum, true are A/E :

 A

Has three layers with artery

 B

Heterotopic epithelium in 50-60% cases

 C

Always gastric epithelium

 D

May present with hemorrhage

Ans. C

Explanation:

Ans. is ‘c’ i.e. Always gastric epithelium 

Quiz In Between


Q. 7

True about Meckel’s diverticulum is/are ‑

 A

Bleeding PR

 B

Can be a leading point of intussusception

 C

Multiple diverticuli common

 D

a and b

Q. 7

True about Meckel’s diverticulum is/are ‑

 A

Bleeding PR

 B

Can be a leading point of intussusception

 C

Multiple diverticuli common

 D

a and b

Ans. D

Explanation:

Answer ‘a’ i.e. Bleeding PR ; ‘b’ i.e. Can be a leading point of intussusception


Q. 8

Which is true regarding site of Meckel’s diverticulum:

 A

2 feet proximal to ileocaecal valve on mesentric border

 B

2 feet distal to duodenojejunal flexure on antimesentric border

 C

2 feet distal to D-3 flexure on mesentric border

 D

2 feet proximal to ileococcal valve on antimesentric border

Q. 8

Which is true regarding site of Meckel’s diverticulum:

 A

2 feet proximal to ileocaecal valve on mesentric border

 B

2 feet distal to duodenojejunal flexure on antimesentric border

 C

2 feet distal to D-3 flexure on mesentric border

 D

2 feet proximal to ileococcal valve on antimesentric border

Ans. D

Explanation:

Ans. is ‘d’ i.e. 2 feet proximal to ileococcal valve on antimesentric border 


Q. 9

Complications of Meckel’s diverticulum include ‑

 A

Hemorrhage

 B

Intussusception

 C

Strangulation

 D

All are correct

Q. 9

Complications of Meckel’s diverticulum include ‑

 A

Hemorrhage

 B

Intussusception

 C

Strangulation

 D

All are correct

Ans. D

Explanation:

Ans. is ‘d’ i.e., All are correct 

Quiz In Between


Q. 10

The commonest presentation of meckel’s diverticulum is –

 A

Bleeding

 B

Obstruction

 C

Diverticulitis

 D

Intussception

Q. 10

The commonest presentation of meckel’s diverticulum is –

 A

Bleeding

 B

Obstruction

 C

Diverticulitis

 D

Intussception

Ans. A

Explanation:

Ans. is ‘a’ i.e., Bleeding 


Q. 11

Example of syndesmosis joint is:

September 2007

 A

Tibiotalar joint

 B

Tibiofibular joint

 C

Elbow joint

 D

Carpometacarpal joint

Q. 11

Example of syndesmosis joint is:

September 2007

 A

Tibiotalar joint

 B

Tibiofibular joint

 C

Elbow joint

 D

Carpometacarpal joint

Ans. B

Explanation:

Ans. B: Tibiofibular Joint

I. Six types of synovial joints are:

  • Hinge
  • Ball-and-socket
  • Pivot
  • Condyloid (angular or ellipsoidal)
  • Plane (gliding)
  • Saddle.

– The elbow is an example of a hinge joint. Here, the convex and concave articulating bones allow movement along one plane, similar to a door.

-The shoulder and hip are the only ball-and-socket joints in the body.

In this type of joint, one bone has a spherical head that articulates with a corresponding concavity. This joint frees the joint to move in many directions.

– In a pivot joint, one round-shaped articulating bone fits within a corresponding depression on another bone. This joint allows one bone to rotate against the other. An example is the radioulnar joint (joint of the radius and ulna) in the forearm.

– In a condyloid (angular) joint, one bone has an oval articulating head that rests within an oval concavity. This joint permits angular movement of the bones. The metacarpophalangeal joint (junction between the metacarpals and phalanges) of the hand are examples of condyloid joints

– Plane joints have two flat bones joined. The sole movement of the bones is short gliding motions. An example of this joint is the intertarsal joint (junction between the tarsal bones) of the feet.

Saddle joint bones have convex and concave surfaces similar to a saddle. This joint allows the joint to move in many directions. The carpometacarpal joint of the thumb is an example saddle joint.

II. As their name implies, amphiarthrosis joints (slightly movable joints) have limited movement. The two types of amphiarthrosis joints are:

  • Syndesmosis (fibrous)
  • Symphysis (cartilaginous).

–  A Syndesmosis joint occurs when two bones join by a section of cartilage. The junction between the tibia and fibula is an example.

A symphysis joint forms when two bones fuse by a fibrocartilage pad. Typical symphysis joints are between the pubic symphysis (pubic bones in the pelvis), and in the vertebral column between individual vertebrae. Intervertebral discs act as weight-bearing shock absorbers for walking, jumping, and lifting.

III. An immovable joint is called a synarthrosis. The two types of this joint are:

  • Sutures
  • Gomphoses.

– Sutures are joined by short fibers of dense fibrous connective tissue and are in the skull.

– The single example of a gomphosis joint is the teeth sitting within their sockets.

IV. An example of a bony fusion joint is the fusion of the three bones forming a coxa (hip bone): the ilium, ischium, and pubis.


Q. 12

Which of the following is used to detect mucosa in Meckel’s diverticulum:           

March 2011

 A

Technetium-99 scan

 B

Barium meal

 C

CT scan

 D

MRI scan

Q. 12

Which of the following is used to detect mucosa in Meckel’s diverticulum:           

March 2011

 A

Technetium-99 scan

 B

Barium meal

 C

CT scan

 D

MRI scan

Ans. A

Explanation:

Ans. A: Technetium-99 scan

Meckel’s diverticulum can be very difficult to demonstrate by contrast radiology; small bowel enema would be the most accurate investigation

Technetium-99m scanning may be useful in identifying Meckel’s diverticulum as a source of gastrointestinal bleeding


Q. 13

Meckel’s diverticulum is a remnant of ‑

 A

Stenson’s duct

 B

Wolffian duct

 C

Mullerian duct

 D

Vitellointestinal duct

Q. 13

Meckel’s diverticulum is a remnant of ‑

 A

Stenson’s duct

 B

Wolffian duct

 C

Mullerian duct

 D

Vitellointestinal duct

Ans. D

Explanation:

Ans. is ‘d’ i.e., Vitellointestinal duct 

Meckel’s diverticulum

  • Meckel’s diverticulum is the persistent proximal part of the vitellointestinal duct which normally disappears during intrauterine life.
  • It follows ‘rule of 2’ :- present in 2% subjects, 2 inches (5 cm) long and is situated 2 feet (60 cm) proximal to ileocoecal valve.
  • It is attached to antimesenteric border of ileum.
  • Its calibre is equal to that of the ileum.
  • Its apex may be free or attached to umblicus or mesentery by a fibrous band. o Vitellointestinal duct posseses all three coats of intestinal wall.

Quiz In Between



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