Tag: Meckel’s Diverticulum

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



Meckel’s Diverticulum

MECKEL’S DIVERTICULUM


MECKEL’S DIVERTICULUM

  • Meckel’s diverticulum is a persistent remnant of the vitellointestinal duct.
  • It is found on the antimesentric side of the ileum.
  • Meckel’s diverticulum is a congenital diverticulum.
  • It is a true diverticulum (contains all the 3 layers of intestine).

Clinical features-

  1. Haemorrhage
  • Melaena may occur
  • Radioisotope scanning with technetium- 99m may demonstrate Meckel’s diverticulum.

2. Diverculitis

 3. Intussusception

4. Chronic ulceration

 5. Intestinal obstruction- leas to the development of volvulus.

6. Perforation

 7. Meckel’s diverticulum is an inguinal or femoral hernia is called Littre’s hernia.

Investigations-

  • Technetium- 99m labelled pertechnetate taken up by mucin secreting cells & parietal cells.
  • Useful in children with bleeding.

Treatment-

  • Meckel’s diverticulectomy

Exam Important

  • Meckel’s diverticulum is a persistent remnant of the vitellointestinal duct.
  • It is found on the antimesentric side of the ileum.
  • Meckel’s diverticulum is a congenital diverticulum.
  • It is a true diverticulum (contains all the 3 layers of intestine)

Clinical features-

  1. Haemorrhage
  • Melaena may occur
  • Radioisotope scanning with technetium- 99m may demonstrate Meckel’s diverticulum.

2. Diverculitis

3. Intussusception

4. Chronic ulceration

5. Intestinal obstruction- leas to the development of volvulus.

6. Perforation

7. Meckel’s diverticulum is an inguinal or femoral hernia is called Littre’s hernia.

Investigations-

  • Technetium- 99m labelled pertechnetate taken up by mucin secreting cells & parietal cells.
  • Useful in children with bleeding.

Treatment-

  • Meckel’s diverticulectomy
Don’t Forget to Solve all the previous Year Question asked on MECKEL’S DIVERTICULUM

Module Below Start Quiz

Meckel’s Diverticulum

Meckel’s Diverticulum


MECKEL’S DIVERTICULUM

  • Most common congenital anomaly of the GIT
  • True diverticulum (contains all the 3 layers of intestine)
  • Situated at the anti-mesenteric border of small intestine
  • Represents the patent intestinal end of the Vitellointestinal duct
  • Contains heterotopic mucosa (mc-gastric mucosa)
  • Rule of 2: 2% incidence; 2 inches (5 cm) in length; 2 feet proximal to ileo-caecal valve, 2 times common in males, 50% symptomatic by age 2 years
  • Meckel’s diverticulum should be looked for when a normal appendix is found at surgery for suspected appendicitis
  • Littre’s hernia – when the content of an inguinal or femoral hernia is Meckel’s diverticulum

Symptoms

  • Painless rectal bleeding or melena — most common presentation (most likely cause in a child presenting with rectal bleeding and anemia)
  • Intussusception
  • Meckel’s diverticulitis
  • Chronic peptic ulceration
  • Intestinal obstruction
  • Technetium-99m scanning is useful in identifying Meckel’s diverticulum as a source of GI bleeding, is most accurate
  • Treatment: Resection of diverticulum or the segment of intestine containing diverticulum
  • If silent Meckel’s diverticulum is found during the course of an operation, it can be left alone provided it is wide mouthed and not thickened.
Exam Question
 
  • Meckel’s diverticulum is best diagnosed by Tc99 pertechnetium scan.
  • Meckel’s diverticulum arises from Ileum.
  • Meckel Diverticulum is a failure of the intraabdominal portion of the umbilical vesicle to atrophy.
  • Meckel’s Diverticulum:It occurs in 2% population ,It is a  is a ‘true’ diverticulum and consists of all the 3 layers of the gut – the mucosa, the muscularis & outer scrosa. It arises from antimesenteric border,Located 60 cm from the cecal valve,
  • The most common location for a Meckel’s diverticulum is the Terminal Ileum.
  • Vitellointestinal Duct represents the embryological origin of Meckel’s diverticulum.
  • Meckel’s Diverticulum may present with bleeding per rectum and Intussusception.
  • Peroforation may occur in Meckel’s Diverticuum.
  • Heterotopic gastric muscosa can ulcerate and cause a brisk gastrointestinal bleed.
  • A fibrous band between the apex and umbilicus can cause intestinal obstruction.
  • Best Diagnosis for Ectopic gastric mucosa of meckels diverticulum is Radionuclide Scan.
  • A wide mouth meckels diverticulum is found. accidently on laparotomy. The treatment of choice would be to leave as such.
  • Heterotopic epithelium is present in 50-60% cases.
  • Has three layers with artery.
  • Complications of Meckel’s Diverticulum:Hemorrhage,Intussception and Strangulation.
  • Uncommon complication of meckels diverticulum is Malignancy.
  •  Meckels diverticulum is located at 2 feet proximal to ileococcal valve on antimesentric border.
  • The commonest presentation of meckel’s diverticulum is Lower GI Bleeding.
  • Lined by heterotopic epithelium.
  • 3-5 % of Population,
  • More common in females.
Don’t Forget to Solve all the previous Year Question asked on Meckel’s Diverticulum

Meckel’s Diverticulum

Meckel’s Diverticulum

Q. 1

Meckel’s diverticulum is best diag‑ nosed by: 

 A X-ray 
 B Ultrasound 
 C CT scan 
 D Tc99 pertechnetium scan 
Q. 1

Meckel’s diverticulum is best diag‑ nosed by: 

 A X-ray 
 B Ultrasound 
 C CT scan 
 D Tc99 pertechnetium scan 
Ans. D

Explanation:

Tc99 pertechnetium scan 


Q. 2

Meckel’s Diverticulum is best diag­nosed by:

 A X-ray
 B Ultrasound
 C CT scan
 D Tc99 pertechnetium scan
Q. 2

Meckel’s Diverticulum is best diag­nosed by:

 A X-ray
 B Ultrasound
 C CT scan
 D Tc99 pertechnetium scan
Ans. D

Explanation:

Tc99 pertechnetium scan


Q. 3

Meckel’s diverticulum arises from:

 A

The foregut

 B

Caecum

 C

Colon

 D

Ileum

Q. 3

Meckel’s diverticulum arises from:

 A

The foregut

 B

Caecum

 C

Colon

 D

Ileum

Ans. D

Explanation:

Ileum


Q. 4

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. 4

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. 5

Which of the following is accurate regarding Meckel diverticulum?

 A

Is the allantoic duct remnant

 B

Is a failure of the right umbilical vein to involute

 C

Is an extraabdominal remnant of the umbilical vesicle

 D

Is a failure of the intraabdominal portion of the umbilical vesicle to atrophy

Q. 5

Which of the following is accurate regarding Meckel diverticulum?

 A

Is the allantoic duct remnant

 B

Is a failure of the right umbilical vein to involute

 C

Is an extraabdominal remnant of the umbilical vesicle

 D

Is a failure of the intraabdominal portion of the umbilical vesicle to atrophy

Ans. D

Explanation:

 

  • The omphalomesenteric (vitelline) duct is a remnant of the embryonic yolk sac.
  • When the entire duct remains intact postnatally, it is recognized as an omphalomesenteric fistula.
  • When the duct is obliterated at the intestinal end but communicates with the umbilicus at the distal end, it is called an umbilical sinus.
  • When the epithelial tract persists but both ends are occluded, an umbilical cyst or intra-abdominal enterocystoma may develop.
  • The entire tract may be obliterated, but a fibrous band may persist between the ileum and the umbilicus
  • The most common remnant of the omphalomesenteric (vitelline) duct is Meckel diverticulum, which is present in 1–3% of the population.
  • Meckel diverticulum may be lined wholly or in part by small intestinal, colonic, or gastric mucosa, and it may contain aberrant pancreatic tissue.
  • Heterotopic tissue is found in 5% of asymptomatic and 60% of symptomatic cases.
  • In contrast to duplications and pseudodiverticula, Meckel diverticulum is located on the antimesenteric border of the ileum, 10–90 cm from the ileocecal valve. Meckel diverticulum occurs with equal frequency in both sexes.

Q. 6

All are TRUE about Meckel’s diverticulum, EXCEPT:

 A

It occurs in 2% population

 B

It is a true diverticulum

 C

It always contains gastric mucosa

 D

It arises from antimesenteric border

Q. 6

All are TRUE about Meckel’s diverticulum, EXCEPT:

 A

It occurs in 2% population

 B

It is a true diverticulum

 C

It always contains gastric mucosa

 D

It arises from antimesenteric border

Ans. C

Explanation:

Approximately 60% of Meckel’s diverticula contain heterotopic mucosa, of which over 60% consist of gastric mucosa. It arises from the antimesenteric border of ileum.

A useful mnemonic describing Meckel’s diverticulum is the “rule of twos”: 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. 7

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

 A

The foregut

 B

Caecum

 C

Colon

 D

Ileum

Q. 7

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. 8

The most common location for a Meckel’s diverticulum is the?

 A

Proximal jejunum

 B

Distal jejunum

 C

Proximal ileum

 D

Terminal ileum

Q. 8

The most common location for a Meckel’s diverticulum is the?

 A

Proximal jejunum

 B

Distal jejunum

 C

Proximal ileum

 D

Terminal ileum

Ans. D

Explanation:

The most common location of a Meckel’s is the terminal ileum usually located 45-90 cm from the ileocecal valve.The location on the antimesenteric border is normal and is not an indication for surgical resection. 


Q. 9

Which of the following represents the embryological origin of Meckel’s diverticulum?

 A

Urogenital sinus

 B

Allatoic diverticulum

 C

Vitello intestinal duct

 D

None of the above

Q. 9

Which of the following represents the embryological origin of Meckel’s diverticulum?

 A

Urogenital sinus

 B

Allatoic diverticulum

 C

Vitello intestinal duct

 D

None of the above

Ans. C

Explanation:

Meckel’s diverticulum results from failure or incomplete obliteration of Vitello intestinal duct( omphalomesentric duct). It follows the rule of ‘2’ : 2% prevalence, 2:1 female predominance, located 2 feet proximal to the ileocecal valve in adults, 50% of symptomatic individuals are less than 2 years.


Reference:
Schwatz’s Principles of Surgery 9e chapter 28.


Q. 10

Meckel’s diverticulum is a remnant of:

 A

Stenson’s duct

 B

Wolffian duct

 C

Mullerian duct

 D

Vitellointestinal duct

Q. 10

Meckel’s diverticulum is a remnant of:

 A

Stenson’s duct

 B

Wolffian duct

 C

Mullerian duct

 D

Vitellointestinal duct

Ans. D

Explanation:

D i.e. Vitellointestinal duct

–  Persistence of small portion of vitelline duct or yolk stalk remnant is called meckel’s diverticulum or ileal diverticulum.

Reduction of physiological hernia occurs at 10 weeks of embryonic period


Q. 11

Which nerve passes through Meckel’s cave‑

 A

Abducens

 B

Facial

 C

Trigeminal

 D

Trochlear

Q. 11

Which nerve passes through Meckel’s cave‑

 A

Abducens

 B

Facial

 C

Trigeminal

 D

Trochlear

Ans. C

Explanation:

  Arcuate eminence of petrous temporal bone is caused by superior aspect of superior semicircular canalQ.

Meckel’s cave houses gasserian ganglion of trigeminal nerveQ.


Q. 12

Meckel’s diverticulum is a derivative of –

 A

Allantoic diverticulum

 B

Vitellointestinal duct

 C

Ventral mesogastrium

 D

Ductus arteriosus

Q. 12

Meckel’s diverticulum is a derivative of –

 A

Allantoic diverticulum

 B

Vitellointestinal duct

 C

Ventral mesogastrium

 D

Ductus arteriosus

Ans. B

Explanation:

Answer is ‘b’ ie vitellointestinal duct 

  • The Vitellointestinal duct or the omphalomesentric duct is the connection between the yolk sac and the developing gut.
  • Normally, it gets obliterated and disappears.
  • But sometimes it may persist in various forms giving rise to congenital anomalies:‑

a.       Umbilical fecal fistula – due to persistence of entire vitellointestinal duct.

b.       Umbilical sinus – when the duct is obliterated at the intestinal end but communicates with the umbilicus at the distal end.

c.       Meckel’s diverticultun – when the duct is obliterated at the umbilicus but persists at it intestinal end.

d.       Umbilical cyst or vitelline cyst — when both ends are occluded but the tract in between persists.

e.       Fibrous band — the entire tract may be obliterated, but a fibrous band may persist between the ileum and the umbilicus. The fibrous band may lead to intestinal obstruction.


Q. 13

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. 13

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.

Q. 14

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. 14

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. 15

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. 15

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. 16

Best Diagnosis for Ectopic gastric mucosa of meckels diverticulum –

 A

Fluoroscopy

 B

Occult blood test in stool

 C

Ultrasound abdomen

 D

Radionuclide scan

Q. 16

Best Diagnosis for Ectopic gastric mucosa of meckels diverticulum –

 A

Fluoroscopy

 B

Occult blood test in stool

 C

Ultrasound abdomen

 D

Radionuclide scan

Ans. D

Explanation:

Ans is ‘d’ ie. Radionuclide scan 

“If a Meckels diverticulum is suspected because of repeated gastrointestinal haemorrhage the abdomen can be scanned after the injection of 99Tc-labelled pertechnetate intravenously. This may localise heterotopic gastric mucosa revealing the site of a meckels diverticulum in 90% of cases.” – Bailey & Love


Q. 17

A wide mouth meckels diverticulum is found. accidently on laparotomy. what will be t/t of choice‑

 A

Resection of diverticulum 

 B

Leave as such

 C

Ligate at base

 D

Resection withpart of ileum

Q. 17

A wide mouth meckels diverticulum is found. accidently on laparotomy. what will be t/t of choice‑

 A

Resection of diverticulum 

 B

Leave as such

 C

Ligate at base

 D

Resection withpart of ileum

Ans. B

Explanation:

Ans is ‘b’ ie leave it as such 

“A wide-mouthed, thin walled unattached diverticulum in an adult patient can probably quite safely be left alone.”

Maingot’s

  • Treatment
  • Any symptomatic Meckel’s diverticula is resected (Diverticulectomy)
  • There are two techniques for excision of the diverticulum

–  simple excision resection with the segment of ileum containing the diverticulum and then reanastomosis.

  • Resection of ileum with reanastomosis is reserved for patients with peptic ulceration in the ileal mucosa a gangrenous diverticulitis affecting the base of the diverticulum if the base of the diverticulum is inflamed or perforated in rare cases of malignant disease situated in Meckel’s diverticulum.
  • Management of asymptomatic Meckel’s diverticula found incidentally on laprotomy
  • Management is controversial and different books write differently.
  • According to Maingot’s

– a wide-mouthed, thin walled Meckel’s diverticulum without any attached band can be left.

– prophylactic diverticulectomy is done – if the diverticula has a narrow base if there is any palpable thickening or adhesions suggestive of ectopic tissue.

– if there is any attachment either by bands to the umbilicus or by a mesodiverticular vascular strand.


Q. 18

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. 18

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 


Q. 19

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. 19

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. 20

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. 20

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. 21

Complications of Meckel’s diverticulum include ‑

 A

Hemorrhage

 B

Intussusception

 C

Strangulation

 D

All are correct

Q. 21

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 


Q. 22

The commonest presentation of meckel’s diverticulum is –

 A

Bleeding

 B

Obstruction

 C

Diverticulitis

 D

Intussception

Q. 22

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. 23

The most frequent congenital anomaly of the GI tract is –

 A

Imperforate anus

 B

Meckel’s diveticulum

 C

Malrotation

 D

Duodenal atresia

Q. 23

The most frequent congenital anomaly of the GI tract is –

 A

Imperforate anus

 B

Meckel’s diveticulum

 C

Malrotation

 D

Duodenal atresia

Ans. B

Explanation:

Ans. is ‘b’ i.e., Meckel’s diveticulum 


Q. 24

Which one of the following conditions is diagnosed by T99 Pertechnetate Scintigraphy?

 A

Pharyngeal diverticulum

 B

Duodenal diverticulum

 C

Meckel’s diverticulum

 D

Colonic diverticulum

Q. 24

Which one of the following conditions is diagnosed by T99 Pertechnetate Scintigraphy?

 A

Pharyngeal diverticulum

 B

Duodenal diverticulum

 C

Meckel’s diverticulum

 D

Colonic diverticulum

Ans. C

Explanation:

Ans. is ‘c’ i.e., Meckel’s diverticulum 


Q. 25

Meckel’s diverticulum is remnant of –

 A

Vitello intestinal duct

 B

Urachus

 C

Oganic diaphragm

 D

None

Q. 25

Meckel’s diverticulum is remnant of –

 A

Vitello intestinal duct

 B

Urachus

 C

Oganic diaphragm

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., Vitello intestinal duct 


Q. 26

Most common presentation of Meckel’s diverticulum?

 A

Lower GI bleeding

 B

Upper GI bleeding

 C

Diarrhorea

 D

Abdominal pain

Q. 26

Most common presentation of Meckel’s diverticulum?

 A

Lower GI bleeding

 B

Upper GI bleeding

 C

Diarrhorea

 D

Abdominal pain

Ans. A

Explanation:

Ans. is ‘a’ i.e. Lower GI bleeding 


Q. 27

Bleeding per rectum is present in all, except ‑

 A

Meckel’s diverticulum

 B

Sigmoid volvulus

 C

Carcinoma rectum

 D

Ulcerative colitis

Q. 27

Bleeding per rectum is present in all, except ‑

 A

Meckel’s diverticulum

 B

Sigmoid volvulus

 C

Carcinoma rectum

 D

Ulcerative colitis

Ans. B

Explanation:

Ans. is `b’ i.e., Sigmoid Volvulus 

Volvulus does not cause bleeding

Causes of lower G.I. bleeding

 

 

A) Common

B) Less common

C) Rare

Angiodysplasia

Neoplasia      —> Carcinoma, polyps

Meckel’s diverticulum

Diverticulitis

Colitis           –>   Radiation, Ischaemic, Ulcerative

Intussusception

Anorectal disease

Infective         –>   Enteric fever, Amoebic ulcer, T.B.

 

(Hemorrhoids, Anal fissure)

HIV related (Gonorrhoea, C.M.V.)

 


Q. 28

All of the following are cause of blood in stools in children except –

 A

Meckels diverticulum

 B

Carcinoma

 C

Intussusception

 D

Juvenile polyp

Q. 28

All of the following are cause of blood in stools in children except –

 A

Meckels diverticulum

 B

Carcinoma

 C

Intussusception

 D

Juvenile polyp

Ans. B

Explanation:

Ans. is ‘b’ i.e., Carcinoma


Q. 29

A female patient complains of perumbilical pain & nausea particularly after taking food. The diagnosis is

 A

Meckel’s diverticulum

 B

Peptic ulcer syndrome

 C

Lactose intolerance

 D

None

Q. 29

A female patient complains of perumbilical pain & nausea particularly after taking food. The diagnosis is

 A

Meckel’s diverticulum

 B

Peptic ulcer syndrome

 C

Lactose intolerance

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., Meckel’s diverticulum 

See 4th point (It is due to peptic ulcer in Meckel’s diverticulum)


Q. 30

True diverticulum is:     

 A

Zenker’s diverticulum

 B

Meckel’s diverticulum

 C

Duodenal diverticulum

 D

Bladder diverticulum

Q. 30

True diverticulum is:     

 A

Zenker’s diverticulum

 B

Meckel’s diverticulum

 C

Duodenal diverticulum

 D

Bladder diverticulum

Ans. B

Explanation:

Ans. B: Meckel’s diverticulum

Diverticula are classified as true and false.

True diverticula are composed of all layers of the intestinal wall, whereas false diverticula are formed from the herniation of the mucosal and submucosal layers.

Diverticula can be classified as intraluminal or extraluminal.

  • Intraluminal diverticula and Meckel’s diverticulum are congenital
  • Extraluminal diverticula may be found in various anatomic locations and are referred to as duodenal, jejunal, ileal, or jejunoileal diverticula.

Meckel’s diverticulum is a congenital anomaly representing a persistent portion of the vitellointestinal duct.

It can become ulcerated or cause intestinal obstruction.

It is present in approximately 2% of the population, with males more frequently experiencing symptoms.


Q. 31

Radioisotope scan used for diagnosing ectopic gastric mucosa in Meckel’s diverticulum:          

March 2012

 A

Gallium citrate

 B

Thallium

 C

Selenium

 D

Technetium-99 pertechnate

Q. 31

Radioisotope scan used for diagnosing ectopic gastric mucosa in Meckel’s diverticulum:          

March 2012

 A

Gallium citrate

 B

Thallium

 C

Selenium

 D

Technetium-99 pertechnate

Ans. D

Explanation:

Ans: D i.e. Tecnetium-99 pertechnate

Uses of radioisotopes

  • Gallium citrate is useful for tumours/abscess
  • Thallium scan is used to study myocardial perfusion
  • Selenium is useful in thyroid malignancy
  • For detection of ectopic gastric mucosa in Meckel’s divertculum, Tc-99 pertechnate is used

Uses of radiotherapy

  • Hot spot in MI is detected by: Technetium scan
  • Pancreatic scanning is done by: Selenium 75
  • Scan used for parathyroid gland: Sestamibi scan
  • Scan for measurement of renal GFR: Tc99-DTPA scan
  • Vesicourethral reflex (VUR) is seen by: MAG3-tc99 scan
  • Isotope used in thyroid scan: 1-131
  • 99Tc scan shows hot spot in: Adenolymphoma (Salivary gland tumour)
  • PACS/ picture archiving and communication system: New system (completely computerized network) to replace conventional analogue film and paper clinical request forms and reports
  • Brachytherapy: Radiation therapy in which sources are placed within or near tumour for therapy
  • Gamma knife (using gamma rays) is used in: Stereotactic surgery (cuts tumour in different location/ 3D)
  • Mantle irradiation is done in: Hodgkin’s disease
  • Hyper-fractionation radiotherapy is used to treat: Lung cancer
  • Intra-operative radiotherapy is used to treat: Pancreatic Ca
  • Emergency radiotherapy is given in:

—       SVC syndrome,

—       Pericardial tamponade

  • RAID/ (RadioActive Iodine Uptake test) is done mostly using: 1-123
  • Photodynamic therapy with hemato-porphyrins and light is used in the treatment of:

—       Colon Ca,

—       Skin Ca


Q. 32

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. 32

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. 33

All of the following are true for Meckel’s diverticu­lum EXCEPT:   

March 2013 (a, b, e, f)

 A

Lind by heterotopic epithelium

 B

3-5% population

 C

More commoner in females

 D

Mesenteric border

Q. 33

All of the following are true for Meckel’s diverticu­lum EXCEPT:   

March 2013 (a, b, e, f)

 A

Lind by heterotopic epithelium

 B

3-5% population

 C

More commoner in females

 D

Mesenteric border

Ans. D

Explanation:

Ans. D i.e. Mesenteric border

Meckel’s diverticulum

  • True congenital diverticulum,
  • Vestigeal remnant of omphalomesenteric duct/ vitelline duct,
  • 2 feet from ileocaecal valve,
  • 2 types of ectopic tissue are common:

– Gastric &

– Pancreatic

  • Torsion may lead to obstruction, ischemia & necrosis,
  • IOC to diagnose Meckel’s diverticula: Technetium-99m pertechnetate (99mTc),
  • It can be a leading point of intussusception

Q. 34

Uncommon complication of meckels diverticulum is:

September 2005

 A

Intussusception

 B

Diverticulitis

 C

Malignancy

 D

Increased bleeding

Q. 34

Uncommon complication of meckels diverticulum is:

September 2005

 A

Intussusception

 B

Diverticulitis

 C

Malignancy

 D

Increased bleeding

Ans. C

Explanation:

Ans. C: Malignancy

Epidemiology

– More common in males by ratio of 3:2

Lifetime complication rate: 4%

– More than 50% of complications occur before age 10

  • History-Initial report by Hildanus in 1598, Detailed description by Johann Meckel in 1809
  • Pathophysiology: Meckel’s Diverticulum

– Incomplete vitelline duct (omphalomesenteric) closure

– Location

  • . Proximal to ileocecal valve by 100 cm
  • Usually within 45 to 60 cm of ileocecal valve
  • Differential Diagnosis of Meckel’s Diverticulitis-Appendicitis
  • Complications of Meckel’s Diverticulum

– GI Bleeding (25-50% of complications)

  • Often associated with ectopic gastric mucosa
  • Hemorrhage is most common presentation under age 2

– Meckel’s Diverticulitis (10-20% of complications)-Similar in presentation to Appendicitis

– Bowel Obstruction

  • Volvulus at fibrotic band attached to abdominal wall
  • Intussusception
  • Incarcerated Inguinal Hernia (Littre’s hernia)

– Other complications-Carcinoid Tumor

  • Radiology

–  Radionuclide Scintigraphy (Sodium Tc-pertechnetate)

  • Preferential uptake by gastric tissue
  • Most accurate test in Meckel’s Diverticulum-Test Sensitivity is 85% in children and Test Specificity is 95% in children
  • Less accurate in adults -Cimetidine increases accuracy in adults

– Small bowel enema-Indicated for negative scintigraphy in adults

– Arteriography (indicated for acute hemorrhage)


Q. 35

Meckel’s diverticulum is a remnant of ‑

 A

Stenson’s duct

 B

Wolffian duct

 C

Mullerian duct

 D

Vitellointestinal duct

Q. 35

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.


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