Computed tomography of complicated Meckel’s diverticulum in adults: a pictorial review

Insights into Imaging, May 2010

Objective To show various CT aspects of complicated Meckel’s diverticulum in adult patients to facilitate the preoperative diagnosis of this rare pathology in emergency settings. Methods A computer search of medical records over a 15 year period identified 23 adult patients who underwent surgery for acute abdomen generated by a complicated Meckel’s diverticulum. CT images available for review were analyzed, and some specific patterns leading to the diagnosis of complicated Meckel’s diverticulum are presented in this review. Results Complications were related to inflammation (14 patients), bleeding (5 patients), intestinal obstruction (3 patients), and penetrating foreign body (1 patient). The presence of a Meckel’s diverticulum was usually suggested at CT scan by an abnormal outpouching, blind-ending digestive structure connected to the terminal ileum by a neck of variable caliber. Depending on the type of complications, the diverticulum was surrounded by mesenteric inflammatory changes, or presented as a localized fluid or air-fluid collection contiguous with the terminal ileum. The diverticulum was also the source of active bleeding or acted as the lead point to intestinal obstruction or intussusception. Conclusion CT findings of complicated Meckel’s diverticulum are polymorphic and should be considered in the evaluation of adult patients with acute abdomen.

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Computed tomography of complicated Meckel’s diverticulum in adults: a pictorial review

Alexandra Platon Pascal Gervaz Christoph D. Becker Philippe Morel Pierre-Alexandre Poletti Objective To show various CT aspects of complicated Meckel's diverticulum in adult patients to facilitate the preoperative diagnosis of this rare pathology in emergency settings. Methods A computer search of medical records over a 15 year period identified 23 adult patients who underwent surgery for acute abdomen generated by a complicated Meckel's diverticulum. CT images available for review were analyzed, and some specific patterns leading to the diagnosis of complicated Meckel's diverticulum are presented in this review. Results Complications were related to inflammation (14 patients), bleeding (5 patients), intestinal obstruction (3 patients), and penetrating foreign body (1 patient). The presence of a Meckel's diverticulum was usually suggested at CT scan by an abnormal outpouching, blind-ending digestive structure connected to the terminal ileum by a neck of variable caliber. Depending on the type of complications, the diverticulum was surrounded by mesenteric inflammatory changes, or presented as a localized fluid or air-fluid collection contiguous with the terminal ileum. The diverticulum was also the source of active bleeding or acted as the lead point to intestinal obstruction or intussusception. Conclusion CT findings of complicated Meckel's diverticulum are polymorphic and should be considered in the evaluation of adult patients with acute abdomen. - Meckels diverticulum is a congenital anomaly of the gastrointestinal system due to incomplete obliteration of the omphalomesenteric duct. Meckels diverticulum is found with an incidence of 12% in the general population, and most of the diverticula remain asymptomatic [1]. Complications result most commonly from bleeding, inflammation, and obstruction [1, 2]. A study performed over a 42 year period in a general population showed a lifetime risk of complications of 6.4% [3]; symptomatic Meckels diverticulum has been reported in 16% of patients with surgically proven diverticula [4]. According to this latter study, younger (<4 years) patients tend to present with obstructions, whereas adult patients tend to present with hemorrhage. Complicated Meckels diverticulum usually manifests during the first years of life, and it is considered to be a rare pathology in adult life. The purpose of our review is to show various CT aspects of complicated Meckels diverticulum in adult patients encountered over a 15 year period in our emergency department. We aim to facilitate the diagnosis of complicated Meckels diverticulum prior to surgery in emergency conditions. Anatomy and embryology of the Meckels diverticulum The presence of the Meckels diverticulum is explained by the intrauterine evolution of the bowel. The initial embryological communication between the midgut and the yolk sac is made through the omphalomesenteric (vitelline) duct. During normal developmental evolution, this duct is obliterated and disappears; this process usually takes place during the 8th to 9th week of embryonic life. Different forms of congenital anomalies will result as a consequence of failure of closure and/or resorption of this embryological communication. The pattern of these anomalies depends on the degree of persistent ductal patency linking the ileum to the umbilicus; they may appear as fibrous cord, as ileoumbilical fistula, or as omphalomesenteric cysts [2, 5]. However, the most frequent of all closure anomalies of the omphalomesenteric duct is Meckels diverticulum, which received its name in 1809, in honor of the German anatomist Johann Friedrich Meckel. Meckels diverticulum development is related to the persistent patency of the intestinal attachment of the omphalomesenteric duct, while its umbilical end obliterates. The result will be a true diverticulum, formed by all the layers of the intestinal wall; the diverticulum takes its origin from the antimesenteric border of the small bowel, within 40100 cm of the ileocecal valve [2, 5]. The arterial supply comes from the vitelline artery, which is a branch of the superior mesenteric artery. The diverticulum is normally lined by intestinal mucosa, but a frequent histological finding is the presence of heterotopic gastric or pancreatic mucosa [2]. The majority of Meckels diverticulum cases remain clinically silent during the entire lifetime, and their presence may be discovered incidentally during surgery, autopsy, or when performing upper gastrointestinal studies [2, 5]. Bleeding is a frequent complication of Meckels diverticulum. It is reported to be more frequent in children and young adults and is usually associated with ulcerations produced by the acid secretion from the heterotopic gastric mucosa inside the diverticulum. The bleeding may present as acute massive hemorrhage or as anemia from chronic bleeding; stools can be melenic or have a currant jelly-like aspect [2, 5]. Another frequent complication associated with Meckels (...truncated)


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Alexandra Platon, Pascal Gervaz, Christoph D. Becker, Philippe Morel, Pierre-Alexandre Poletti. Computed tomography of complicated Meckel’s diverticulum in adults: a pictorial review, Insights into Imaging, 2010, pp. 53-61, Volume 1, Issue 2, DOI: 10.1007/s13244-010-0017-8