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|Diagnosis in short|
Gross image of a Meckel diverticulum. (AFIP/WC)
|LM||small bowel mucosa, +/-gastric mucosa (foveolar epithelium, oxyntic mucosa), +/-pancreatic epithelium|
|Gross||small bowel outpouching on antemesenteric aspect ~5 cm long, ~60 cm from the ileocecal valve|
|Prevalence||uncommon ~2% of population|
|Clin. DDx||acute appendicitis, other causes of abdominal pain|
Meckel diverticulum (also Meckel's diverticulum), is congenital structure of the distal small bowel that occasionally gets inflamed and may present with acute appendicitis-like symptoms.
- Most common congenital anomaly of the gastrointestinal tract.
- Remnant of the omphalomesenteric duct - a connection of the yolk sac and midgut.
The rule of 2s:
- 2 feet from the terminal ileum
- 2% of the population
- 2% symptomatic.
- 2 inches long.
- 2 year old.
- 2 types of epithelium - gastric and pancreatic.
Main clinical DDx of a symptomatic Meckel diverticulum:
- Antimesenteric attachement, i.e. a Meckel's diverticulum hangs off the side opposite of the mesentery.
- Small bowel mucosa.
- +/-Gastric mucosa:
- Foveolar epithelium: champagne flute-like columnar epithelium.
- Oxyntic mucosa: parietal cells (pink) and chief cells (purple).
- +/-Pancreatic epithelium:
- Pancreatic acini.
Small bowel with Meckel's diverticulum, Excision: - Benign small bowel diverticulum with focal active inflammation and reactive lymphoid hyperplasia at tip, compatible with clinical impression of inflamed Meckel's diverticulum. - Unremarkable small bowel wall at resection margin.