Incidence: 2 % of the population. Normally, the omphalomesentic duct that connects the vitelline cavity to the entoblast in the embryo get occluded during the 5th week of life. Incomplete occlusion of its proximal part produces the Meckel's diverticulum. It is located on the antimesenteric side of the small intestine, in the last 100 cm before the ileocaecal valve, in the axis of the superior mesenteric artery.

It is a true diverticulum as its wall is composed of the 3 elements of the normal intestinal wall: this explains why, in at least 30 % of the cases, heterotopic digestive tissues such as  gastric mucosa (secreting HCl) or pancreatic tissue (with exocrine and/or endocrine secretions) are found at its level, which causing specific complications.

Meckel's diverticulum is usually asymptomatic but can lead to the following complications in 4-5 % of the cases:

-        an intestinal obstruction due to a fibrous band connecting it to the mesentery or umbilicus,

-          an acute intestinal intussusception

-          an ulceration or sometimes a massive bleeding (rectal bleeding) in case of gastric mucosal ectopy (see picture),

-         a diverticulitis that can lead to perforation and peritonitis, the signs and symptoms of which are similar to those of  acute appendicitis (which is why it is classic to look for a Meckel diverticulum in case of a "negative" appendectomy).

If an asymptomatic Meckel's diverticulum is found at laparotomy, the surgeon frequently decides to resect it.

Anesthetic implications:

in case of bleeding: anemia, hypovolemia.

References:

-         Moore T.C.
Omphalomesenteric duct malformations.
Semin Pediatr Surg 1996; 5:116-23

Updated April 2020