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1. What is Meckel's diverticulum?
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This is the remnant of the vitellointestinal duct of the embryo.
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2. What is the 'rule of 2's' with regard to Meckel's diverticulum?
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It occurs in 2% of the population, it is 2 feet (60 cm) from the caecum, it is 2 inches (5 cm) long.
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3. How might a Meckel's diverticulum present?
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(1) Perforation by a foreign body.
(2) Patent vitellointestinal duct.
(3) Peptic ulceration.
(4) Raspberry tumour at the umbilicus.
(5) Intussusception (ileoileal).
(6) Vitellointestinal band volvulus.
(7) Acute inflammation.
(8) Symptomless finding.
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4. How does the acute inflammation of a Meckel's diverticulum present?
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Clinically identical to acute appendicitis.
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5. How can Meckel's diverticulum cause peptic ulceration? How does this present?
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Peptic ulceration due to contained heterotopic gastric epithelium, which bears HCl-secreting parietal cells. This particularly occurs in children and characteristically is the cause of melaena at about 10 years old. Rarely, the peptic ulcer perforates or gives rise to postcibal pain. The diverticulum may also contain ectopic pancreatic tissue.
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6. How do most Meckel’s diverticula present?
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Most are incidental findings.
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7. How would you investigate a Meckel’s diverticulum?
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Technetium scan; barium follow-through or small bowel enema; computed tomography scan.
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8. How might a technetium scan be useful in the investigation of Meckel’s diverticulum?
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Radiolabelled technetium (99mTc) is taken up by gastric mucosa, and scintigraphy will outline the stomach and, in addition, the Meckel’s diverticulum, usually near the right iliac fossa.
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9. How might a barium follow-through be useful in the investigation of a Meckel’s diverticulum?
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This may show the diverticulum arising from the antimesenteric border of the ileum.
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10. Where is Meckel’s diverticulum typically situated?
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In the right iliac fossa.
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11. How would you treat a Meckel’s diverticulum?
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Treatment involves resection of the diverticulum.
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12. What is Crohn’s disease?
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Crohn’s disease is a non-specific inflammatory disease of the alimentary canal, with diseased segments sandwiched between normal segments (i.e. it is discontinuous). Crohn first described its occurrence in the ileum and termed it ‘regional ileitis’. However, this description is inaccurate, as the disease may affect any part of the alimentary tract from mouth to anus. Crohn’s disease may affect the large bowel alone.
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13. How did Crohn first describe Crohn’s disease?
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Correct answer:
Crohn first described its occurrence in the ileum and termed it ‘regional ileitis’. However, this description is inaccurate, as the disease may affect any part of the alimentary tract from the mouth to the anus.
