Meckels Diverticulum

Failure of the omphalomesenteric duct to completely involute may lead to a persistent outpouching along the antimesenteric border of the distal ileum, a Meckel's diverticulum (Fig. 2-22). Meckel's diverticulum occurs in approximately 2% of the general population, and it is the most common congenital abnormality of the gastrointestinal tract. Stasis of intestinal contents within the diverticulum predisposes to the development of enteroliths (Fig. 2-23). Obstruction is the predominant symptom (39%). Hemorrhage, perforation, diverticulitis, and intussusception are the other symptoms (12-14% each).10,31,32 Hemorrhage and perforation are usually associated with the presence of ectopic gastric mucosa (Fig. 2-24), while perforation due to ingested foreign body has rarely been reported.33

Perforated Meckel Diverticulum

Fig. 2-19. Chronic recurrent midgut volvulus.

A 29-year-old male presented with recurrent episodic abdominal pain.

(a) Precontrast CT shows small bowel loops and mesenteric vessels (curved arrows) wrapping around the superior mesenteric artery (straight arrow). High and medially positioned cecum (C) and small bowel loops occupying the right side of the abdomen are noted. An increased attenuation of mesenteric fat indicates congestion or edema.

(b) Barium enema examination shows a high and medial position of the cecum (C) and volvulated ileal loops (arrows).

Fig. 2-19. Chronic recurrent midgut volvulus.

A 29-year-old male presented with recurrent episodic abdominal pain.

(a) Precontrast CT shows small bowel loops and mesenteric vessels (curved arrows) wrapping around the superior mesenteric artery (straight arrow). High and medially positioned cecum (C) and small bowel loops occupying the right side of the abdomen are noted. An increased attenuation of mesenteric fat indicates congestion or edema.

(b) Barium enema examination shows a high and medial position of the cecum (C) and volvulated ileal loops (arrows).

Picture That Represents Persistent

Fig. 2—20. Persistent descending mesocolon.

A double-contrast barium enema reveals a short descending colon with a long, redundant transverse colon. This represents incomplete fusion of the descending colon mesentery, with its remnant allowing excessive mobility. In addition, the cecum is pointed superiorly in the right upper quadrant, which represents premature arrest of the postarterial rotation. Therefore, this patient has a not uncommon combination of incomplete rotation and malfixation.

(From Javors BR, Sloves JH.4)

Fig. 2—20. Persistent descending mesocolon.

A double-contrast barium enema reveals a short descending colon with a long, redundant transverse colon. This represents incomplete fusion of the descending colon mesentery, with its remnant allowing excessive mobility. In addition, the cecum is pointed superiorly in the right upper quadrant, which represents premature arrest of the postarterial rotation. Therefore, this patient has a not uncommon combination of incomplete rotation and malfixation.

(From Javors BR, Sloves JH.4)

Fig. 2—21. Volvulus of the splenic flexure of the colon.

In a patient with a markedly dilated splenic flexure, this postevacuation film from a barium enema reveals the classic criss-crossing mucosal fold pattern (arrows) of a volvulus. In this patient, there was an elongated left colon on a persistent mesentery, a lack of proper resorption.

Meckels Diverticulum Barium Studies

Fig. 2—22. Meckel's diverticulum.

Enteroclysis study reveals a barium-filled Meckel's diverticulum (arrows) arising from the antimesenteric border of the distal ileum.

Meckel Diverticulum Barium

Fig. 2—23. Meckel's diverticulum with enteroliths.

(a) Coned-down view of the right lower quadrant shows multiple faceted calcifications.

(b) Spot film of the same area from a small bowel study demonstrates these enteroliths to lie within a large Meckel's diverticulum.

Fig. 2—23. Meckel's diverticulum with enteroliths.

(a) Coned-down view of the right lower quadrant shows multiple faceted calcifications.

(b) Spot film of the same area from a small bowel study demonstrates these enteroliths to lie within a large Meckel's diverticulum.

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Responses

  • Kirsti
    Is meckels on mesenteric border?
    1 year ago
  • jewel cronin
    How to find meckels on ct?
    11 months ago

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