Meckel’s Diverticulum

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Meckel’s Diverticulum is a condition people are born with, where a small pouch forms in the wall of the small intestine, usually close to where it connects to the large intestine.

This pouch is a leftover from early foetal development and is present in about 2% of the population. Most people with Meckel’s Diverticulum have no symptoms, and it is often discovered during tests or surgeries for other issues.

Causes and Risk Factors

Meckel’s Diverticulum develops during foetal growth when certain structures do not fully close. Factors that can increase the chances of symptoms or complications include:

Ectopic Tissue

Gastric or pancreatic tissue within the diverticulum can lead to ulceration and inflammation of the surrounding intestinal lining.

Bowel Obstruction

The size and position of the diverticulum may lead to obstruction due to entrapment or twisting (volvulus) of the intestine around it.

Age

Symptomatic Meckel’s Diverticulum is most often seen in children under 10 but may also present with complications in adults.

Male Predominance

Males are two to three times more likely to experience symptoms, which tend to be more severe than females.

Family History

A family history of congenital gastrointestinal abnormalities can slightly increase the risk of developing Meckel’s Diverticulum.

Diagnosis of Meckel’s Diverticulum

Diagnosing Meckel’s Diverticulum involves identifying the diverticulum and ruling out other conditions. Methods include:

Medical History and Physical Examination

The doctor reviews the patient’s medical history and symptoms, including abdominal pain and rectal bleeding. The duration of symptoms and any patterns, such as the onset of pain or bleeding in response to meals, aid in diagnosis. A physical exam may reveal tenderness or other signs indicating possible inflammation or obstruction.

Blood Tests

Blood tests, including a complete blood count (CBC), assess for anaemia, which may indicate chronic blood loss associated with Meckel’s Diverticulum. Elevated white blood cell counts may also suggest inflammation or infection.

Imaging Studies

The Technetium-99m Pertechnetate scan (Meckel’s scan) is the most specific test for identifying ectopic gastric mucosa. CT scans and MRIs help detect complications, while ultrasound is often preferred in paediatric cases for its non-invasive nature.

Capsule Endoscopy

This method may be used if initial imaging results are inconclusive. The patient swallows a small capsule with a camera, which captures images as it travels through the small intestine, helping identify abnormalities that traditional imaging may miss.

Diagnostic Laparoscopy

This is a minimally invasive procedure used when other tests, like imaging or endoscopy, do not yield clear results for Meckel’s Diverticulum. Through small abdominal incisions, a laparoscope (a thin, flexible tube with a camera) is inserted to examine the intestines and directly visualise the diverticulum. This technique enables accurate assessment of its structure, size, and any associated complications.

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Treatment Options for Meckel’s Diverticulum

Non-Surgical Treatment
Observation

For asymptomatic cases, close monitoring without immediate intervention may be recommended to observe for any symptom development. Patients should watch for symptoms such as abdominal pain or rectal bleeding and report any changes to their doctor.

Medications

If symptoms such as pain or mild bleeding occur, medications may be used to treat underlying issues such as inflammation. Proton pump inhibitors (PPIs) can be prescribed to reduce stomach acid and prevent ulcers caused by ectopic gastric tissue.

Surgical Treatment
Diverticulectomy

A diverticulectomy removes the diverticulum to prevent or treat complications such as bleeding or obstruction. This procedure is often recommended for symptomatic cases of Meckel’s Diverticulum.

Bowel Resection

In severe cases, with significant damage, inflammation, or obstruction, a bowel resection may be necessary. This procedure involves removing the affected section of the small intestine and reconnecting the healthy portions to maintain intestinal function.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Can Meckel’s Diverticulum lead to long-term complications if left untreated?

    Yes, while many cases are asymptomatic, untreated Meckel’s Diverticulum can occasionally lead to complications such as chronic anaemia from persistent bleeding, bowel obstruction, or, in rare cases, inflammation or infection.

    Are there lifestyle changes that can help manage asymptomatic Meckel’s Diverticulum?

    Lifestyle changes do not directly impact Meckel’s Diverticulum. However, staying informed about symptoms such as rectal bleeding or abdominal pain and having regular check-ups can help ensure any changes are detected early.

    Can Meckel’s Diverticulum recur after surgery?

    Once the diverticulum is surgically removed, it does not recur. However, if part of the intestine is resected, patients may still need follow-up care to ensure proper healing and function of the bowel.

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