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Urachus
9%
23/262
Omphalomesenteric duct
56%
148/262
Paramesonephric duct
6%
16/262
Allantois
13%
35/262
Ureteric bud
5%
14/262
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The patient in the question stem is most likely suffering from Meckel's diverticulitis. Meckel's diverticulum results from a persistent omphalomesenteric duct. Meckel's diverticulum, the most common congenital anomaly of the intestine, is caused by the persistence of the omphalomesenteric duct (also known as the vitelline duct or yolk stalk), which connects the midgut lumen to the yolk sac in the embryo. It normally obliterates during the 7th week of embryonic development. Meckel's diverticulum is a "true" diverticulum; it contains mucosa, submucosa, and the muscular layer. Meckel's diverticulum may be remembered with the "Rules of 2": It occurs in 2% of the population, in the first 2 years of life, and 2 feet from the ileocecal valve. Typically it is diagnosed with a technetium-99m (99mTc) pertechnetate scintigraphy scan, which highlights parietal cells within ectopic gastric mucosa whose enzyme release predisposes to inflammation and diverticulitis. Martin et al. review Meckel's diverticulum. They state Meckel's diverticulum can be especially difficult to diagnose, either because it clinically mimics disorders such as Crohn's disease, appendicitis or peptic ulcer disease, or because it may remain asymptomatic. Of the 50% of cases where ectopic tissue is discovered, the majority is gastric (60-85%), while only 5-16% is pancreatic tissue. Negrea et al. explain that the structure of nervous tissue in Meckel's diverticula predispose a patient to intussussception. The loss of nervous tissue density with age explains the higher frequency of complications in children. Illustration A shows a technetium-99m (99mTc) pertechnetate scintigraphy scan highlighting parietal cells within ectopic gastric mucosa; the arrow is pointing to a Meckel's diverticulum. Illustration B shows a surgical specimen with a Meckel's diverticulum. Incorrect answers: Answer 1: A persistent urachus may present as a patent urachus (urine discharge from umbilicus), a vesicourachal diverticulum, a urachal sinus, or a urachal cyst. Answer 3: The paramesonephric duct (mullerian duct) develops into the female internal reproductive structures. Answer 4: The allantois becomes the urachus (described above). Answer 5: The ureteric bud becomes the ureter, pelvis, and the calyces and collecting duct of the kidney.
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