Review Question - QID 101927

The patient described above is suffering from Meckel diverticulum. The most common complication is ulceration which can lead to bleeding.

Meckel diverticulum results when the vitelline duct persists after birth. Because all layers of bowel wall are present, and the duct is continuous with the rest of the bowel, this is a true diverticulum. Ectopic gastric mucosa may be found within Meckel diverticula, and the ectopic gastric secretions produced there can lead to ulcerations and eventually bleeding.

Martin et al. note that greater than 50% of patients with Meckel diverticula have ectopic tissue within the diverticulum. More commonly, the ectopic tissue is gastric but it may also be pancreatic. In terms of the pancreatic secretions, the alkaline nature of the secretions may also cause ulcerations.

Malik et al. discuss complications of Meckel diverticulum. They note that GI bleeding from the diverticulum due to ulceration is one of the most frequent causes of painless bleeding in children. In addition, Meckel diverticula may lead to obstruction via volvulus of normal gut around the out-pocketing.

Illustration A depicts a Meckel diverticulum. Note how the lumen is continuous with that of the normal bowel. Biopsy would show all layers of the bowel wall present in the diverticulum.
Illustration B shows a nuclear medicine Tc-99m pertechnetate scan, with the red arrow highlighting the outpouching of the Meckel diverticulum.

Incorrect Answers:
Answer 1: Enlarged rugal folds would be more consistent with Menetrier disease.
Answer 2: Dysplasia is not a common clinical finding in Meckel diverticulum.
Answer 4: Megacolon would be more consistent with Hirschsprung disease.
Answer 5: Paneth cell metaplasia would be more consistent with Crohn's disease.