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Meckel’s Diverticulum MCQs

QUESTION: Meckel’s diverticulum is the most common form of persistent __________ duct remnant.

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ANSWER: The answer is vitelline duct remnant.

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Meckel’s Diverticulum – on-table photos .

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QUESTION:  Does Meckel’s diverticulum occur in the mesenteric or antimesenteric border of the small bowel?

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ANSWER:  It occurs on the antimesenteric border of the small bowel.

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QUESTION: Does Meckel’s diverticulum occur in the duodenum, jejunum, or ileum?

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ANSWER: Meckel’s diverticulum occurs on the antimesenteric border of the ileum within 60 cm of ileocecal valve

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QUESTION: What are the symptoms of Meckel’s diverticulum?

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ANSWER

The condition is usually asymptomatic but complications, including peptic ulceration in the ectopic gastric mucosa with bleeding or perforation, may occur.

It is occasionally associated with intussusception and volvulus.

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Meckel’s Diverticulum case presentation .

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QUESTION:  List the possible complications from Meckel’s diverticulum

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ANSWER:

Complications

– bleeding — 22%; usually painless, due to ulceration of adjacent tissue from ectopic gastric mucosa; usually stops spontaneously, but can be massive

– obstruction — 13%; secondary to internal hernia around persistent omphalomesenteric band

– inflammation — 2%; mimics acute appendicitis

– intussusception — 1%

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QUESTION: How do you diagnose Meckel’s diverticulum?

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ANSWER:

Diagnosis

– high degree of suspicion, confirmed by 99m-technetium-pertechnate scan; can have false-positive results with enteric duplications or false-negative results with H2 blockers if ectopic gastric mucosa present

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QUESTION: What is the “rule of 2’s of Meckel diverticulum?

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ANSWER:

remember the “rule of 2s” — occurs in 2% of the population, symptomatic in 2% of cases, approximately 2 feet from the ileocecal valve, 2 inches in length, 2 types of mucosa (gastric/pancreatic), twice as many males as females, 2 presentations (bleeding, obstruction)

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QUESTION: What is the treatment for Meckel diverticulum?

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ANSWER

Treatment by wedge resection of diverticulum or segmental ileal resection with primary anastomosis; include appendectomy

Incidental Meckel’s diverticulum — generally recommend resection in patient <18 years of age, particularly if heterotopic tissue present; not indicated in asymptomatic adults

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Meckel’s Diverticulum Surgery

Laparoscopic Assisted Meckel’s Diverticulectomy in a child 

MECKEL’S DIVERTICULUM: SEGMENTAL SMALL BOWEL RESECTION USING SINGLE PORT ACCESS .

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QUESTION:  A 28 year old woman presents with hematochezia. She is admitted to the hospital and undergoes upper endoscopy that is negative for any lesions. Colonoscopy is performed and no bleeding sources are identified, although the gastroenterologist notes blood in the right colon and old blood coming from above the ileocecal valve. Which of the following is the test of choice in this patient?

a. Angiography

b. Small-bowel enteroclysis

c. CT scan of the abdomen

d. 99mTc pertchnate scan

e. Small-bowel endoscopy

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ANSWER 

The anwer is d. (Townsend, pp1260-1262)

The patient most likely has bleeding from the small bowel, given the findings on endoscopy, and the most common cause of small intestinal bleeding in patients under the age of 30 is a Meckel’s diverticula.

Because Meckel’s diverticula can contain ectopic gastric mucosa, acid secretion can cause small-bowel ulcerations.

Small-bowel enteroclysis is a contrast study that can sometimes identify mases or lesions in the small bowel.

While enteroclysis, small-bowel endoscopy, angiography, and CT scanning can all be useful adjuncts in the workup of GI bleeding, the patient in this scenario shoud have a 99mTc pertechnate scan, which is diagnostic for a Meckel’s diverticula.

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QUESTION:  All of the following statements about the embryology of Meckel’s diverticulum are true except

a. Meckel’s diverticulum usually arises from the ileum within 90cm of the ileocecal valve

b. Meckel’s diverticulum results from the failure of the vitelline duct to obliterate

c. The incidence of Meckel’s diverticulum in the general population is 5%

d. Gastric mucosa is the most common ectopic tissue found within a symptomatic Meckel’s diverticulum

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ANSWER 

The answer is c. Meckel’s is a true diverticulum that results in failure of the vitelline (or omphalomesenteric) duct to obliterate in the 7th week of genstation. The incidence is 1-2%, not 5. Pancreatic tissue is the most common, but gastric is the most common in symptomatic patients — bleeding usually. It is usually 2feet (45-90cm) from t6he ileocecal valve on the antimesenteric border.

Rule of 2’s 2ft from valve, 2cm in length, 2% incidence, 2% symptomatic usually presents in first 2 years of life, and 2X more common in men.

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QUESTION:  The most common presentation of Meckel’s diverticulum in an adult is:

a. GI bleed

b. Intussuception

c. Littre’s hernia

d. Diverticulitis

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ANSWER: Answer a: Most common presentation of Meckel’s in adults is GI bleed. This is due to gastric mucosa in the Meckel’s. Littre’s hernia is when you get your Meckel’s in your inguinal hernia — good luck seeing that one.

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QUESTION:  

MECKEL’S DIVERTICULUM REVIEW

– found on antimesenteric border of small bowel

– embryology – persistent vitelline duct

– rule of 2s

– 2 feet from ileocecal valve

– 2% of population

– 2% symptomatic

– 2 tissue types (panreatic – most common; gastric – most likely to be symptomatic

– 2 presentations (diverticulitis and bleeding)

– #1 cause of painless lower GI bleeding in children

– can get Meckel’s scan with pertechnetate if suspicious of Meckel’s and having trouble locating

Treatment

– resection with symptoms, suspicion of gastric mucosa, or narrow neck

– diverticulitis involving the base or if the base is > 1/3 size of the bowle, need to perform segmental resection

 

SOURCES

MCAT

 

USMLE STEP 1

        

CLINICAL ROTATIONS

                      

ABSITE
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