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Meckel Diverticulum
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Remnant of omphalomesenteric duct
            • Presents with bleeding (when containing ectopic gastric mucosa), inflammation, intussusception, bowel obstruction, or perforation
            • Rule of 2s
              • Incidence: 2% of general population
              • Found within 2 feet of ileocecal valve
              • Most have clinical symptoms before 2 years of age

          IMAGING

          • General Features

            • Radiographic Findings

              • Fluoroscopic Findings

                • Ultrasonographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Francis A et al: Pediatric Meckel's diverticulum: report of 208 cases and review of the literature. Fetal Pediatr Pathol. 35(3):199-206, 2016
                                        2. Sanchez TR et al: Sonography of abdominal pain in children: appendicitis and its common mimics. J Ultrasound Med. 35(3):627-35, 2016
                                        3. Gezer HÖ et al: Meckel diverticulum in children: evaluation of macroscopic appearance for guidance in subsequent surgery. J Pediatr Surg. 51(7):1177-80, 2015
                                        4. Kawamoto S et al: CT detection of symptomatic and asymptomatic Meckel diverticulum. AJR Am J Roentgenol. 205(2):281-91, 2015
                                        5. Kunitsu T et al: Neonatal Meckel diverticulum: obstruction due to a short mesodiverticular band. Pediatr Int. 57(5):1007-9, 2015
                                        6. Park JS et al: Suppurative Meckel diiverticulum in a 3-year-old girl presenting with periumbilical cellulitis. Pediatr Gastroenterol Hepatol Nutr. 18(1):66-70, 2015
                                        7. Patel NB et al: Evaluating the patient with right lower quadrant pain. Radiol Clin North Am. 53(6):1159-70, 2015
                                        8. Vali R et al: The value of repeat scintigraphy in patients with a high clinical suspicion for Meckel diverticulum after a negative or equivocal first Meckel scan. Pediatr Radiol. 45(10):1506-14, 2015
                                        9. Anwar MO et al: Meckel's diverticulum with intussusception in a 5-year-old patient with Down's syndrome. BMJ Case Rep. 2014, 2014
                                        10. Huang CC et al: Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol. 55(5):369-75, 2014
                                        11. Kim SW et al: MDCT findings of a Meckel's diverticulum with ectopic pancreatic tissue. Clin Imaging. 38(1):70-2, 2014
                                        12. Kotha VK et al: Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol. 87(1037):20130743, 2014
                                        13. Redmond P et al: Bowel obstruction due to multiple retained foreign bodies in a Meckel diverticulum. J Pediatr. 165(3):639-639.e1, 2014
                                        14. Spottswood SE et al: SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0. J Nucl Med Technol. 42(3):163-9, 2014
                                        15. Fallon SC et al: Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg. 48(5):1032-6, 2013
                                        16. Han EJ et al: Adenocarcinoma arising in Meckel's diverticulum on 18F-FDG PET/CT. Clin Nucl Med. 38(3):e157-9, 2013
                                        17. He Q et al: Double-balloon enteroscopy for diagnosis of Meckel's diverticulum: comparison with operative findings and capsule endoscopy. Surgery. 153(4):549-54, 2013
                                        18. Kwait DC et al: Perforated Meckel's diverticulum presenting as a hematocele on scrotal sonography. J Clin Ultrasound. 41(4):242-4, 2013
                                        19. Sinha CK et al: Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years. Pediatr Surg Int. 29(5):511-7, 2013
                                        20. Hegde S et al: MR enterography of perforated acute Meckel diverticulitis. Pediatr Radiol. 42(2):257-62, 2012
                                        21. Kotecha M et al: Multimodality imaging manifestations of the Meckel diverticulum in children. Pediatr Radiol. 42(1):95-103, 2012
                                        22. Pepper VK et al: Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum. Surg Clin North Am. 92(3):505-26, vii, 2012
                                        23. Sun C et al: Intestinal obstruction due to congenital bands from vitelline remnants: sonographic features and review of the literature. J Ultrasound Med. 31(12):2035-8, 2012
                                        24. Thirunavukarasu P et al: Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management. Ann Surg. 253(2):223-30, 2011
                                        25. Bevernage C et al: Life-threatening lower gastrointestinal bleeding in a 2-year-old boy treated by transcatheter embolization: uncommon features of a complicated Meckel diverticulum. Pediatr Radiol. 40(10):1702-5, 2010
                                        26. Durakbasa CU et al: Symptomatic omphalomesenteric duct remnants in children. Pediatr Int. 52(3):480-4, 2010
                                        27. Wu YC et al: The 'wandering' Meckel diverticulum: an unusual scintigraphic finding. Pediatr Radiol. 40 Suppl 1:S103, 2010
                                        28. Olson DE et al: CT findings in children with Meckel diverticulum. Pediatr Radiol. 39(7):659-63; quiz 766-7, 2009
                                        29. Milbrandt K et al: Intussusception associated with a Meckel's diverticulum and a duplication cyst. J Pediatr Surg. 43(12):e21-3, 2008
                                        30. Yang JC et al: Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage. Pediatr Radiol. 38(8):909-11, 2008
                                        31. Baldisserotto M: Color Doppler sonographic findings of inflamed and perforated Meckel diverticulum. J Ultrasound Med. 23(6):843-8, 2004
                                        32. Bennett GL et al: CT of Meckel's diverticulitis in 11 patients. AJR Am J Roentgenol. 182(3):625-9, 2004
                                        33. Levy AD et al: From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation. Radiographics. 24(2):565-87, 2004
                                        34. Ojha S et al: Meckel's diverticulum with segmental dilatation of the ileum: radiographic diagnosis in a neonate. Pediatr Radiol. 34(8):649-51, 2004
                                        35. Rerksuppaphol S et al: Ranitidine-enhanced 99mtechnetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum. Pediatr Surg Int. 20(5):323-5, 2004
                                        36. Segal SD et al: Rare mesenteric location of Meckel's diverticulum, a forgotten entity: a case study aboard USS Kitty Hawk. Am Surg. 70(11):985-8, 2004
                                        37. Singh MV et al: A fading Meckel's diverticulum: an unusual scintigraphic appearance in a child. Pediatr Radiol. 34(3):274-6, 2004
                                        38. Adams BK et al: A moving Meckel's diverticulum on Tc-99m pertechnetate imaging in a patient with lower gastrointestinal bleeding. Clin Nucl Med. 28(11):908-10, 2003
                                        39. Baldisserotto M et al: Sonographic findings of Meckel's diverticulitis in children. AJR Am J Roentgenol. 180(2):425-8, 2003
                                        40. Danzer D et al: Bleeding Meckel's diverticulum diagnosis: an unusual indication for computed tomography. Abdom Imaging. 28(5):631-3, 2003
                                        41. Jelenc F et al: Meckel's diverticulum perforation with intraabdominal hemorrhage. J Pediatr Surg. 37(6):E18, 2002
                                        42. Mortele KJ et al: Giant Meckel's diverticulum containing enteroliths: typical CT imaging findings. Eur Radiol. 12(1):82-4, 2002
                                        43. Sy ED et al: Meckel's diverticulum associated with ileal volvulus in a neonate. Pediatr Surg Int. 18(5-6):529-31, 2002
                                        44. Farris SL et al: Axial torsion of Meckel's diverticulum presenting as a pelvic mass. Pediatr Radiol. 31(12):886-8, 2001
                                        45. Neidlinger NA et al: Meckel's diverticulum causing cecal volvulus. Am Surg. 67(1):41-3, 2001
                                        46. O'Hara SM: Pediatric gastrointestinal nuclear imaging. Radiol Clin North Am. 34(4):845-62, 1996
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Definitions

                                                  • Remnant of omphalomesenteric duct
                                                  • Presents with bleeding (when containing ectopic gastric mucosa), inflammation, intussusception, bowel obstruction, or perforation
                                                  • Rule of 2s
                                                    • Incidence: 2% of general population
                                                    • Found within 2 feet of ileocecal valve
                                                    • Most have clinical symptoms before 2 years of age

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • Fluoroscopic Findings

                                                      • Ultrasonographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Francis A et al: Pediatric Meckel's diverticulum: report of 208 cases and review of the literature. Fetal Pediatr Pathol. 35(3):199-206, 2016
                                                                              2. Sanchez TR et al: Sonography of abdominal pain in children: appendicitis and its common mimics. J Ultrasound Med. 35(3):627-35, 2016
                                                                              3. Gezer HÖ et al: Meckel diverticulum in children: evaluation of macroscopic appearance for guidance in subsequent surgery. J Pediatr Surg. 51(7):1177-80, 2015
                                                                              4. Kawamoto S et al: CT detection of symptomatic and asymptomatic Meckel diverticulum. AJR Am J Roentgenol. 205(2):281-91, 2015
                                                                              5. Kunitsu T et al: Neonatal Meckel diverticulum: obstruction due to a short mesodiverticular band. Pediatr Int. 57(5):1007-9, 2015
                                                                              6. Park JS et al: Suppurative Meckel diiverticulum in a 3-year-old girl presenting with periumbilical cellulitis. Pediatr Gastroenterol Hepatol Nutr. 18(1):66-70, 2015
                                                                              7. Patel NB et al: Evaluating the patient with right lower quadrant pain. Radiol Clin North Am. 53(6):1159-70, 2015
                                                                              8. Vali R et al: The value of repeat scintigraphy in patients with a high clinical suspicion for Meckel diverticulum after a negative or equivocal first Meckel scan. Pediatr Radiol. 45(10):1506-14, 2015
                                                                              9. Anwar MO et al: Meckel's diverticulum with intussusception in a 5-year-old patient with Down's syndrome. BMJ Case Rep. 2014, 2014
                                                                              10. Huang CC et al: Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol. 55(5):369-75, 2014
                                                                              11. Kim SW et al: MDCT findings of a Meckel's diverticulum with ectopic pancreatic tissue. Clin Imaging. 38(1):70-2, 2014
                                                                              12. Kotha VK et al: Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol. 87(1037):20130743, 2014
                                                                              13. Redmond P et al: Bowel obstruction due to multiple retained foreign bodies in a Meckel diverticulum. J Pediatr. 165(3):639-639.e1, 2014
                                                                              14. Spottswood SE et al: SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0. J Nucl Med Technol. 42(3):163-9, 2014
                                                                              15. Fallon SC et al: Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg. 48(5):1032-6, 2013
                                                                              16. Han EJ et al: Adenocarcinoma arising in Meckel's diverticulum on 18F-FDG PET/CT. Clin Nucl Med. 38(3):e157-9, 2013
                                                                              17. He Q et al: Double-balloon enteroscopy for diagnosis of Meckel's diverticulum: comparison with operative findings and capsule endoscopy. Surgery. 153(4):549-54, 2013
                                                                              18. Kwait DC et al: Perforated Meckel's diverticulum presenting as a hematocele on scrotal sonography. J Clin Ultrasound. 41(4):242-4, 2013
                                                                              19. Sinha CK et al: Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years. Pediatr Surg Int. 29(5):511-7, 2013
                                                                              20. Hegde S et al: MR enterography of perforated acute Meckel diverticulitis. Pediatr Radiol. 42(2):257-62, 2012
                                                                              21. Kotecha M et al: Multimodality imaging manifestations of the Meckel diverticulum in children. Pediatr Radiol. 42(1):95-103, 2012
                                                                              22. Pepper VK et al: Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum. Surg Clin North Am. 92(3):505-26, vii, 2012
                                                                              23. Sun C et al: Intestinal obstruction due to congenital bands from vitelline remnants: sonographic features and review of the literature. J Ultrasound Med. 31(12):2035-8, 2012
                                                                              24. Thirunavukarasu P et al: Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management. Ann Surg. 253(2):223-30, 2011
                                                                              25. Bevernage C et al: Life-threatening lower gastrointestinal bleeding in a 2-year-old boy treated by transcatheter embolization: uncommon features of a complicated Meckel diverticulum. Pediatr Radiol. 40(10):1702-5, 2010
                                                                              26. Durakbasa CU et al: Symptomatic omphalomesenteric duct remnants in children. Pediatr Int. 52(3):480-4, 2010
                                                                              27. Wu YC et al: The 'wandering' Meckel diverticulum: an unusual scintigraphic finding. Pediatr Radiol. 40 Suppl 1:S103, 2010
                                                                              28. Olson DE et al: CT findings in children with Meckel diverticulum. Pediatr Radiol. 39(7):659-63; quiz 766-7, 2009
                                                                              29. Milbrandt K et al: Intussusception associated with a Meckel's diverticulum and a duplication cyst. J Pediatr Surg. 43(12):e21-3, 2008
                                                                              30. Yang JC et al: Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage. Pediatr Radiol. 38(8):909-11, 2008
                                                                              31. Baldisserotto M: Color Doppler sonographic findings of inflamed and perforated Meckel diverticulum. J Ultrasound Med. 23(6):843-8, 2004
                                                                              32. Bennett GL et al: CT of Meckel's diverticulitis in 11 patients. AJR Am J Roentgenol. 182(3):625-9, 2004
                                                                              33. Levy AD et al: From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation. Radiographics. 24(2):565-87, 2004
                                                                              34. Ojha S et al: Meckel's diverticulum with segmental dilatation of the ileum: radiographic diagnosis in a neonate. Pediatr Radiol. 34(8):649-51, 2004
                                                                              35. Rerksuppaphol S et al: Ranitidine-enhanced 99mtechnetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum. Pediatr Surg Int. 20(5):323-5, 2004
                                                                              36. Segal SD et al: Rare mesenteric location of Meckel's diverticulum, a forgotten entity: a case study aboard USS Kitty Hawk. Am Surg. 70(11):985-8, 2004
                                                                              37. Singh MV et al: A fading Meckel's diverticulum: an unusual scintigraphic appearance in a child. Pediatr Radiol. 34(3):274-6, 2004
                                                                              38. Adams BK et al: A moving Meckel's diverticulum on Tc-99m pertechnetate imaging in a patient with lower gastrointestinal bleeding. Clin Nucl Med. 28(11):908-10, 2003
                                                                              39. Baldisserotto M et al: Sonographic findings of Meckel's diverticulitis in children. AJR Am J Roentgenol. 180(2):425-8, 2003
                                                                              40. Danzer D et al: Bleeding Meckel's diverticulum diagnosis: an unusual indication for computed tomography. Abdom Imaging. 28(5):631-3, 2003
                                                                              41. Jelenc F et al: Meckel's diverticulum perforation with intraabdominal hemorrhage. J Pediatr Surg. 37(6):E18, 2002
                                                                              42. Mortele KJ et al: Giant Meckel's diverticulum containing enteroliths: typical CT imaging findings. Eur Radiol. 12(1):82-4, 2002
                                                                              43. Sy ED et al: Meckel's diverticulum associated with ileal volvulus in a neonate. Pediatr Surg Int. 18(5-6):529-31, 2002
                                                                              44. Farris SL et al: Axial torsion of Meckel's diverticulum presenting as a pelvic mass. Pediatr Radiol. 31(12):886-8, 2001
                                                                              45. Neidlinger NA et al: Meckel's diverticulum causing cecal volvulus. Am Surg. 67(1):41-3, 2001
                                                                              46. O'Hara SM: Pediatric gastrointestinal nuclear imaging. Radiol Clin North Am. 34(4):845-62, 1996