eMedicine Specialties > General Surgery > Abdomen

Meckel Diverticulum: Workup

Author: Nafisa K Kuwajerwala, MD, Staff Surgeon, Breast Oncology, William Beaumont Hospital
Coauthor(s): Yvan J Silva, MD, FRCS(C), FACS, Professor of Surgery, Program Director of Surgery, North Oakland Medical Centers, Wayne State University School of Medicine; Venkata Subramanian Kanthimathinathan, MD, Staff Physician, Department of General Surgery, Loma Linda University Medical Center
Contributor Information and Disclosures

Updated: Aug 19, 2008

Workup

Laboratory Studies

  • A diagnosis of symptomatic or complicated Meckel diverticulum is difficult to confirm on the basis of traditional history, physical examination, and laboratory testing. It is always considered as a differential diagnosis in cases of intestinal obstruction and intestinal hemorrhage. Painless, profuse hematochezia, especially in a child, should alert a clinician to the possibility of such a diagnosis and should prompt further investigation. Thus, in a child, the differential diagnosis for right lower quadrant pain includes appendicitis, acute mesenteric lymphadenitis, intussusception, or Meckel diverticulitis. In an adult, Meckel diverticulum should be entertained in the diagnosis for lower GI bleeding, which would also include angiodysplasias, malignancy, arteriovenous malformations, and other causes.

Imaging Studies

  • Asymptomatic
    • Laparoscopy and laparotomy are the most frequent means by which an incidental diverticulum is found.
    • Upper GI series with small bowel follow-through also detects a diverticulum. The diverticulum appears as a smooth, globular white shadow on the antimesenteric border of the ileum, approximately 50 cm proximal to the ileocecal valve.
  • Symptomatic
    • Technetium Tc 99m-pertechnate radioisotope scanning should be performed in patients with hemorrhage.
      • Premedication with pentagastrin and an H2 receptor blocker enhances diagnosis by this method.
      • Approximately 30 images may be required (at 1-min intervals) to demonstrate activity in the terminal ileum.
    • Superior mesenteric angiography may be helpful in patients presenting with acute GI bleeding and is effective when blood loss exceeds 0.5 mL/min.

More on Meckel Diverticulum

Overview: Meckel Diverticulum
Workup: Meckel Diverticulum
Treatment: Meckel Diverticulum
Follow-up: Meckel Diverticulum
Multimedia: Meckel Diverticulum
References
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References

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Further Reading

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Keywords

Meckel's diverticulum, diverticula, diverticulitis, ulcer, intussusception, Littré hernia, Littre hernia, peritonitis

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Contributor Information and Disclosures

Author

Nafisa K Kuwajerwala, MD, Staff Surgeon, Breast Oncology, William Beaumont Hospital
Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Yvan J Silva, MD, FRCS(C), FACS, Professor of Surgery, Program Director of Surgery, North Oakland Medical Centers, Wayne State University School of Medicine
Yvan J Silva, MD, FRCS(C), FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Venkata Subramanian Kanthimathinathan, MD, Staff Physician, Department of General Surgery, Loma Linda University Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

 
 
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