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Pediatric Meckel Diverticulum

  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Carmen Cuffari, MD  more...
Updated: Nov 17, 2015


Meckel diverticulum (also referred to as Meckel's diverticulum) is the most common congenital abnormality of the small intestine; it is caused by an incomplete obliteration of the vitelline duct (ie, omphalomesenteric duct). Although originally described by Fabricius Hildanus in 1598, it is named after Johann Friedrich Meckel, who established its embryonic origin in 1809.[1]

Despite the availability of modern imaging techniques, diagnosis is challenging. Although Meckel diverticulum is usually of no medical significance, two types of complications can require clinical attention. One type involves ectopic mucosal tissue and most often leads to GI bleeding in younger children. In the second type, the sequelae lead to an obstruction, inflammation, or rarely perforation of the bowel.



Early in embryonic life, the fetal midgut receives its nutrition from the yolk sac via the vitelline duct. The duct then undergoes progressive narrowing and usually disappears by 7 weeks' gestation. When the duct fails to fully obliterate, different types of vitelline duct anomalies appear. Examples of such anomalies include (1) a persistent vitelline duct (appearing as a draining fistula at the umbilicus); (2) a fibrous band that connects the ileum to the inner surface of the umbilicus; (3) a patent vitelline sinus beneath the umbilicus; (4) an obliterated bowel portion; (5) a vitelline duct cyst; and, most commonly (97%) Meckel diverticulum, which is a blind-ending true diverticulum that contains all of the layers normally found in the ileum.[2] The tip of the diverticulum is free in 75% of cases and is attached to the anterior abdominal wall or another structure in the remainder of cases.

Enterocystomas, umbilical sinuses, and omphaloileal fistulas are among the other congenital anomalies associated with Meckel diverticulum.

The diverticulum is usually supplied by the omphalomesenteric artery (a remnant of the vitelline artery), which arises from the ileal branch of the superior mesenteric artery. Usually, the artery terminates in the diverticulum; however, it has been reported to continue up to the abdominal wall in some cases. Rarely, these blood vessels persist in the form of fibrous remnants that run between the Meckel diverticulum and the abdominal wall or small bowel mesentery.

The Meckel diverticulum is almost always found on the antimesenteric border of the ileum, usually 40-60 cm proximal to the ileocecal valve. On average, the diverticulum is 3 cm long and 2 cm wide. Slightly more than one half contain ectopic mucosa. Meckel diverticulum is typically lined by ileal mucosa, but other tissue types are also found with varying frequency.

Although Meckel diverticulum almost always occurs on the antimesenteric border of the ileum, case reports have described a mesenteric location. As per the rule of 2s, it is usually 2 feet (40-60 cm) proximal to the ileocecal valve, 2 cm wide (and is 3 cm long), found in 2% of the population,[3] often presents before age 2 years, is twice as likely to be symptomatic in boys, and contains ectopic mucosa about half the time. Meckel diverticulum is typically lined by ileal mucosa, but other tissue types are also found with varying frequency.

The heterotopic mucosa is most commonly gastric. This is important because peptic ulceration of this or adjacent mucosa can lead to painless bleeding, perforation, or both. In one study, heterotropic gastric mucosa was found in 62% of cases, pancreatic tissue was found in 6%, both pancreatic tissue and gastric mucosa were found in 5%, jejunal mucosa was found in 2%, Brunner tissue was found in 2% and both gastric and duodenal mucosa were found in 2%.[2] Rarely, colonic, rectal, endometrial, and hepatobiliary tissues have been noted.




United States

The prevalence of Meckel diverticulum is usually noted to be approximately 2% of the population,[3] but published series range from 0.2-4%.[4] Complications are only seen in about 5% of those with the anomaly. In a comprehensive survey of 43 children's hospitals in the United States, 815 children had a Meckel diverticulectomy during a 2-year span. Slightly more than half (60%) were symptomatic and the remainder were incidental in children who had laparotomy for a different reason.[5]


Prevalence figures similar to those found in the United States have been reported in Europe and Asia.


See Complications.


One study investigated the Pediatric Hospital Information System (PHIS) database to identify demographics of patients with ICD-9 diagnoses of Meckel diverticulum and a procedure code for Meckel diverticulectomy. Data from a 9-year period (2004-2012) was analyzed for age, payor, ethnicity and symptoms. The database included patients admitted to 44 children’s hospitals in the United States. The ethnic distribution of symptomatic Meckel diverticulum was 63.4% white, 4.7% African-American, 16.4% Hispanic, 3.9% Asian, and 11.6% other.[6]


Although no sex-based difference was reported in studies that evaluated this condition as an incidental finding during operations or autopsies, males are as much as 3-4 times more prone to complications than females. In a large series of cases from 2007-2008, Meckel diverticulectomy was 2.3 times more common in boys and boys accounted for 74% of the primary cases.[5]


The classic presentation in children is considered to be painless rectal bleeding in a toddler younger than 2 years. One large series found that 53% had surgery before their fourth birthday. However, the largest group (slightly more than 30%) were younger than one year.[5] Although most other pediatric cases occur in patients aged 2-8 years, many continue to present with hematochezia.

Although children usually present with hematochezia and adults usually present with obstruction, the same recent series of 815 children found that a primary diverticulectomy was performed in 30% of the children (< 18 y) for obstruction while 27% presented with bleeding and 19% had intussusception.[5] About one quarter did not have a clear cut diagnosis. Although neonatal presentation of Meckel is rare, case reports have described perforation, intussusception, segmental ileal dilation, ileal volvulus, and massive hematochezia.[5]

A recent literature review of Meckel Diverticulum in the neonatal period found that the most common manifestations in this age were bowel obstruction (58.3%) and pneumoperitoneum (33.3%). In addition, in both term and preterm neonates, males were even more frequently affected than females, with a male-to-female ratio of 6.5:1.

In adults, obstruction and inflammation are more common presentations than lower GI bleeding. Several population-based studies have reported a decreased incidence of complications with increasing age, although other studies have not. Therefore, the issue of incidental diverticulectomy in older patients remains controversial.

Contributor Information and Disclosures

Simon S Rabinowitz, MD, PhD, FAAP Professor of Clinical Pediatrics, Vice Chairman, Clinical Practice Development, Pediatric Gastroenterology, Hepatology, and Nutrition, State University of New York Downstate College of Medicine, The Children's Hospital at Downstate

Simon S Rabinowitz, MD, PhD, FAAP is a member of the following medical societies: American Gastroenterological Association, American Academy of Pediatrics, Phi Beta Kappa, American Association for the Advancement of Science, American College of Gastroenterology, American Medical Association, New York Academy of Sciences, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Sigma Xi

Disclosure: Nothing to disclose.


Neha Ahuja, MD Resident Physician, Department of Pediatrics, Richmond University Medical Center

Neha Ahuja, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Eric S Maller, MD 

Eric S Maller, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Society of Transplant Surgeons, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Sally Kenawy, MD Resident Physician, Department of Pediatrics, State University of New York Downstate Medical Center

Sally Kenawy, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Prem Shukla, MD; Pauline Mills, MD; Madhavi Katturupalli, MD; and Hongye Li, MD, to the development and writing of this article. The authors would also like to thank Dori Harasek for her assistance in the preparation of this article.

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Anteroposterior view of abdominal radiograph showing multiple dilated loops of a small bowel with air-fluid levels.
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