Meckel's diverticulum pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

The vitelline duct or the omphalomesenteric duct is the connection between the midgut and the yolk sac responsible for providing nutrition to the midgut, during fetal development. The vitelline duct subsequently undergoes involution, in the period between the fifth and the sixth weeks of gestation while the intestinal loop is rapidly pulled into the abdominal cavity. Failure of duct involution may lead to persistence of the proximal portion of omphalomesenteric duct, which may be referred to as the Meckel's diverticulum. The Meckel’s diverticulum is a true diverticulum (comprising of all layers of intestinal wall i.e. mucosa, submucosa and muscularis propria). It arises from the antimesenteric border of the ileum and extends into the umbilical cord. The blood supply comes from the vitelline artery, which is a branch of the superior mesenteric artery, prone to torsion, ischemia, infarction, and obstruction. The diverticulum may contain ectopic tissue due to the presence of a pluripotent cell lining, faulty association between endodermal and neural crest cells and absence of inhibitory effect of the mesoderm on the local endoderm.

Pathophysiology

Meckel's diverticulum
Source: Wikimedia commons [1]

Genetics

  • There is some evidence to suggest a familial association with the development of Meckel's diverticulum, but this has not been adequately explored.[10]

Associated Conditions

Gross Pathology

  • On gross pathology, the features of Meckel's diverticulum are as follows:
  • Location:
  • Appearance:
    • Small pouch or a blind segment
  • Length:
    • Variable, from less than 1cm to 8cm
  • Size:

Microscopic Pathology

Meckel's diverticulum with gastric heterotopic cell rests
Source: Wikimedia commons [13]

References

  1. "File:Diverticule de Meckel.jpg - Wikimedia Commons".
  2. "Fundamentals of Pediatric Surgery - Second Edition | Peter Mattei | Springer".
  3. "The Developing Human - 9th Edition".
  4. 4.0 4.1 "Robbins and Cotran Pathologic Basis of Disease, Professional Edition - 8th Edition".
  5. Tiu A, Lee D (2006). "An unusual manifestation of Meckel's diverticulum: strangulated paraumbilical hernia". N. Z. Med. J. 119 (1236): U2034. PMID 16807577.
  6. Garg D, Singh AP, Kothari S, Kumar A (2017). "Urachal Cyst, Meckel's Diverticulum and Band, and Urachus". APSP J Case Rep. 8 (1): 8. doi:10.21699/ajcr.v8i1.477. PMC 5253616. PMID 28164005.
  7. Simms MH, Corkery JJ (1980). "Meckel's diverticulum: its association with congenital malformation and the significance of atypical morphology". Br J Surg. 67 (3): 216–9. PMID 7362966.
  8. Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL (2001). "Meckel's diverticulum". J. Am. Coll. Surg. 192 (5): 658–62. PMID 11333103.
  9. Elsayes KM, Menias CO, Harvin HJ, Francis IR (2007). "Imaging manifestations of Meckel's diverticulum". AJR Am J Roentgenol. 189 (1): 81–8. doi:10.2214/AJR.06.1257. PMID 17579156.
  10. Lajarrige C, Druon D, Gruss R, Delepierre A, Aina E, Chaqchaq A, Kremp L (1989). "[3 cases of Meckel's diverticulum in the same family]". Presse Med (in French). 18 (39): 1930. PMID 2531871.
  11. "Meckel's Diverticulum".
  12. "Meckel's Diverticulum".
  13. "File:Meckel's diverticulum with ectopic gastric mucosa and perforation, HE 1.jpg - Wikimedia Commons".



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