What are the key characteristics and management strategies for Meckel's (Meckel's diverticulum) diverticulum, particularly in relation to the rule of 2s?

From the Research

Meckel's diverticulum is a congenital outpouching of the small intestine that follows the "rule of 2s": it affects about 2% of the population, is typically located within 2 feet of the ileocecal valve, is commonly 2 inches in length, often contains 2 types of ectopic tissue (gastric and pancreatic), usually becomes symptomatic before age 2, and affects males 2 times more frequently than females. Management of Meckel's diverticulum depends on whether the diverticulum is symptomatic or asymptomatic. Symptomatic Meckel's diverticulum, which may present with painless rectal bleeding, intestinal obstruction, diverticulitis, or perforation, requires surgical resection, as seen in a case report where a 13-year-old male presented in hemorrhagic shock secondary to an undifferentiated gastrointestinal bleed and was effectively resuscitated and underwent surgical resection of the diverticulum 1.

Key Characteristics

• Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract, resulting from the incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation 2
• It is classically located 2 feet proximal to the ileocecal valve, with variations in location, size, and form recorded 2
• The prevalence of Meckel's diverticulum is reported between 0.3% and 2.9% in the general population, with a male-to-female gender distribution reported up to 4 times more frequent in men 3

Management Strategies

• Symptomatic Meckel's diverticulum requires surgical resection, typically performed via diverticulectomy or segmental resection of the adjacent ileum
• For asymptomatic Meckel's diverticulum discovered incidentally during surgery, management remains somewhat controversial, with asymptomatic diverticula with concerning features (length >2 cm, narrow base, presence of ectopic tissue, or fibrous bands) recommended for removal 3
• Technetium-99m pertechnetate scan (Meckel's scan) is the diagnostic test of choice for detecting ectopic gastric mucosa in suspected cases, with a sensitivity of 85-90% in children but lower in adults 1

Complications

• Complications from a Meckel's diverticulum include diverticulitis, bleeding, intussusception, bowel obstruction, a volvulus, a vesicodiverticular fistula, perforation, or very rarely as a tumor 4
• Ectopic gastric tissue is present in 24.2% to 71.0% of symptomatic Meckel's diverticulum and is associated with hemorrhage, making it essential to consider this in the management of symptomatic cases 3