Meckel Diverticulitis

RLQ Pain in 54 M • Xray of the Week

This 54 year old male presented to the Emergency Department with right lower quadrant pain and vomiting. What is the diagnosis?

Axial CT with contrast. There is a thick-walled diverticulum arising from the distal ileum with surrounding mesenteric edema, and mural enhancement diagnostic of Meckel diverticulitis. (blue arrow)

Discussion

Present in 2% of the population, Meckel diverticulum forms as a result of incomplete closure of the intestinal end of the omphalomesenteric duct, and is present within 40–100 cm of the ileocecal valve. The total lifetime complication rate of a Meckel diverticulum is approximately 4%. Complications include intestinal obstruction (40%) and diverticulitis (20%), torsion, intussusception, and hemorrhage. The symptoms are non specific and are most commonly attributed to appendicitis. CT scan demonstrates an inflamed diverticulum in the RLQ or midline with a normal appendix. The diverticulum may contain calcified enteroliths. Treatment is surgical excision.

References:

1. Bennett GL, Birnbaum BA, Balthazar EJ. CT of Meckel's diverticulitis in 11 patients. AJR Am J Roentgenol. 2004;182 (3): 625-9. AJR Am J Roentgenol (full text)

2. Wong CS, Dupley L, Varia HN, Golka D, Linn T. Meckel's diverticulitis: a rare entity of Meckel's diverticulum. J Surg Case Rep. 2017;2017(1):rjw225. Published 2017 Jan 6. doi:10.1093/jscr/rjw225

3.Thurley PD, Halliday KE, Somers JM et-al. Radiological features of Meckel's diverticulum and its complications. Clin Radiol. 2009;64 (2): 109-18. DOI: https://doi.org/10.1016/j.crad.2008.07.012

4. Milam RA, Fonseca RB. Case 240: Meckel Diverticulitis. Radiology 2017; 283:303–307 https://pubs.rsna.org/doi/full/10.1148/radiol.2017150885

5. Elsayes KM, Menias CO, Harvin HJ et-al. Imaging manifestations of Meckel's diverticulum. AJR Am J Roentgenol. 2007;189 (1): 81-8.

6. Kotha VK, Khandelwal A, Saboo SS, et al. Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol. 2014;87(1037):20130743. doi:10.1259/bjr.20130743

7. Platon A, Gervaz P, Becker CD, Morel P, Poletti PA. Computed tomography of complicated Meckel's diverticulum in adults: a pictorial review. Insights Imaging. 2010;1(2):53–61. doi:10.1007/s13244-010-0017-8

Kevin M. Rice, MD is the president of Global Radiology CME

Dr. Rice has served in many leadership positions; he has been the Chair of the Radiology Department and Chief of Staff of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances and given as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD

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