On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.100 n.7 Cape Town Jul. 2010
Meckel's diverticulitis revisited
To the Editor: Meckel's diverticulum, a true congenital diverticulum, is a small bulge in the intestine present from birth. It is a vestigial remnant of the original yolk sac or vitello-intestinal duct1 and was originally described by Johann F Meckel in 1809.2,3
I present a case of Meckel's diverticulitis in a 4-year-old boy who presented with overt iron deficiency anaemia. Ferritin levels were low and the peripheral blood showed a hypochromic, microcytic anaemia consistent with an iron-deficient picture. The haemoglobin concentration was 10 g/dl. He had a bright red melaena stool and right iliac abdominal pain. A barium meal showed Meckel's diverticulitis. The Meckel's diverticulum and adjacent ileum were successfully removed surgically.
Meckel's diverticulum is found in 2% of the population, more frequently in males; it is usually 2 foot from the ileocaecal valve and 2 inches in length (the rule of the 2s). The diverticulum usually contains oxyntic cells from gastric mucosa that cause an ulcer giving rise to intestinal bleeding. The diverticulum may contain pancreatic tissue and may obstruct or strangulate in a type of volvulus.
This patient presented with iron deficiency anaemia, but Meckel's diverticulitis can often simulate acute appendicitis. It is generally not necessary to remove Meckel's diverticula found incidentally during surgery for other reasons.4
Hilary Denis Solomons
PO Box 64203
1. Elsayes KM, Menias CO, Harvin HJ, et al. Radiological features of Meckel's diverticulum. AJR Am J Roentgenol 2007; 189: 81-88. [ Links ]
2. Meckel JF. Über die Divertikel am Darmkanal. Archiv für die Physiologie 1809; 9: 421-453. [ Links ]
3. Tiu A, Lee D. An unusual manifestation of Meckel's diverticulum; strangulated paraumbilical hernia. N Z Med J 2006; 119(1236): U2034. [ Links ]
4. Martin JP, Connor PD, Charles K. Meckel's diverticulum and its complications. Am Fam Physician 2000; 61(4): 1037-1042, 1044. [ Links ]