Meckel’s Diverticulum with Covered Perforation – A Rare Sonographic Diagnosis in Elderly Adults with Acute Abdomen

Introduction

Meckel’s diverticulum is the result of an incomplete obliteration of the vitelline duct, which joins the yolk sac to the midgut lumen and is typically obliterated during the sixth week of gestation. It’s considered the most common congenital anomaly of the gastrointestinal tract, affecting 2 % of the general population. It is a true diverticulum, located in the distal ileum and consisting of all layers of the bowel wall. The distance between the diverticulum and the ileocecal valve changes with increasing age, from an average distance of 34 cm in children (< 2 years) to an average distance of 67 cm in adults. Only 4 % of people with Meckel’s diverticulum develop complications (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006). Most complications occur in patients under the age of 2. Further predisposing factors are male sex (male: female = 3:1), diverticulum length of more than 2 cm and ectopic tissue in the diverticulum wall. Heterotopic gastric mucosa is present in 50 % of all Meckel’s diverticula, pancreatic mucosa is encountered in approximately 5 % of diverticula, and colonic mucosa is present on rare occasions (Chandramohan K et al. Gastrointestinal stromal tumour in Meckel’s diverticulum; World Journal of Surgical Oncology 2007, 5: 50). The most common clinical presentations of the Meckel’s diverticulum in adults are intestinal obstruction (22–50 %) and diverticulitis (20 %).Bleeding is less common. In children the most frequent complication is hemorrhage (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006).