Table of Contents  
Year : 2012  |  Volume : 5  |  Issue : 1  |  Page : 54-59  

Imaging findings in inflammed Meckel's diverticulum

Department of Radio-Diagnosis, Padmashree Dr. D. Y. Patil Medical College, Pune, Maharashtra, India

Date of Web Publication20-Jun-2012

Correspondence Address:
Abhijeet Patil
501, Vikas Paradise, LBS Road, Mulund (W), Mumbai - 400 080
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-2870.97514

Rights and Permissions

Meckel's diverticulum is congenital abnormality of gastrointestinal tract. It is generally accepted that the radiological demonstration of a Meckel's diverticulum is not practicable. But when there is associated complications with Meckel's diverticulum it becomes relatively easy. Abdominal radiograph does not provide any information but USG and CT features are helpful in diagnosing however the single most accurate diagnostic test for a Meckel's diverticulum is scintigraphy.

Keywords: Gastrointestinal tract, imaging, Meckel′s diverticulum

How to cite this article:
Patil A, Kulkarni V, Naware S. Imaging findings in inflammed Meckel's diverticulum. Med J DY Patil Univ 2012;5:54-9

How to cite this URL:
Patil A, Kulkarni V, Naware S. Imaging findings in inflammed Meckel's diverticulum. Med J DY Patil Univ [serial online] 2012 [cited 2021 Dec 6];5:54-9. Available from:

  Introduction Top

Meckel's diverticulum is congenital abnormality of gastrointestinal tract. Theappearance on imaging is variable and non-specific. It is generally accepted that the radiological demonstration of a Meckel's diverticulum is not practicable. [1]

  • Caffey (1945) states that "It cannot be satisfactorily demonstrated Roentgen graphically."
  • Potts (1948) wrote "Roentgen logic examination is valueless except in those very rare instances in which barium is given by mouth and by rare good fortune a film happened to be taken at the right time to show an accumulation in the diverticulum. I have never had the good fortune to see one demonstrated Roentgen graphically."

  Case Report Top

A 6-year-old boy presented with pain in periumbilical region of abdomen associated with 7-8 episodes of vomiting and constipation since 4 days. Intermittent fever was since 2 days. Per abdominal examination revealed guarding with right iliac fossa tenderness. On auscultation bowel sounds were absent.

Laboratory results showed raised leukocyte count and which was 13,000 and Hemoglobin was 12.5 gm/dl.

The plain abdominal radiograph [Figure 1] showed multiple loops filled with gas but non-specific diagnostic features with no obvious signs of intestinal obstruction.
Figure 1: Erect abdominal radiograph

Click here to view

Abdominal ultra sonography was carried out on Siemen's Acuson X300 machine. It revealed abnormal hypoechoic cystic swelling seen superficially near anterior abdominal wall close to umbilicus [Figure 2]. It measures 3 × 2.5 cm in size with soft echoes within it. Pericystic lesion reveals fat stranding suggestive of chronic inflammation.
Figure 2: Ultrasonographic image in the transverse plane at the right peri-umbilical region

Click here to view

This cystic structure is attached to small bowel loop which is dilated and shows no peristalsis [Figure 3]. Minimal free fluid is seen in the pelvis. Marked probe tenderness is noted in the cystic lesion.
Figure 3: Ultrasonographic image in the longitudinal plane in the right peri-umbilical region

Click here to view

CT performed on GE duo FII scanner without oral and intravenous contrast. Abnormal cystic lesion noted in the right peri-umbilical region which is abutting the anterior abdominal wall merging with adjacent small bowel loop [Figure 4] and [Figure 5]. This loop contains fluid within it with stranding of mesenteric fat [Figure 6]. No pneumoperitoneum, no intestinal obstruction seen.
Figure 4: Axial CT image revealing the hypodense lesion

Click here to view
Figure 5: Axial CT image revealing the hypodense lesion abutting the anterior abdominal wall

Click here to view
Figure 6: Axial CT image revealing the hypodense lesion in close approximation with bowel loops

Click here to view

An inflamed Meckel's diverticulum was excised at laparotomy [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], and [Figure 12].
Figure 7: Intra-operative image revealing diverticulum like mass which is attached to the anterior abdominal wall

Click here to view
Figure 8: Intra-operative image showing Meckel's diverticulum

Click here to view
Figure 9: Intra-operative image revealing Meckel's diverticulum with fibrous septa extending to small bowel loops

Click here to view
Figure 10: Intra-operative image revealing Meckel's diverticulum with fibrous septa extending to small bowel loops

Click here to view
Figure 11: Post-operative image of the specimen of Meckel's diverticulum

Click here to view
Figure 12: Post-operative image of the specimen of Meckel's diverticulum

Click here to view

  Discussion Top

Meckel's diverticulum is the consequences of incomplete regression of the omphalomesenteric duct. The omphalomesenteric duct in the embryo serves as a communication between the gut and the yolk sac. Obliteration of the duct occurs gradually between the fifth and seventh week, as placental nutrition becomes established. The duct may persist as a fistula between the small bowel and the abdominal wall [Figure 13]A, as a fibrous cord connecting the small bowel with the abdominal wall [Figure 13]B, as a Meckel's diverticulum [Figure 13]C, on as an umbilical sinus [Figure 13]D. Meckel's diverticulum opens into the anti-mesenteric side of the small intestine. This is a differential feature from duplications of small bowel which arise on the mesenteric side of the small intestine. [1]
Figure 13: Omphalomesenteric duct abnormalities. (A) Persistent duct. (B) Fibrous cord remnant. (C) Meckel's diverticulum. (D) Umbilical sinus

Click here to view

Clinical Presentation

Meckel's diverticulum can cause symptoms at any age; however, about 50% of the patients come to the hospital in the first 2 years of life. [2]

Complications of Meckel's diverticulum develop in approximately 2.5% of the cases and include inflammation, peptic ulceration with hemorrhage on perforation, intussusceptions, and volvulus about the fibrous cord. Neoplasia has also been reported. [3]

Patients with Meckel's diverticulum may have different symptoms. Gastrointestinal bleeding secondary to peptic ulceration is the most common. The bleeding is copious and usually not accompanied by abdominal pain. The stool may at first be dark or black, but subsequently is bright red. Abdominal pain is the second most common clinical presentation and may be secondary to Meckel's diverticulitis, sealed off perforation with abscess formation, on recurrent intussusceptions with spontaneous reductions [Table 1]. Small bowel obstruction is caused by intussusceptions, volvulus, mechanical obstruction about a persistent cord, or internal hernia through the mesentery of a Meckel's diverticulum. [4] Perforation of a diverticulum has also been reported following blunt abdominal trauma, on penetration of a foreign body-most commonly fish bones-through the wall of the diverticulum. [5]
Table 1: Clinical features of Meckel's diverticulum

Click here to view

Carcinoid tumors within a Meckel's diverticulum have been associated with the Carcinoid syndrome. [5]

Complications and Pathology [3]

Meckel's diverticulum assumes importance chiefly through its liability to various complications, and these have been described between the ages of 5 h and 77 years [Table 2].
Table 2: Complications of Meckel's diverticulum

Click here to view

  1. Acute inflammation. This may lead to local abscess formation, gangrene, perforation and peritonitis.
  2. Acute intestinal obstruction may occur, following strangulation of the bowel by a fibrous or vascular cord from the sac to the umbilicus. Sometimes the tip of the sac is adherent to some other viscous and traps the intestines. If there is twisting of the bowel, volvulus may occur.
  3. Intussusception caused by an invaginated diverticulum is well recognized, and is said to cause between 2.5 to 5 per cent of all intussusceptions. This is said to be commoner in children between 3 and 12 years.
  4. Hemorrhage is a frequent finding; this is usually the result of a peptic ulcer, often chronic, in the secreting gastric mucosa, and a small eroded artery in this region.
  5. New growths are rare, but many different types are recognized. Of benign tumors, lipoma, myoma, neuroma, papilloma, Carcinoid tumor, leiomyoma and argentaffin tumors.
  6. Tuberculosis of a Meckel's diverticulum, with perforation and generalized peritonitis is recorded
  7. Region ileitis affecting the diverticulum.
  8. In a review of foreign body perforations of the diverticulum, majority are caused by fish bones.
  9. Miscellaneous. Intra-uterine perforation into the bladder, forming a fistula. Perforation of a diverticulum, presenting as a unilateral hydrocele, acute diverticulitis with round worms in the peritoneal cavity , a Meckel's diverticuloappendiceal fistula and calcium carbonate faecoliths.
Imaging Diagnosis

Diagnosis of Meckel's diverticulum radiological may be difficult. [6]

Plain Abdominal Radiographs: Plain abdominal radiographs may reveal non-specific signs of intestinal obstruction. [6] Inflammation in a Meckel's diverticulum, unlike appendicitis, rarely produces gas and fluid levels in the caecum. A rare non-specific sign is the association of enteroliths within the diverticulum and air-fluid levels. [6]

Barium Studies: The conventional small-bowel series has often been considered unreliable for the detection of Meckel's diverticulum because the technique has some inherent limitations. The diverticulum can occasionally be diagnosed by reflux of barium during a colon enema; however, the colon barium enema is not used as a primary imaging method to make the diagnosis of Meckel's diverticulum. [7]

Enteroclysis: It is considered by some authors a better technique than the conventional barium follow-through studies in diagnosing small bowel disease and Meckel's diverticulum. [8] With this technique, it is possible to obtain consistent, moderate distension of bowel segments that are suspected to be abnormal. The confirmation of the Meckel's origin of the diverticulum rests on the visualization of its fold patterns, especially at the site of its attachment to the normal intestine. A "triradiate" fold pattern in which the loops are collapsed and a "mucosal triangular plateau" in which the loops are distended are the junction fold appearances that are considered characteristic. [7] A gastric rugal pattern may also be identified within the diverticulum. [7]

Sonography: Meckel's diverticulum can be identified on sonography in cases of complications. In cases of an obstructed and fluid-filled diverticulum, sonography may show a tubular over distended fluid structure connected to the umbilicus. [9]

CT: It is usually of little value in diagnosing Meckel's diverticulum because distinction between a diverticulum and intestinal loops is usually impossible. If the diverticulum is attached to the umbilicus, the diagnosis may be suspected on CT scans. [9],[10]

Nuclear Medicine: Radionuclide scans may provide a diagnosis of Meckel's diverticulum when uptake of radionuclide occurs in ectopic gastric mucosa or by identifying the site of gastrointestinal bleeding. 99 m Tc pertechnetate is preferentially taken up by the mucus-secreting cells of gastric mucosa and ectopic gastric tissue in the diverticulum. [11],[12]

Angiography: In patients with Meckel's diverticulum, arteriography is usually indicated when there is active bleeding in the gastrointestinal tract, or in episodes of self-limiting bleeding, after scintigraphy and Enteroclysis show normal findings. Bleeding at a rate of at least 0.5 ml/min is generally required in adults to demonstrate contrast extravasations; a greater rate of bleeding may be necessary to detect this finding in children. [13] The angiographic diagnosis is based on visualization of an anomalous artery feeding the diverticulum, the presence of dense capillary staining, and extravasations of contrast material in actively bleeding patients. Selective superior mesenteric arteriography can be done. The arterial, capillary, and venous phases and the mucosal blush must be accurately studied.

  Conclusion Top

Imaging-based diagnosis of Meckel's diverticulum is difficult. However, when there is associated complication, it becomes relatively easy. USG and CT are helpful in diagnosing however the single most accurate diagnostic test for a Meckel's diverticulum is scintigraphy with sodium 99 mTc pertechnetate which has the advantage of being noninvasive.

  References Top

1.White AF, O KS, Weber AL, James AE Jr. Radiological manifestations of Meckel's diverticulum. Am J Roentgenol Radium Ther Nucl Med 1973;118:86-94.  Back to cited text no. 1
2.Pantongrag-Brown L, Levine MS, Buetow PC, Buck JL, Elsayed AM. Meckel's enteroliths: Clinical, radiologic, and pathologic findings. AJR Am J Roentgenol 1996;167:1447-50.  Back to cited text no. 2
3.Tainsh CL, Medhurst E. The demonstration and pathology of Meckel's diverticulum with report of a case. AJR Am J Roentgenol 1955;28:351-8.  Back to cited text no. 3
4.Groebli Y, Bertin D, Morel P. Meckel's diverticulum in adults: Retrospective analysis of 119 cases and historical review. Eur J Surg 2001;167:518-24.  Back to cited text no. 4
5.Hol L, Kuipers EJ. Clinical challenges and images in GI. Meckel's diverticulum. Gastroenterology 2007;133:392, 732.  Back to cited text no. 5
6.Athey GN. Unusual demonstration of a Meckel's diverticulum containing enteroliths. Br J Radiol 1980;53:365-8.  Back to cited text no. 6
7.Rossi P, Gourtsoyiannis N, Bezzi M, Raptopoulos V, Massa R, Capanna G, et al. Meckel's Diverticulum: Imaging Diagnosis. AJR Am J Roentgenol 1996;166:567-73.  Back to cited text no. 7
8.Maglinte DD, Elmore MF, Isenberg M, Dolan PA. Meckel diverticulum: Radiologic demonstration by enteroclysis. AJR Am J Roentgenol 1980;134:925-32.  Back to cited text no. 8
9.Johnston AT, Khan AL, Bleakney R, Keenan RA. Stromal tumour within a Meckel's diverticulum: CT and ultrasound findings. Br J Radiol 2001;74:1142-4.  Back to cited text no. 9
10.Hughes JA, Hatrick A, Rankin S. Computed tomography findings in an inflamed Meckel diverticulum. Br J Radiol 1998;71:882-3.  Back to cited text no. 10
11.Omar AM, Al-Saee'd TA, Elgazzar A. Scintigraphic pattern of intestinal duplication on a Meckel's diverticulum scan. Clin Nucl Med 1998;23:708-9.  Back to cited text no. 11
12.Swaniker F, Soldes O, Hirschl RB. The utility of technetium 99 m pertechnetate scintigraphy in the evaluation of patients with Meckel's diverticulum. J Pediatr Surg 1999;34:760-5.  Back to cited text no. 12
13.Mitchell AW, Spencer J, Allison DJ, Jackson JE. Meckel's diverticulum: Angiographic findings in 16 patients. AJR Am J Roentgenol 1998;170:1329-33.  Back to cited text no. 13


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]

  [Table 1], [Table 2]

This article has been cited by
1 Subacute Meckel’s diverticulum perforation
Alberto Robles Méndez Hernández,Oscar Alejandro Mora-Torres,Hugolino Andrade Lopez,Jorge Alfonso Perez Castro Y Vazquez
BMJ Case Reports. 2021; 14(3): e237840
[Pubmed] | [DOI]
2 The morphological characteristics of the Meckel’s diverticulum of pre-hatch and post-hatch broiler chicken
Anietie Francis Udoumoh,Innocent Chima Nwaogu,Udensi Maduabuchi Igwebuike,Ikechukwu Reginald Obidike
Comparative Clinical Pathology. 2019;
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
  Case Report
   Article Figures
   Article Tables

 Article Access Statistics
    PDF Downloaded461    
    Comments [Add]    
    Cited by others 2    

Recommend this journal