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# Meckel diverticulum

A small pouch left over from fetal development on the lower small bowel. Most cause no trouble, but some bleed painlessly or block the bowel.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Ileum](https://durgical.com/en/anatomy/ileum/)
- [Cecum](https://durgical.com/en/anatomy/cecum/)
- [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/)
- [Jejunum](https://durgical.com/en/anatomy/jejunum/)

## Why it happens

- [Gastric acid secretion](https://durgical.com/en/physiology/gastric-acid-secretion/)
- [Stomach: gastric glands, parietal and chief cells](https://durgical.com/en/histology/stomach-gastric-glands-parietal-and-chief-cells/)

## What it is

A true diverticulum of the antimesenteric border of the distal [ileum](https://durgical.com/en/anatomy/ileum/), left when the vitelline (omphalomesenteric) duct fails to close. It may contain heterotopic gastric or pancreatic tissue, and it is the most common congenital anomaly of the gastrointestinal tract.

## Who gets it

Present in about 2% of people, and only a small fraction ever have symptoms, most of them children under two years. The classic rule of twos summarises it. In Colombia and Latin America it is a recognised cause of painless rectal bleeding in young children and of intestinal obstruction in surgical practice.

## Causes

- Incomplete obliteration of the vitelline duct, which connects the fetal midgut to the yolk sac
- Ectopic gastric mucosa secreting acid that ulcerates adjacent ileal mucosa
- Related vitelline remnants: fibrous band to the umbilicus, umbilical sinus or fistula

## Risk factors

- Male sex (symptoms more frequent in boys)
- Young age, especially under 2 years
- Presence of heterotopic gastric mucosa

## Pathophysiology

Acid secreted by ectopic gastric mucosa ulcerates the neighbouring ileum, causing painless, sometimes massive, bleeding. The diverticulum can act as a lead point for intussusception, twist around a band to the umbilicus (volvulus), or trap bowel causing obstruction. Obstruction of its neck leads to inflammation that mimics appendicitis.

## Classification

- Rule of twos: about 2% of the population, about 2 feet (60 cm) from the ileocaecal valve, about 2 inches long, 2 types of ectopic tissue (gastric, pancreatic), symptoms often before 2 years

## Symptoms and signs

- Painless rectal bleeding, often brick-red or maroon, in a young child
- Pallor and fatigue from anaemia
- Colicky abdominal pain, vomiting and distension (obstruction or intussusception)
- Periumbilical or right lower abdominal pain and fever (diverticulitis)
- Umbilical discharge from a persistent vitelline remnant
- Often no symptoms at all

## Red flags

- Heavy rectal bleeding with tachycardia or hypotension
- Bilious vomiting and distension (obstruction)
- Signs of peritonitis (perforation)
- Currant-jelly stools with intermittent pain (intussusception)

## Diagnosis

**Clinical**
Suspect in a young child with painless lower gastrointestinal bleeding, or in a child with obstruction and no previous surgery. Assess haemodynamic status first.

**Tests**
Blood count and iron studies for anaemia, blood group and crossmatch, coagulation; stool testing for blood.

**Imaging**
Technetium-99m pertechnetate scan (Meckel scan), which highlights ectopic gastric mucosa, is the key test for bleeding. Ultrasound for intussusception; CT for obstruction or inflammation. Diagnostic laparoscopy when tests are negative but suspicion is high.

## Differential diagnosis

- Juvenile polyp
- Intussusception
- Anal fissure
- Acute appendicitis
- Infectious colitis or inflammatory bowel disease

## Goal of treatment

Stabilise bleeding or obstruction and surgically remove the diverticulum with any ulcerated bowel in symptomatic patients.

## Treatment

**Acute**
Resuscitation for bleeding or obstruction: intravenous access, fluids, transfusion when needed, nil by mouth and gastric decompression.

**Surgical**
Surgical diverticulectomy or segmental ileal resection with anastomosis, by laparoscopy or open surgery.

**Medical**
Treatment of iron deficiency anaemia after bleeding; acid-suppressing drugs may be used while awaiting surgery.

**Conservative**
Incidental asymptomatic diverticula found at surgery may be left or removed depending on features and age (an individual surgical decision).

## Complications

- Massive lower gastrointestinal bleeding
- Intussusception and small bowel obstruction
- Volvulus around a vitelline band
- Diverticulitis and perforation with peritonitis
- Iron deficiency anaemia

## Prognosis

After resection recovery is usually complete and recurrence does not occur. Delayed diagnosis of bleeding or obstruction raises morbidity.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the classic presentation of a symptomatic Meckel diverticulum in a toddler?

Painless rectal bleeding.

## Which embryological structure fails to close in Meckel diverticulum?

The vitelline (omphalomesenteric) duct.

## What scan detects ectopic gastric mucosa in a Meckel diverticulum?

A technetium-99m pertechnetate scan.

## Is a Meckel diverticulum a true or a false diverticulum?

A true diverticulum, containing all layers of the bowel wall.

## On which border of the ileum does a Meckel diverticulum arise?

The antimesenteric border of the distal ileum.

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## Related conditions

- [Intussusception (children)](https://durgical.com/en/conditions/intussusception/)
- [Lower gastrointestinal bleeding](https://durgical.com/en/conditions/lower-gastrointestinal-bleeding/)
- [Acute appendicitis](https://durgical.com/en/conditions/acute-appendicitis/)
- [Small bowel obstruction](https://durgical.com/en/conditions/small-bowel-obstruction/)
- [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/)
- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Meckel diverticulum: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000234.htm) (MedlinePlus (U.S. National Library of Medicine), 2024).

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