Fact-sheet: Meckel diverticulum


Updated on 04/07/2026 at 8:43 AM

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Definition

Congenital diverticulum of the terminal ileum secondary to incomplete resorption of the omphalomesenteric duct, which connects the primitive intestinal loop to the yolk sac during embryonic life, described by JF Meckel in 1809.

Implanted on the antimesenteric border of the ileum, unlike intestinal duplications.

Can occur in several forms: isolated ligament, omphalomesenteric sinus, omphalomesenteric cyst, umbilico-ileal fistula, diverticulum with or without a fibrous band.

Ileal-type mucosa, but ectopic elements in 50% of cases (gastric++ with metaplasia, pancreatic, or duodenal).

Clinical features

Most common congenital anomaly of the gastrointestinal tract: prevalence =2-4%, usually asymptomatic.

Symptomatic in approximately 4-5% of cases in the form of complications:

  • inflammatory: perforation, diverticulitis.
  • obstructive, more common in children: ileo-ileal intussusception or enterolithiasis.
  • tumoral (rare), more common in adults: carcinoid tumors, stromal tumors.

Laboratory findings

Unremarkable in the absence of complications.

Radiography

Small bowel enteroclysis. Abdominal compression during enteroclysis.

Blind-ending sac on the antimesenteric border of the ileum with a wide base or narrow neck.

Inverted Meckel diverticulum (20% of cases): Solitary, elongated intraluminal mass with smooth margins, often club-shaped, parallel to the long axis of the distal ileum

Ultrasound

Difficult diagnosis.

Second appendix-like image, but arising from the terminal ileum.

Small bowel obstruction due to intussusception of an inverted diverticulum:
classic target and sandwich sign at the last loop, sparing the cecum.

CT

The Meckel diverticulum is located <60 cm from the ileocecal valve: 4-10 cm blind-ending sac on the antimesenteric side of the distal ileum.

Diverticulitis: Inflammation, regional infiltration with variable degree of complication (similar to colonic diverticulum: extraluminal air, abscess) Obstruction due to a diverticular band: blind-ending digestive structure connected to a small bowel loop, which encircles both the last loop and other small bowel loops with upstream dilation. Obstruction due to ileo-ileal intussusception of an inverted diverticulum: target/sandwich sign of the last loop with upstream dilation Enterolith: small bowel calculus without other signs of gallstone ileus (no pneumobilia) Littré hernia: herniation of the Meckel diverticulum into a hernial orifice (inguinal ++) Neoplasia: very rare, revealed by a complication, tissue thickening

Nuclear medicine

99mTc-pertechnetate scintigraphy, looking for ectopic gastric mucosa and lower gastrointestinal bleeding

Management

Rarely discovered in the absence of complications.

Imaging recommendations: CT if pain. Scintigraphy if gastrointestinal bleeding

Treatment: Resection.

Differential diagnosis

  • Duplication cyst, but implantation on the mesenteric border of the ileum
  • Appendicitis
  • Crohn disease
  • Mesenteric lymphadenitis and enteritis
  • Cecal diverticulitis