During surgical resection for colon cancer, an 8.5-cm diverticulum was found incidentally in a 70-year-old man. The lesion arose from the antimesenteric surface of the terminal ileum; it was located about 2 ft proximal to the ileocecal junction. Palpation of the diverticulum revealed a hard mass at its tip and a thickened wall at its base. Meckel diverticulum was diagnosed. Dr Virendra Parikh of Fort Wayne, Ind, writes that Meckel diverticulum is a congenital defect that arises when the proximal portion of the vitelline duct, which connects the midgut of the embryo and the yolk sac, fails to atrophy. The sacculation occurs on the antimesenteric border of the ileum, 60 cm proximal to the ileocecal valve. Heterotopic tissue, most commonly gastric or pancreatic mucosa, may be present in the diverticulum. The “rule of 2” applies to Meckel diverticula.1 These lesions:
- Are twice as prevalent in men as in women.
- Occur in 2% of the total population.
- Cause symptoms in 2% of those affected.
- Arise approximately 2 ft proximal to the ileocecal valve.
- May extend more than 2 inches in length.
- May contain 2 types of mucosa.
- Can cause 2 types of symptoms—bleeding and obstruction.
Diverticulitis, which can mimic acute appendicitis, can occur in up to 20% of patients.1 The patient underwent colon resection and segmental ileal resection and anastomosis, which included the Meckel diverticulum. The histologic examination revealed an enterolith (fecal concretion) at the tip of the diverticulum and gastric mucosa at its base.