ARRS 2022 Abstracts

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E2010. Meckel Diverticulitis: Educational Overview of Anatomy, Pathophysiology, Radiographic Imaging, and Techniques
Authors
  1. Zachary Aulgur; AdventHealth
  2. Midhir Patel; AdventHealth
  3. Daniel Malek; AdventHealth
  4. Andrew Dakkak; AdventHealth
  5. Matthew Burger; AdventHealth
Background
Meckel diverticulitis is an inflammatory process of Meckel’s diverticulum, an embryonic remnant of vitelline duct present in up to nearly 3% of the population. Meckel’s diverticulum is more common in males, has a close proximity to the ileocecal valve, and most patients are asymptotic. However, as many as 40% of individuals with Meckel’s diverticulum may have complications, of which, diverticulitis accounts for about 30% of symptomatic cases. Certain radiographic features are crucial to identifying Meckel diverticulitis. Early identification is critical to guide treatment including resection of complicated Meckel’s diverticulum after inflammation subsides.

Educational Goals / Teaching Points
The goals of this exhibit are to review the pathophysiology of Meckel diverticulitis; discuss common clinical presentations and management of Meckel diverticulitis; and discuss imaging techniques and radiographic findings of Meckel diverticulitis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Meckel diverticulitis often mimics appendicitis, given its close proximity to the ileocecal valve and clinical presentation of right lower quadrant abdominal pain. Visualization of a normal appendix is an important diagnostic feature. First-line imaging modality is CT, which often shows signs of inflammation including soft tissue stranding, mural thickening, and contrast enhancement surrounding an outpouching in the small intestine. In children, where symptomatic Meckel diverticulitis may be more common, ultrasound and Tc-99m pertechnetate scintigraphy is a useful modality. Ultrasound findings include irregular thickened hyperechoic internal bowel walls and hypoechogenic external walls. Tc-99m pertechnate often aids in the diagnosis of an underlying Meckel diverticulum, as the radiotracer is actively taken up into ectopic gastric mucosa found in Meckel’s diverticulum.

Conclusion
Meckel diverticulitis can present with characteristic imaging findings. Correct imaging techniques and radiographic identification are crucial for treatment. Given the prevalence and rate of complications of Meckel diverticulitis, it is important to be aware of this entity that can mimic other common pathologies.