Objectives

1) Recognise appearances of a typical Meckel’s diverticulum on appropriate radiological imaging.

2) Explore the pathophysiology and demographics of a Meckel’s diverticulum.

3) Understand potential common and rare complications of a Meckel’s diverticulum and their imaging appearances.

Background

Meckel’s diverticulum is a common congenital abnormality in the bowel, which follows the “rule of 2’s” – incident in 2% of the population, presents around 2 years of age, 2 types of tissue, 2 feet from the ileocaecal valve and 2 inches long. Here we present adult imaging findings of a typical Meckel’s diverticulum, a case complicated by diverticulitis and a rare case of an intussuscepting inverted Meckel’s.

Imaging findings OR Procedure findings

1) 18-year-old male with rectal bleeding, cause not found on flexible sigmoidoscopy. CT shows small bowel diverticulum, confirmed as Meckel’s diverticulum on 99m Tc-Sestamibi SPECT/CT study.

2) 76-year-old female with RIF pain. CT shows a fluid-filled blind ending structure in the right iliac fossa with inflammatory stranding and localised perforation. Intra-operative findings and histology revealed an ulcerated and inflamed Meckel’s diverticulum.

3) 60-year-old male with iron deficiency anaemia refractory to treatment. Capsule endoscopy demonstrated a polypoid lesion in the distal small bowel. CT showed a layer of enhancing tissue filled with fat derived from the small bowel mesentery in keeping with a “inverted Meckel’s” (pseudolipoma).

Conclusion

Meckel’s diverticulum and its complications should be kept in mind with those presenting with abnormalities localised to the right iliac fossa. In rare cases an inverted Meckel’s diverticulum can mimic an intraluminal “fatty” polypoid lesion.