<prompt> What is false about Meckels diverticulitis?Present in 3 of the populationPresents with periumbilical painRemnant of proximal part of vitellointestinal ductLies on the anti-mesenteric border  <response>: Ans. a. Present in 3 of the population Ref: Sabiston 19e p1268-1270; Schwartz 9e p1002-1004, 1435; Bailey 26e p1169-1170, 25e p1158-1159; Shackelford 7e p695-698Meckels diverticulum is present in 2 of the population and not 3.A Meckels diverticulum is a persistent remnant of the vitellointestinal duct and is present in about 2 per cent of the population. It is found on the antimesenteric side of the ileum, commonly at 60 cm from the ileocaecal valve and is classically 5 cm long. A Meckels diverticulum contains alt three coats of the bowel wall and has its own blood supply. - Bailey 26e p1169Meckels diverticulumMost commonly encountered congenital anomaly of the small intestineQOccur 2 of the populationQ.Rule of two in Meckels diverticulum 2 prevalenceQ 2 inch in lengthQ 2 feet proximal to ileocecal valveQ Half of these who are symptomatic are 2 yearsQ of ageTrueQ diverticulum as it has all the 3 layers of the intestineQ.Located on the antimesenteric border of the ileum 45 to 60 cm proximal to the ileocecal valveResults from incomplete closure of omphalomesenteric or vitellointestinal ductQ.An equal incidence among men womenQ.MC heterotopic tissue: Gastric mucosa 50Q Pancreatic mucosa 5 colonic mucosa rarelyClinical Features:Most are entirely benign incidentally discovered during autopsy, laparotomy, or barium studiesMC clinical presentation is GI bleeding 25-50QHemorrhage: MC symptomatic presentation in children 2 yearsQHemorrhage is manifested as painless bright red blood from the rectum, with intermittent episodesQ persisting without treatment.Source of the bleeding is a chronic acid-induced ulcer in the ileum adjacent to a Meckels diverticulum that contains gastric mucosa.Intestinal obstruction 31: Due to volvulus, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia Littres hernia QComplications of Meckels diverticulumMC complication in children young adults: BleedingQMC complication in adults: Intestinal obstructionQDiverticulitis 10-20 is more common in adult patients.Progression of the diverticulitis may lead to perforation and peritonitis.When the appendix is found to be normal during exploration for suspected appendicitis, the distal ileum should be inspected for the presence of an inflamed Meckels diverticulumQ.Diagnosis:Most accurate diagnostic test in children: Scintigraphy with sodium 99mTc-pertechnetateQ.99mTc-pertechnetateQ ScanThe 99mTc-pertechnetate is preferentially taken up by the mucus-secreting cells of gastric mucosa ectopic gastric tissue in the diverticulumQ.Sensitivity-85. specificity-95 and an accuracy-90 in the pediatric age groupLess accurate in adults because of the reduced prevalence of ectopic gastric mucosaQ 1 The sensitivity specificity can be improved by pentagastrin and glucagon or H2-receptor antagonists cimetidineQ.In adults with normal nuclear medicine findings, barium studies should be performed.Treatment:Symptomatic Meckels diverticulum: Diverticulectomy or resection of the segment of ileumQ bearing the diverticulum.Segmental intestinal resection is required for bleeding because the bleeding site usually is in the ileum adjacent to the diverticulumQ.Asymptomatic diverticula found in children during laparotomy should be resectedQ.Incidentally found Meckels diverticulum should be removed at any age up to 80 years as long as no additional conditions e.g., peritonitis made removal hazardousQ. 