Complications of Meckel's diverticula in adults.

anatomic variant found in 2% of the population. It is a remnant of the vitelline duct, which is usually located on the antimesenteric border of the ileum, within about 60 cm of the terminal ileum. As a congenital variant, Meckel’s diverticula are often found in children and less commonly present in the adult population. The anatomic variant was initially identified by Fabricus Hildanus in 1598; however, Johann Meckel was the first to publish a detailed description of this not uncommon finding. From an embryological standpoint, a Meckel’s diverticulum originates when the vitelline (or omphalomesenteric) duct, which normally connects the primitive gut to the yolk sac, fails to obliterate around the seventh or eighth week of gestation. This leads to several possible anomalies, including an omphalomesenteric fistula, an enterocyst, a fibrous band connecting the intestine to the umbilicus or a Meckel’s diverticulum with or without a fibrous cord connecting to the umbilicus. Anatomically, the Meckel’s diverticulum is a true diverticulum containing all layers of the small intestine, arising from the anti-mesenteric border of the ileum and receiving its blood supply from a remnant of the vitelline artery, which emanates from the superior mesenteric artery. A commonly quoted “rule of 2s” also applies: (1) 2% of the population have the anomaly, (2) it is approximately 2 inches in length, (3) it is usually found within 2 feet of the ileocecal valve, (4) it is often found in children under 2 years of age and (5) it affects males twice as often as females. Although these are good general guidelines, they are not based on accurate data. In an autopsy series, 0.14%–4.5% of cadavers contained a Meckel’s diverticulum. The average length of a Meckel’s diverticulum is 3 cm, with 90% ranging between 1 cm and 10 cm and the longest recorded being 100 cm. The mean distance from the ileocecal valve seems to vary with age, as Yamaguchi and colleagues showed in their study of 600 patients, with an average distance of 34 cm for children under 2 years of age. In people aged 3–21 years, the average distance of the Meckel’s diverticulum from the ileocecal valve is 46 cm and for adults is 67 cm. The Meckel’s diverticulum has actually been found to occur equally in both sexes, but it causes complications more frequently in males. A good, up-to-date review of the history, embryology, anatomy, complications and treatment of Meckel’s diverticulum can be found at http://www .emedicine.com/med/topic2797.htm, by Kuwajerwala and colleagues. Here we provide an illustrative presentation, outlining the common complications of Meckel’s diverticulum in adults. We saw 2 of these cases within a 2-week period and 2 additional cases in the preceding 3 years.