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Meckel's diverticulum in Crohn's disease
1University of British Columbia, Vancouver, Canada.
Abstract:
Meckel's diverticulum is a congenital abnormality of the distal ileum associated with failed vitelline duct closure. Detailed pathological studies have estimated its frequency to be about 2% of the general population, and it has been anecdotally recorded in patients with Crohn's disease. Most patients with Crohn's disease have imaging studies of the small intestine during the course of their disease, and often, an intestinal resection. Thus, it seems possible to estimate the prevalence of Meckel's diverticula in Crohn's disease. In addition, patient characteristics may be important, especially if management of Crohn's disease is altered. Of 877 patients with Crohn's disease, 10 (about 1%) had a Meckel's diverticulum diagnosed, including six men and four women. All were diagnosed with Crohn's disease before age 50 years and seven were diagnosed before age 30 years. There were five with ileocolonic disease, two with colon-only disease and three with ileum-only disease. The clinical behaviour of five patients could be classified as penetrating and two as stricturing. A total of 311 patients had an ileocolonic resection, including eight (about 2%) with a Meckel's diverticulum. In contrast to some case reports, no heterotopic mucosa was detected and the Meckel's diverticulum was incidental and, apparently, an unexpected finding. In each case, the diverticulum was not involved with Crohn's disease but was included in the ileal resection. These results suggest that the overall prevalence of a Meckel's diverticulum is not increased in Crohn's disease but may result in resection of additional small intestine.
Insights
This study found that Meckel
Area of Science:
- Gastroenterology
- Surgical Pathology
- Congenital Abnormalities
Background:
- Meckel's diverticulum is a congenital anomaly affecting the distal ileum, occurring in approximately 2% of the general population.
- Anecdotal evidence suggests an association between Meckel's diverticulum and Crohn's disease, a chronic inflammatory bowel condition.
- Crohn's disease management frequently involves small intestine imaging and resection, presenting an opportunity to assess Meckel's diverticulum prevalence.
Purpose of the Study:
- To estimate the prevalence of Meckel's diverticulum in patients diagnosed with Crohn's disease.
- To investigate if patient characteristics or disease behavior influence the co-occurrence of Meckel's diverticulum and Crohn's disease.
- To determine the clinical significance and management implications of incidental Meckel's diverticulum findings in Crohn's disease patients.
Main Methods:
- Retrospective analysis of 877 patients with Crohn's disease.
- Review of diagnostic imaging and surgical pathology reports to identify Meckel's diverticulum.
- Correlation of Meckel's diverticulum findings with patient demographics, Crohn's disease characteristics, and surgical interventions.
Main Results:
- Meckel's diverticulum was diagnosed in 10 out of 877 (approximately 1.1%) Crohn's disease patients.
- Among 311 patients undergoing ileocolonic resection, 8 (approximately 2.6%) had an incidental Meckel's diverticulum.
- No heterotopic mucosa was found; Meckel's diverticula were incidental findings, not involved in Crohn's disease pathology, but often resected.
Conclusions:
- The prevalence of Meckel's diverticulum does not appear to be significantly increased in patients with Crohn's disease.
- Incidental Meckel's diverticulum may lead to the resection of additional small intestine during Crohn's disease surgery.
- Routine awareness and detection of Meckel's diverticulum are important in Crohn's disease management to avoid unnecessary bowel resection.