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Ileitis associated with Meckel's diverticulum
Claire M Hamilton1, Thomas Arnason1
1Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
Aims:
Histological features of chronic active ileitis in the small intestine neighbouring a Meckel's diverticulum raise the possibility of concurrent Crohn's disease. Several studies have reported a significant association between Meckel's diverticulum and Crohn's disease, whereas some case reports have proposed that the ileitis is attributable to acid-secreting gastric heterotopia. The aim of this study was to evaluate the incidence, histomorphology and clinical follow-up of Meckel's diverticulum-associated ileitis.
Methods And Results:
Medical records and slides from 48 consecutive surgical resections performed for Meckel's diverticulum were reviewed. Nine of 48 adults had significant inflammatory changes in the small intestine neighbouring the diverticulum. Two were transmural ulcers attributable to ingestion of a sharp object. Two patients had established Crohn's disease, both with long segments (>95 mm) of transmural inflammation located >100 mm from the diverticulum. The remaining five patients had inflammatory changes (ulceration, pseudopyloric metaplasia, submucosal fibrosis, and muscularis mucosa hyperplasia) confined to a short segment (<20 mm) of mucosa/submucosa within 50-60 mm of the diverticulum. Two had gastric heterotopia in the diverticulum. None of these five patients used non-steroidal anti-inflammatory drugs (NSAIDs). On follow-up, none had symptoms, imaging or pathology suggestive of Crohn's disease.
Conclusions:
Ileitis affecting a short segment of mucosa and submucosa in the small intestine near a Meckel's diverticulum is relatively common, and is not necessarily related to Crohn's disease.
Insights
Inflammation near Meckel's diverticulum is common but often not Crohn's disease. Short segment ileitis in adults with Meckel's diverticulum typically resolves without progression to Crohn's disease.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Digestive Diseases
Background:
- Meckel's diverticulum can present with ileitis, raising suspicion for Crohn's disease.
- Previous reports suggest ileitis may stem from gastric heterotopia or be linked to Crohn's disease.
- The association between Meckel's diverticulum, ileitis, and Crohn's disease requires further investigation.
Purpose of the Study:
- To determine the incidence and histomorphology of ileitis associated with Meckel's diverticulum.
- To evaluate the clinical follow-up of patients with Meckel's diverticulum-associated ileitis.
- To differentiate ileitis near Meckel's diverticulum from Crohn's disease.
Main Methods:
- Review of medical records and histological slides from 48 surgical resections for Meckel's diverticulum.
- Analysis of inflammatory changes in the small intestine adjacent to the diverticulum.
- Clinical follow-up of patients with identified ileitis.
Main Results:
- Nine of 48 patients exhibited significant inflammatory changes near the diverticulum.
- Two patients had Crohn's disease with inflammation distant from the diverticulum.
- Five patients had short-segment ileitis with specific histological features, two with gastric heterotopia, and none developed Crohn's disease on follow-up.
Conclusions:
- Short segment ileitis adjacent to Meckel's diverticulum is relatively common.
- This type of ileitis is not necessarily indicative of Crohn's disease.
- Histological features and clinical course help distinguish Meckel's diverticulum-associated ileitis from Crohn's disease.
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