Congenital condition
Meckel's diverticulum is present from birth, and usually silent.
Meckel's diverticulum is a small pouch that forms in the lower part of the small intestine from birth. It occurs when a structure from foetal development, known as the vitelline duct, does not close fully, leaving a pocket in the intestine. Most people have no symptoms.
FRCSEd (General Surgery)Five clinics in Singapore
In short
Most
Have no symptoms at all
Most people with Meckel's diverticulum have no symptoms, and it is often discovered accidentally during tests or procedures for other health concerns.
From birth
When the pouch forms
It forms when the vitelline duct, which connects the developing intestines to the yolk sac, fails to close completely, leaving a small pouch in the small intestine.
Ulcers
Where the bleeding comes from
The pouch may contain stomach or pancreatic tissue, which produces acid. Ulcers that follow can bleed, giving bright red or dark blood in the stool.
Under 10
Where symptoms cluster
Symptoms and complications are more common in males than females, with symptomatic cases appearing more often in children under 10.
What every patient should know
What every patient should know
Most
People never know they have one
Source: Dr Sulaiman Bin Yusof, published clinical guidance
The vitelline duct forms
It connects the developing intestines to the yolk sac
It is meant to close
During foetal development, before birth
Sometimes it does not
What is left is a pocket in the small intestine
Most common
Congenital anomaly of the digestive tract
Source: Sagar, Kumar and Shah, Journal of the Royal Society of Medicine, 2006
His story
Dr Sulaiman Bin Yusof
Senior Consultant Colorectal and General Surgeon, seeing patients at five clinics in Singapore.
- MBChB (Sheffield), M.Med (Surgery), FRCSEd (General Surgery)
- Consults in English and Malay
- MOH Fellowship, Peter MacCallum Cancer Centre, Melbourne
- Singapore Health Quality Service Star Award 2023
- Dean's Honour Roll for Teaching
What it is
A pocket left over from before you were born.
Meckel’s diverticulum is a small pouch that forms in the lower part of the small intestine from birth. It occurs when a structure from foetal development, known as the vitelline duct, does not close fully, leaving a pocket in the intestine.
Most people with Meckel’s diverticulum have no symptoms, and it is often discovered accidentally during tests or procedures for other health concerns. However, in some cases, it can cause digestive problems that require medical attention.
Being told you have one is not the same as being told something needs doing about it. What matters is whether it is causing symptoms, and that is what an assessment is for.
Symptoms
When it does cause trouble, this is usually how.
While many people with Meckel’s diverticulum have no symptoms, complications may lead to noticeable digestive issues. Symptoms can include the following.
Abdominal pain
Discomfort typically occurs near the belly button or lower abdomen. Pain may range from mild to severe, especially if the diverticulum contains acid-secreting tissue leading to ulceration.
Blood in stool
Ulcers within the diverticulum can cause bleeding, resulting in bright red or dark blood in the stool. This bleeding is often not painful, and is more noticeable in children.
Vomiting and abdominal bloating
In some cases, Meckel's diverticulum can cause a blockage in the intestine, particularly in younger children. This can lead to symptoms such as vomiting, abdominal bloating, and constipation as food and waste struggle to pass through the digestive tract.
Fatigue from anaemia
Chronic bleeding from the diverticulum may result in anaemia, characterised by fatigue, pale skin, and shortness of breath due to reduced oxygen levels in the blood.
None of these signs belongs only to Meckel’s diverticulum. They overlap with a good deal else in the digestive tract, which is why the point of the tests below is as much to rule other things out as to find this one.
Causes and risk
What is inside the pouch decides whether it ever causes trouble.
The pouch itself is a remnant of foetal development. What it contains, and who it tends to affect, are what determine whether it stays silent or starts to bleed.
Acid
Why a pouch in the small intestine ulcerates
Source: Dr Sulaiman Bin Yusof, published clinical guidance
The pouch holds stomach tissue
Or pancreatic tissue, in a place neither belongs
That tissue makes acid
In a part of the bowel not built to handle it
An ulcer forms, and bleeds
Bright red or dark blood in the stool
Foetal development
Meckel's diverticulum forms when the vitelline duct, which connects the developing intestines to the yolk sac in the fetus, fails to close completely, leaving a small pouch in the small intestine.
Ectopic tissue
The diverticulum may contain stomach or pancreatic tissue, which can produce acid and increase the risk of ulcer formation and bleeding.
Higher risk in males
Symptoms and complications from Meckel's diverticulum are more common in males than females, with symptomatic cases appearing more often in children under 10.
Link to other birth conditions
Individuals who are born with certain conditions, such as oesophageal or rectal issues, may be more likely to develop Meckel's diverticulum.
Diagnosis
It looks like a great many other things, so the tests do two jobs.
Meckel’s diverticulum can be difficult to diagnose because its symptoms are often similar to those of other digestive disorders. The following methods may be used.
Meckel's scan
This imaging test involves injecting a small amount of radioactive substance into the bloodstream. The substance travels to areas with stomach-like tissue, which can be detected by a scanner. This scan is most effective in younger patients, where it can help locate the diverticulum.
Endoscopy and colonoscopy
In an endoscopy, a camera is inserted through the mouth to view the upper digestive tract, while in a colonoscopy, it is inserted through the rectum to view the large intestine. Although these tests may not always detect Meckel's diverticulum, they are helpful in identifying or ruling out other conditions that may cause similar symptoms.
Imaging studies
CT and MRI scans create detailed images of the internal organs. They can sometimes reveal abnormalities in the small intestine, such as a diverticulum, aiding in diagnosis.
Blood tests
Blood tests can check for anaemia (low red blood cells), which may occur if there is ongoing blood loss due to Meckel's diverticulum. Detecting anaemia can help doctors determine if bleeding is part of the problem.
What a colonoscopy involves, what the preparation is like and what the day looks like, is on the colonoscopy page.
Treatment
Whether anything is done depends on whether it is causing symptoms.
The options divide in two: what can be done without surgery, and what surgery involves when it is needed. Which applies depends on the symptoms, and on what the pouch has already done to the bowel around it.
No symptoms
Close monitoring rather than immediate intervention
Mild symptoms
Medication to reduce acid and manage discomfort
Bleeding, pain or infection
The pouch is removed from the intestinal wall
Damage to the bowel around it
That segment is removed along with the pouch
Observation, without surgery
In cases without symptoms, close monitoring is often recommended instead of immediate intervention. Patients should be vigilant for any new symptoms, like abdominal pain or rectal bleeding, and promptly report these to their colorectal specialist to reassess the need for treatment.
Medication, without surgery
For mild symptoms, medications may help manage discomfort and prevent complications. Proton pump inhibitors (PPIs) can be prescribed to reduce stomach acid, which helps prevent ulcer formation in cases where the diverticulum contains acid-producing tissue. However, medication alone may not resolve all potential issues and is generally considered a temporary measure.
Diverticulectomy, surgical
This surgical procedure removes the diverticulum from the wall of the small intestine. It is typically recommended if symptoms such as bleeding, pain, or infection are present. During surgery, the surgeon removes the pouch and then stitches the intestine closed. This removes the source of further complications such as recurrent bleeding or intestinal blockages.
Bowel resection, surgical
If the diverticulum has caused significant damage to the surrounding intestine, a portion of the affected intestine may need to be removed along with the diverticulum. This procedure removes the damaged section, and the surgeon reconnects the healthy ends of the intestine to restore normal bowel function. It is generally considered for complex cases where diverticulectomy alone may not be sufficient.
Anything new during a period of monitoring, abdominal pain or rectal bleeding, is worth reporting promptly to a colorectal specialist so that the need for treatment can be reassessed.
Common questions
The questions that come up in consultation.
How is Meckel's diverticulum different from other types of diverticula?
Unlike other diverticula, which are usually acquired with age and occur in the colon, Meckel's diverticulum is congenital (present from birth) and occurs in the small intestine.
Is there a risk of Meckel's diverticulum recurring after it is removed?
Once removed, Meckel's diverticulum does not recur. However, any ongoing symptoms after surgery should be evaluated to ensure no other digestive issues are present.
Can Meckel's diverticulum be managed by lifestyle changes alone?
Since it is a congenital condition, lifestyle changes alone cannot prevent Meckel's diverticulum or its complications. However, being aware of symptoms and seeking timely medical advice is beneficial.
It was found by accident during another test. Does it have to come out?
Not necessarily. In cases without symptoms, close monitoring is often recommended instead of immediate intervention.
Why would a pouch in the small intestine bleed?
Ulcers within the diverticulum can cause bleeding, resulting in bright red or dark blood in the stool. That bleeding is often not painful and is more noticeable in children, which is part of why chronic blood loss can go unnoticed until it shows up as anaemia, with fatigue, pale skin and shortness of breath.
Book a consultation
Found by accident, or causing symptoms? Either way, it is worth knowing which.
Consult Dr Sulaiman for an assessment and a personalised treatment plan today. Appointments are available across five clinic locations in Singapore, and self-referrals are welcome.