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From the Archives of the AFIP

Meckel Diverticulum: Radiologic Features with Pathologic Correlation¹

¹ From the Departments of Radiologic Pathology (A.D.L.) and Hepatic and Gastrointestinal Pathology (C.M.H.), Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306-6000; and the Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (A.D.L.). Received August 28, 2003; accepted October 7. Both authors have no financial relationships to disclose. Address correspondence to A.D.L. (e-mail: levya@afip.osd.mil).

View larger version (83K): [in a new window]   Figure 1a. Drawings illustrate the spectrum of anomalies resulting from incomplete atrophy of the omphalomesenteric duct. (a) Umbilicoileal fistula is a completely patent omphalomesenteric duct connecting the ileum to the anterior abdominal wall at the umbilicus. (b) Umbilical sinus results from failure of the umbilical end of the omphalomesenteric duct to close. (c) Umbilical cyst occurs when the midportion of the duct remains patent and each end obliterates. (d) A persistent fibrous cord occurs when the duct obliterates but is not absorbed. (e, f) Meckel diverticulum results when the ileal end of the duct remains patent and the umbilical end atrophies. The diverticulum remains connected to the umbilicus by a fibrous band if the obliterated duct fails to be absorbed (e).

View larger version (78K): [in a new window]   Figure 1b. Drawings illustrate the spectrum of anomalies resulting from incomplete atrophy of the omphalomesenteric duct. (a) Umbilicoileal fistula is a completely patent omphalomesenteric duct connecting the ileum to the anterior abdominal wall at the umbilicus. (b) Umbilical sinus results from failure of the umbilical end of the omphalomesenteric duct to close. (c) Umbilical cyst occurs when the midportion of the duct remains patent and each end obliterates. (d) A persistent fibrous cord occurs when the duct obliterates but is not absorbed. (e, f) Meckel diverticulum results when the ileal end of the duct remains patent and the umbilical end atrophies. The diverticulum remains connected to the umbilicus by a fibrous band if the obliterated duct fails to be absorbed (e).

View larger version (79K): [in a new window]   Figure 1c. Drawings illustrate the spectrum of anomalies resulting from incomplete atrophy of the omphalomesenteric duct. (a) Umbilicoileal fistula is a completely patent omphalomesenteric duct connecting the ileum to the anterior abdominal wall at the umbilicus. (b) Umbilical sinus results from failure of the umbilical end of the omphalomesenteric duct to close. (c) Umbilical cyst occurs when the midportion of the duct remains patent and each end obliterates. (d) A persistent fibrous cord occurs when the duct obliterates but is not absorbed. (e, f) Meckel diverticulum results when the ileal end of the duct remains patent and the umbilical end atrophies. The diverticulum remains connected to the umbilicus by a fibrous band if the obliterated duct fails to be absorbed (e).

View larger version (78K): [in a new window]   Figure 1d. Drawings illustrate the spectrum of anomalies resulting from incomplete atrophy of the omphalomesenteric duct. (a) Umbilicoileal fistula is a completely patent omphalomesenteric duct connecting the ileum to the anterior abdominal wall at the umbilicus. (b) Umbilical sinus results from failure of the umbilical end of the omphalomesenteric duct to close. (c) Umbilical cyst occurs when the midportion of the duct remains patent and each end obliterates. (d) A persistent fibrous cord occurs when the duct obliterates but is not absorbed. (e, f) Meckel diverticulum results when the ileal end of the duct remains patent and the umbilical end atrophies. The diverticulum remains connected to the umbilicus by a fibrous band if the obliterated duct fails to be absorbed (e).

View larger version (82K): [in a new window]   Figure 1e. Drawings illustrate the spectrum of anomalies resulting from incomplete atrophy of the omphalomesenteric duct. (a) Umbilicoileal fistula is a completely patent omphalomesenteric duct connecting the ileum to the anterior abdominal wall at the umbilicus. (b) Umbilical sinus results from failure of the umbilical end of the omphalomesenteric duct to close. (c) Umbilical cyst occurs when the midportion of the duct remains patent and each end obliterates. (d) A persistent fibrous cord occurs when the duct obliterates but is not absorbed. (e, f) Meckel diverticulum results when the ileal end of the duct remains patent and the umbilical end atrophies. The diverticulum remains connected to the umbilicus by a fibrous band if the obliterated duct fails to be absorbed (e).

View larger version (84K): [in a new window]   Figure 1f. Drawings illustrate the spectrum of anomalies resulting from incomplete atrophy of the omphalomesenteric duct. (a) Umbilicoileal fistula is a completely patent omphalomesenteric duct connecting the ileum to the anterior abdominal wall at the umbilicus. (b) Umbilical sinus results from failure of the umbilical end of the omphalomesenteric duct to close. (c) Umbilical cyst occurs when the midportion of the duct remains patent and each end obliterates. (d) A persistent fibrous cord occurs when the duct obliterates but is not absorbed. (e, f) Meckel diverticulum results when the ileal end of the duct remains patent and the umbilical end atrophies. The diverticulum remains connected to the umbilicus by a fibrous band if the obliterated duct fails to be absorbed (e).

View larger version (79K): [in a new window]   Figure 2. Drawing depicts Littre hernia, which consists of a Meckel diverticulum entrapped in an inguinal hernia.

View larger version (129K): [in a new window]   Figure 3a. (a) Intraoperative photograph of a 19-year-old man who presented with gastrointestinal bleeding shows the serosal surface of a 4.0 x 2.5-cm Meckel diverticulum (M) located on the antimesenteric side of the ileum. (b) Intraoperative photograph of the serosal surface of the distal ileum in a 44-year-old woman with guaiac-positive stools and anemia shows a 1-cm diverticulum on the antimesenteric border.

View larger version (113K): [in a new window]   Figure 3b. (a) Intraoperative photograph of a 19-year-old man who presented with gastrointestinal bleeding shows the serosal surface of a 4.0 x 2.5-cm Meckel diverticulum (M) located on the antimesenteric side of the ileum. (b) Intraoperative photograph of the serosal surface of the distal ileum in a 44-year-old woman with guaiac-positive stools and anemia shows a 1-cm diverticulum on the antimesenteric border.

View larger version (140K): [in a new window]   Figure 4a. Meckel diverticulum. (a) Photomicrograph (original magnification, x16; hematoxylin-eosin [H-E] stain) shows the diverticulum composed of all layers of the intestinal wall. Normal small intestinal mucosa and a focus of gastric mucosa (arrow) line the diverticulum. (b) Photomicrograph (original magnification, x48; H-E stain) shows normal small intestinal mucosa with goblet cells along the luminal surface (arrow).

View larger version (180K): [in a new window]   Figure 4b. Meckel diverticulum. (a) Photomicrograph (original magnification, x16; hematoxylin-eosin [H-E] stain) shows the diverticulum composed of all layers of the intestinal wall. Normal small intestinal mucosa and a focus of gastric mucosa (arrow) line the diverticulum. (b) Photomicrograph (original magnification, x48; H-E stain) shows normal small intestinal mucosa with goblet cells along the luminal surface (arrow).

View larger version (160K): [in a new window]   Figure 5a. Heterotopic gastric mucosa in Meckel diverticulum. (a, b) Photomicrographs (original magnification, x40; H-E stain) show gastric fundic mucosa surfaced by foveolar cells (straight arrow). Oxyntic glands (curved arrow in b) contain eosinophilic parietal cells adjacent to basophilic chief cells. (c) Photomicrograph (original magnification, x40; H-E stain) shows small intestinal epithelium with goblet cells (*) adjacent to typical gastric epithelium (arrow). (d) Photomicrograph (original magnification, x16; H-E stain) shows erosions in the mucosa (arrowhead) with underlying heterotopic gastric antral glands (arrow).

View larger version (168K): [in a new window]   Figure 5b. Heterotopic gastric mucosa in Meckel diverticulum. (a, b) Photomicrographs (original magnification, x40; H-E stain) show gastric fundic mucosa surfaced by foveolar cells (straight arrow). Oxyntic glands (curved arrow in b) contain eosinophilic parietal cells adjacent to basophilic chief cells. (c) Photomicrograph (original magnification, x40; H-E stain) shows small intestinal epithelium with goblet cells (*) adjacent to typical gastric epithelium (arrow). (d) Photomicrograph (original magnification, x16; H-E stain) shows erosions in the mucosa (arrowhead) with underlying heterotopic gastric antral glands (arrow).

View larger version (176K): [in a new window]   Figure 5c. Heterotopic gastric mucosa in Meckel diverticulum. (a, b) Photomicrographs (original magnification, x40; H-E stain) show gastric fundic mucosa surfaced by foveolar cells (straight arrow). Oxyntic glands (curved arrow in b) contain eosinophilic parietal cells adjacent to basophilic chief cells. (c) Photomicrograph (original magnification, x40; H-E stain) shows small intestinal epithelium with goblet cells (*) adjacent to typical gastric epithelium (arrow). (d) Photomicrograph (original magnification, x16; H-E stain) shows erosions in the mucosa (arrowhead) with underlying heterotopic gastric antral glands (arrow).

View larger version (159K): [in a new window]   Figure 5d. Heterotopic gastric mucosa in Meckel diverticulum. (a, b) Photomicrographs (original magnification, x40; H-E stain) show gastric fundic mucosa surfaced by foveolar cells (straight arrow). Oxyntic glands (curved arrow in b) contain eosinophilic parietal cells adjacent to basophilic chief cells. (c) Photomicrograph (original magnification, x40; H-E stain) shows small intestinal epithelium with goblet cells (*) adjacent to typical gastric epithelium (arrow). (d) Photomicrograph (original magnification, x16; H-E stain) shows erosions in the mucosa (arrowhead) with underlying heterotopic gastric antral glands (arrow).

View larger version (175K): [in a new window]   Figure 6a. Heterotopic pancreatic tissue in Meckel diverticulum. (a) Photomicrograph (original magnification, x10; H-E stain) shows a round focus of heterotopic pancreatic tissue (arrow) and multiple heterotopic gastric glands (arrowheads). Extensive ulceration is seen. (b) Photomicrograph (original magnification, x160; H-E stain) shows pancreatic acini. (c) Photomicrograph (original magnification, x80; H-E stain) shows pancreatic acinar cells and islets (arrow). (d) Photomicrograph (original magnification, x64; H-E stain) shows pancreatic ducts (*) surrounded by smooth muscle.

View larger version (191K): [in a new window]   Figure 6b. Heterotopic pancreatic tissue in Meckel diverticulum. (a) Photomicrograph (original magnification, x10; H-E stain) shows a round focus of heterotopic pancreatic tissue (arrow) and multiple heterotopic gastric glands (arrowheads). Extensive ulceration is seen. (b) Photomicrograph (original magnification, x160; H-E stain) shows pancreatic acini. (c) Photomicrograph (original magnification, x80; H-E stain) shows pancreatic acinar cells and islets (arrow). (d) Photomicrograph (original magnification, x64; H-E stain) shows pancreatic ducts (*) surrounded by smooth muscle.

View larger version (191K): [in a new window]   Figure 6c. Heterotopic pancreatic tissue in Meckel diverticulum. (a) Photomicrograph (original magnification, x10; H-E stain) shows a round focus of heterotopic pancreatic tissue (arrow) and multiple heterotopic gastric glands (arrowheads). Extensive ulceration is seen. (b) Photomicrograph (original magnification, x160; H-E stain) shows pancreatic acini. (c) Photomicrograph (original magnification, x80; H-E stain) shows pancreatic acinar cells and islets (arrow). (d) Photomicrograph (original magnification, x64; H-E stain) shows pancreatic ducts (*) surrounded by smooth muscle.

View larger version (174K): [in a new window]   Figure 6d. Heterotopic pancreatic tissue in Meckel diverticulum. (a) Photomicrograph (original magnification, x10; H-E stain) shows a round focus of heterotopic pancreatic tissue (arrow) and multiple heterotopic gastric glands (arrowheads). Extensive ulceration is seen. (b) Photomicrograph (original magnification, x160; H-E stain) shows pancreatic acini. (c) Photomicrograph (original magnification, x80; H-E stain) shows pancreatic acinar cells and islets (arrow). (d) Photomicrograph (original magnification, x64; H-E stain) shows pancreatic ducts (*) surrounded by smooth muscle.

View larger version (153K): [in a new window]   Figure 7a. Meckel diverticulitis. (a) Photomicrograph (original magnification, x16; H-E stain) shows submucosal edema and hemorrhage (S). There is a microabscess within the muscularis propria (arrow), as well as an inflammatory infiltrate in the subserosal fat (*). (b) Photomicrograph (original magnification, x40; H-E stain) shows regenerative epithelium (arrow) over a healing ulcer with granulation tissue. There is abundant fibropurulent exudate in the lumen (*).

View larger version (172K): [in a new window]   Figure 7b. Meckel diverticulitis. (a) Photomicrograph (original magnification, x16; H-E stain) shows submucosal edema and hemorrhage (S). There is a microabscess within the muscularis propria (arrow), as well as an inflammatory infiltrate in the subserosal fat (*). (b) Photomicrograph (original magnification, x40; H-E stain) shows regenerative epithelium (arrow) over a healing ulcer with granulation tissue. There is abundant fibropurulent exudate in the lumen (*).

View larger version (190K): [in a new window]   Figure 8a. Ulceration in Meckel diverticulum. (a) Photomicrograph (original magnification, x16; H-E stain) shows marked ulceration of the mucosal surface (arrow). An inflammatory infiltrate and hemorrhage are present. There is a focus of heterotopic pancreatic ducts (*). (b) Photomicrograph (original magnification, x16; H-E stain) shows peptic ulceration in an area of oxyntic gastric epithelium.

View larger version (193K): [in a new window]   Figure 8b. Ulceration in Meckel diverticulum. (a) Photomicrograph (original magnification, x16; H-E stain) shows marked ulceration of the mucosal surface (arrow). An inflammatory infiltrate and hemorrhage are present. There is a focus of heterotopic pancreatic ducts (*). (b) Photomicrograph (original magnification, x16; H-E stain) shows peptic ulceration in an area of oxyntic gastric epithelium.

View larger version (142K): [in a new window]   Figure 9a. Barium examination of the small intestine demonstrating Meckel diverticulum. (a) Image from a small bowel follow-through study in a 10-year-old girl with intermittent bloody stools and anemia shows a wide-mouthed Meckel diverticulum (arrow) on the antimesenteric border of the ileum. The tip of the diverticulum points away from the root of the small bowel mesentery. (b) Image from a small bowel follow-through study in an 11-year-old girl with abdominal pain and anemia shows an elongated Meckel diverticulum extending from the antimesenteric border of the distal ileum. The neck of the diverticulum is narrow (arrow). (Fig 9b courtesy of William M. Thompson, MD, Duke University, Durham, NC.)

View larger version (128K): [in a new window]   Figure 9b. Barium examination of the small intestine demonstrating Meckel diverticulum. (a) Image from a small bowel follow-through study in a 10-year-old girl with intermittent bloody stools and anemia shows a wide-mouthed Meckel diverticulum (arrow) on the antimesenteric border of the ileum. The tip of the diverticulum points away from the root of the small bowel mesentery. (b) Image from a small bowel follow-through study in an 11-year-old girl with abdominal pain and anemia shows an elongated Meckel diverticulum extending from the antimesenteric border of the distal ileum. The neck of the diverticulum is narrow (arrow). (Fig 9b courtesy of William M. Thompson, MD, Duke University, Durham, NC.)

View larger version (145K): [in a new window]   Figure 10a. Enteroliths in a Meckel diverticulum in a 40-year-old man with chronic, intermittent abdominal pain. (a) Supine abdominal radiograph demonstrates multiple stones with peripheral calcification (arrow) in the right upper quadrant. (b) Image from a small bowel follow-through study shows a Meckel diverticulum in the right midabdomen (arrow). The dense collection of barium obscures the stones.

View larger version (165K): [in a new window]   Figure 10b. Enteroliths in a Meckel diverticulum in a 40-year-old man with chronic, intermittent abdominal pain. (a) Supine abdominal radiograph demonstrates multiple stones with peripheral calcification (arrow) in the right upper quadrant. (b) Image from a small bowel follow-through study shows a Meckel diverticulum in the right midabdomen (arrow). The dense collection of barium obscures the stones.

View larger version (163K): [in a new window]   Figure 11. Image from a barium study of the small intestine in a 35-year-old woman with abdominal pain shows a Meckel diverticulum. There is a triradiate fold pattern at the junction of the diverticulum with the ileum (arrow). (Courtesy of William M. Thompson, MD, Duke University, Durham, NC.)

View larger version (92K): [in a new window]   Figure 12a. Meckel diverticulum diagnosed with Tc-99m pertechnetate scintigraphy. (a) Tc-99m pertechnetate scans of a 17-year-old boy with painless rectal bleeding show a small focus of uptake in the right lower quadrant within minutes of radiopharmaceutical injection. The activity changes shape and position during the study (arrows), which is indicative of active hemorrhage and extravasation of radioactivity into the intestinal lumen. (b) Tc-99m pertechnetate scans of a 4-year-old boy who had multiple episodes of bright red bleeding from the rectum show a persistent focus of uptake in the right lower quadrant, a finding consistent with a Meckel diverticulum. There is delayed appearance of proximal small intestinal activity (arrow), most likely secondary to transit of activity from the stomach.

View larger version (90K): [in a new window]   Figure 12b. Meckel diverticulum diagnosed with Tc-99m pertechnetate scintigraphy. (a) Tc-99m pertechnetate scans of a 17-year-old boy with painless rectal bleeding show a small focus of uptake in the right lower quadrant within minutes of radiopharmaceutical injection. The activity changes shape and position during the study (arrows), which is indicative of active hemorrhage and extravasation of radioactivity into the intestinal lumen. (b) Tc-99m pertechnetate scans of a 4-year-old boy who had multiple episodes of bright red bleeding from the rectum show a persistent focus of uptake in the right lower quadrant, a finding consistent with a Meckel diverticulum. There is delayed appearance of proximal small intestinal activity (arrow), most likely secondary to transit of activity from the stomach.

View larger version (90K): [in a new window]   Figure 13a. Meckel diverticulum in a 22-year-old man with chronic abdominal pain and anemia. (a) Angiogram shows a vitellointestinal artery (arrow) arising from a distal ileal branch of the superior mesenteric artery. (b) Late arterial phase image shows a tubular-shaped angiographic blush (arrow) at the site of the diverticulum. (c) Photograph of the opened, resected surgical specimen shows a hemorrhagic Meckel diverticulum.

View larger version (97K): [in a new window]   Figure 13b. Meckel diverticulum in a 22-year-old man with chronic abdominal pain and anemia. (a) Angiogram shows a vitellointestinal artery (arrow) arising from a distal ileal branch of the superior mesenteric artery. (b) Late arterial phase image shows a tubular-shaped angiographic blush (arrow) at the site of the diverticulum. (c) Photograph of the opened, resected surgical specimen shows a hemorrhagic Meckel diverticulum.

View larger version (134K): [in a new window]   Figure 13c. Meckel diverticulum in a 22-year-old man with chronic abdominal pain and anemia. (a) Angiogram shows a vitellointestinal artery (arrow) arising from a distal ileal branch of the superior mesenteric artery. (b) Late arterial phase image shows a tubular-shaped angiographic blush (arrow) at the site of the diverticulum. (c) Photograph of the opened, resected surgical specimen shows a hemorrhagic Meckel diverticulum.

View larger version (162K): [in a new window]   Figure 14. Angiogram shows active hemorrhage from a Meckel diverticulum in a 26-year-old man with hematochezia. Selective injection of the ileocolic artery shows hemorrhage from a proximal branch (arrow). There is extravasation of contrast material into the intestinal lumen (arrowheads).

View larger version (130K): [in a new window]   Figure 15a. Torsion of a Meckel diverticulum causing small intestinal obstruction in a 30-year-old man who presented with abdominal distension and vomiting. Supine (a) and upright (b) abdominal radiographs show features of a mechanical small intestinal obstruction and an oval air collection that contains multiple peripherally calcified stones (arrow) in the right lower quadrant. At surgery, these findings proved to represent torsion of a Meckel diverticulum and multiple enteroliths. (Courtesy of Charles Rohrmann, Jr, MD, University of Washington, Seattle.)

View larger version (121K): [in a new window]   Figure 15b. Torsion of a Meckel diverticulum causing small intestinal obstruction in a 30-year-old man who presented with abdominal distension and vomiting. Supine (a) and upright (b) abdominal radiographs show features of a mechanical small intestinal obstruction and an oval air collection that contains multiple peripherally calcified stones (arrow) in the right lower quadrant. At surgery, these findings proved to represent torsion of a Meckel diverticulum and multiple enteroliths. (Courtesy of Charles Rohrmann, Jr, MD, University of Washington, Seattle.)

View larger version (116K): [in a new window]   Figure 16a. Intussuscepted Meckel diverticulum with infarction producing small intestinal obstruction in a 41-year-old woman with diffuse abdominal pain, nausea, and vomiting. (a) Intravenous contrast material-enhanced CT scan shows diffuse small intestinal dilatation. (b) Contrast-enhanced CT scan of the pelvis demonstrates an ileoileal intussusception, which appears as a thickened edematous segment of small bowel (arrowheads) with alternating bands of soft-tissue and fluid attenuation. There is a central focus of fat attenuation (arrow). (c) Photograph of the opened, resected surgical specimen shows an infarcted and necrotic Meckel diverticulum (arrow) that was the lead point of the intussusception.

View larger version (112K): [in a new window]   Figure 16b. Intussuscepted Meckel diverticulum with infarction producing small intestinal obstruction in a 41-year-old woman with diffuse abdominal pain, nausea, and vomiting. (a) Intravenous contrast material-enhanced CT scan shows diffuse small intestinal dilatation. (b) Contrast-enhanced CT scan of the pelvis demonstrates an ileoileal intussusception, which appears as a thickened edematous segment of small bowel (arrowheads) with alternating bands of soft-tissue and fluid attenuation. There is a central focus of fat attenuation (arrow). (c) Photograph of the opened, resected surgical specimen shows an infarcted and necrotic Meckel diverticulum (arrow) that was the lead point of the intussusception.

View larger version (140K): [in a new window]   Figure 16c. Intussuscepted Meckel diverticulum with infarction producing small intestinal obstruction in a 41-year-old woman with diffuse abdominal pain, nausea, and vomiting. (a) Intravenous contrast material-enhanced CT scan shows diffuse small intestinal dilatation. (b) Contrast-enhanced CT scan of the pelvis demonstrates an ileoileal intussusception, which appears as a thickened edematous segment of small bowel (arrowheads) with alternating bands of soft-tissue and fluid attenuation. There is a central focus of fat attenuation (arrow). (c) Photograph of the opened, resected surgical specimen shows an infarcted and necrotic Meckel diverticulum (arrow) that was the lead point of the intussusception.

View larger version (111K): [in a new window]   Figure 17a. Meckel diverticulitis producing small intestinal obstruction in a 40-year-old man who presented with abdominal pain and vomiting. (a) Intravenous and oral contrast-enhanced CT scan shows distended segments of fluid-filled small intestine. (b) CT image of the pelvis shows a Meckel diverticulum (*) as a blind-ending tubular segment of bowel. There is fecal-like material within the inflamed diverticulum and minimal inflammatory changes surrounding it. (c) Photograph of the unopened resected Meckel diverticulum shows an erythematous and edematous serosa.

View larger version (120K): [in a new window]   Figure 17b. Meckel diverticulitis producing small intestinal obstruction in a 40-year-old man who presented with abdominal pain and vomiting. (a) Intravenous and oral contrast-enhanced CT scan shows distended segments of fluid-filled small intestine. (b) CT image of the pelvis shows a Meckel diverticulum (*) as a blind-ending tubular segment of bowel. There is fecal-like material within the inflamed diverticulum and minimal inflammatory changes surrounding it. (c) Photograph of the unopened resected Meckel diverticulum shows an erythematous and edematous serosa.

View larger version (170K): [in a new window]   Figure 17c. Meckel diverticulitis producing small intestinal obstruction in a 40-year-old man who presented with abdominal pain and vomiting. (a) Intravenous and oral contrast-enhanced CT scan shows distended segments of fluid-filled small intestine. (b) CT image of the pelvis shows a Meckel diverticulum (*) as a blind-ending tubular segment of bowel. There is fecal-like material within the inflamed diverticulum and minimal inflammatory changes surrounding it. (c) Photograph of the unopened resected Meckel diverticulum shows an erythematous and edematous serosa.

View larger version (126K): [in a new window]   Figure 18a. Meckel diverticulitis with abscess producing small intestinal obstruction in a 3-year-old boy who presented with a 1-day history of abdominal pain and nonbilious vomiting. (a) Supine abdominal radiograph shows multiple dilated segments of air-filled small intestine. (b, c) Intravenous and oral contrast-enhanced CT scans show fluid-filled dilated small intestine that is oriented in a radial distribution surrounding small bowel mesentery and vessels. An abscess (arrows in c) containing an air-fluid level was present at the transition point. (d) Intraoperative photograph of the serosal surface of the small intestine shows a Meckel diverticulum (arrow) opening into a contained abscess (arrowheads). At surgery, it was seen that the Meckel diverticulum caused a kink in the intestine, thus producing the closed-loop obstruction observed in b.

View larger version (98K): [in a new window]   Figure 18b. Meckel diverticulitis with abscess producing small intestinal obstruction in a 3-year-old boy who presented with a 1-day history of abdominal pain and nonbilious vomiting. (a) Supine abdominal radiograph shows multiple dilated segments of air-filled small intestine. (b, c) Intravenous and oral contrast-enhanced CT scans show fluid-filled dilated small intestine that is oriented in a radial distribution surrounding small bowel mesentery and vessels. An abscess (arrows in c) containing an air-fluid level was present at the transition point. (d) Intraoperative photograph of the serosal surface of the small intestine shows a Meckel diverticulum (arrow) opening into a contained abscess (arrowheads). At surgery, it was seen that the Meckel diverticulum caused a kink in the intestine, thus producing the closed-loop obstruction observed in b.

View larger version (97K): [in a new window]   Figure 18c. Meckel diverticulitis with abscess producing small intestinal obstruction in a 3-year-old boy who presented with a 1-day history of abdominal pain and nonbilious vomiting. (a) Supine abdominal radiograph shows multiple dilated segments of air-filled small intestine. (b, c) Intravenous and oral contrast-enhanced CT scans show fluid-filled dilated small intestine that is oriented in a radial distribution surrounding small bowel mesentery and vessels. An abscess (arrows in c) containing an air-fluid level was present at the transition point. (d) Intraoperative photograph of the serosal surface of the small intestine shows a Meckel diverticulum (arrow) opening into a contained abscess (arrowheads). At surgery, it was seen that the Meckel diverticulum caused a kink in the intestine, thus producing the closed-loop obstruction observed in b.

View larger version (129K): [in a new window]   Figure 18d. Meckel diverticulitis with abscess producing small intestinal obstruction in a 3-year-old boy who presented with a 1-day history of abdominal pain and nonbilious vomiting. (a) Supine abdominal radiograph shows multiple dilated segments of air-filled small intestine. (b, c) Intravenous and oral contrast-enhanced CT scans show fluid-filled dilated small intestine that is oriented in a radial distribution surrounding small bowel mesentery and vessels. An abscess (arrows in c) containing an air-fluid level was present at the transition point. (d) Intraoperative photograph of the serosal surface of the small intestine shows a Meckel diverticulum (arrow) opening into a contained abscess (arrowheads). At surgery, it was seen that the Meckel diverticulum caused a kink in the intestine, thus producing the closed-loop obstruction observed in b.

View larger version (79K): [in a new window]   Figure 19a. Drawings illustrate an inverted Meckel diverticulum. (a) Mesenteric fat of the Meckel diverticulum is pulled into the center of the diverticulum as it invaginates into the small intestinal lumen. (b) The inverted diverticulum may serve as the lead point for an ileoileal or ileocolic intussusception.

View larger version (74K): [in a new window]   Figure 19b. Drawings illustrate an inverted Meckel diverticulum. (a) Mesenteric fat of the Meckel diverticulum is pulled into the center of the diverticulum as it invaginates into the small intestinal lumen. (b) The inverted diverticulum may serve as the lead point for an ileoileal or ileocolic intussusception.

View larger version (125K): [in a new window]   Figure 20a. Inverted Meckel diverticulum in a 50-year-old man with iron deficiency anemia and occult blood-positive stools. (a) Enteroclysis image shows an elongated tubular filling defect in the ileum (arrowheads). (b) Oral and intravenous contrast-enhanced CT scan shows an intraluminal mass of fat attenuation within the small intestinal lumen. There is a rim of soft-tissue attenuation surrounding the fatty mass. (c) Photograph of the opened, resected surgical specimen shows an inverted Meckel diverticulum on the luminal side of the ileum. The mucosa of the inverted diverticulum is erythematous and edematous. (d). Photograph of the sectioned surgical specimen shows mesenteric fat in the central core of the inverted Meckel diverticulum.

View larger version (147K): [in a new window]   Figure 20b. Inverted Meckel diverticulum in a 50-year-old man with iron deficiency anemia and occult blood-positive stools. (a) Enteroclysis image shows an elongated tubular filling defect in the ileum (arrowheads). (b) Oral and intravenous contrast-enhanced CT scan shows an intraluminal mass of fat attenuation within the small intestinal lumen. There is a rim of soft-tissue attenuation surrounding the fatty mass. (c) Photograph of the opened, resected surgical specimen shows an inverted Meckel diverticulum on the luminal side of the ileum. The mucosa of the inverted diverticulum is erythematous and edematous. (d). Photograph of the sectioned surgical specimen shows mesenteric fat in the central core of the inverted Meckel diverticulum.

View larger version (150K): [in a new window]   Figure 20c. Inverted Meckel diverticulum in a 50-year-old man with iron deficiency anemia and occult blood-positive stools. (a) Enteroclysis image shows an elongated tubular filling defect in the ileum (arrowheads). (b) Oral and intravenous contrast-enhanced CT scan shows an intraluminal mass of fat attenuation within the small intestinal lumen. There is a rim of soft-tissue attenuation surrounding the fatty mass. (c) Photograph of the opened, resected surgical specimen shows an inverted Meckel diverticulum on the luminal side of the ileum. The mucosa of the inverted diverticulum is erythematous and edematous. (d). Photograph of the sectioned surgical specimen shows mesenteric fat in the central core of the inverted Meckel diverticulum.

View larger version (121K): [in a new window]   Figure 20d. Inverted Meckel diverticulum in a 50-year-old man with iron deficiency anemia and occult blood-positive stools. (a) Enteroclysis image shows an elongated tubular filling defect in the ileum (arrowheads). (b) Oral and intravenous contrast-enhanced CT scan shows an intraluminal mass of fat attenuation within the small intestinal lumen. There is a rim of soft-tissue attenuation surrounding the fatty mass. (c) Photograph of the opened, resected surgical specimen shows an inverted Meckel diverticulum on the luminal side of the ileum. The mucosa of the inverted diverticulum is erythematous and edematous. (d). Photograph of the sectioned surgical specimen shows mesenteric fat in the central core of the inverted Meckel diverticulum.

View larger version (114K): [in a new window]   Figure 21a. Inverted Meckel diverticulum in a 61-year-old woman with intermittent abdominal pain. (a) Transverse sonogram of the right lower abdomen shows a targetlike mass with central hyperechogenicity from the core of mesenteric fat surrounded by the wall of the diverticulum and wall of the intestine. (b) Photograph of the unopened, resected surgical specimen shows the serosal surface of the ileum. On the antimesenteric border, there is dimpling at the site of the inverted Meckel diverticulum (arrowhead). (c) Photograph of the opened, resected specimen shows the inverted diverticulum (arrowhead) protruding into the ileal lumen.

View larger version (116K): [in a new window]   Figure 21b. Inverted Meckel diverticulum in a 61-year-old woman with intermittent abdominal pain. (a) Transverse sonogram of the right lower abdomen shows a targetlike mass with central hyperechogenicity from the core of mesenteric fat surrounded by the wall of the diverticulum and wall of the intestine. (b) Photograph of the unopened, resected surgical specimen shows the serosal surface of the ileum. On the antimesenteric border, there is dimpling at the site of the inverted Meckel diverticulum (arrowhead). (c) Photograph of the opened, resected specimen shows the inverted diverticulum (arrowhead) protruding into the ileal lumen.

View larger version (128K): [in a new window]   Figure 21c. Inverted Meckel diverticulum in a 61-year-old woman with intermittent abdominal pain. (a) Transverse sonogram of the right lower abdomen shows a targetlike mass with central hyperechogenicity from the core of mesenteric fat surrounded by the wall of the diverticulum and wall of the intestine. (b) Photograph of the unopened, resected surgical specimen shows the serosal surface of the ileum. On the antimesenteric border, there is dimpling at the site of the inverted Meckel diverticulum (arrowhead). (c) Photograph of the opened, resected specimen shows the inverted diverticulum (arrowhead) protruding into the ileal lumen.

View larger version (136K): [in a new window]   Figure 22a. Inverted Meckel diverticulum with intussusception in a 31-year-old man who complained of abdominal pain, nausea, vomiting, and fever. Oral and intravenous contrast-enhanced CT scans show an ileocolic intussusception composed of concentric rings of soft-tissue and fat attenuation (arrowheads in a). The core of the intussusception contains an elongated mass of fat attenuation (arrow in b), a finding consistent with an inverted Meckel diverticulum.

View larger version (132K): [in a new window]   Figure 22b. Inverted Meckel diverticulum with intussusception in a 31-year-old man who complained of abdominal pain, nausea, vomiting, and fever. Oral and intravenous contrast-enhanced CT scans show an ileocolic intussusception composed of concentric rings of soft-tissue and fat attenuation (arrowheads in a). The core of the intussusception contains an elongated mass of fat attenuation (arrow in b), a finding consistent with an inverted Meckel diverticulum.

View larger version (135K): [in a new window]   Figure 23a. Meckel diverticulitis. (a) Intravenous and oral contrast-enhanced CT scan of a 22-year-old man with fever and guaiac-positive stools shows a rim-enhancing tubular structure beneath the umbilicus (arrow). There are surrounding inflammatory changes and thickening of the subjacent small intestine. (b) Intravenous contrast-enhanced CT scan of a 49-year-old man who presented with abdominal pain, nausea, vomiting, and anorexia shows a rounded fluid collection (arrow) in the right pelvis that contains a calcified enterolith. There are inflammatory changes in the adjacent fat. (c) Intravenous contrast-enhanced CT scan of a 57-year-old man with abdominal pain shows a blind-ending rounded structure (arrowheads) attached to the adjacent ileum. Arrow shows site of attachment.

View larger version (129K): [in a new window]   Figure 23b. Meckel diverticulitis. (a) Intravenous and oral contrast-enhanced CT scan of a 22-year-old man with fever and guaiac-positive stools shows a rim-enhancing tubular structure beneath the umbilicus (arrow). There are surrounding inflammatory changes and thickening of the subjacent small intestine. (b) Intravenous contrast-enhanced CT scan of a 49-year-old man who presented with abdominal pain, nausea, vomiting, and anorexia shows a rounded fluid collection (arrow) in the right pelvis that contains a calcified enterolith. There are inflammatory changes in the adjacent fat. (c) Intravenous contrast-enhanced CT scan of a 57-year-old man with abdominal pain shows a blind-ending rounded structure (arrowheads) attached to the adjacent ileum. Arrow shows site of attachment.

View larger version (120K): [in a new window]   Figure 23c. Meckel diverticulitis. (a) Intravenous and oral contrast-enhanced CT scan of a 22-year-old man with fever and guaiac-positive stools shows a rim-enhancing tubular structure beneath the umbilicus (arrow). There are surrounding inflammatory changes and thickening of the subjacent small intestine. (b) Intravenous contrast-enhanced CT scan of a 49-year-old man who presented with abdominal pain, nausea, vomiting, and anorexia shows a rounded fluid collection (arrow) in the right pelvis that contains a calcified enterolith. There are inflammatory changes in the adjacent fat. (c) Intravenous contrast-enhanced CT scan of a 57-year-old man with abdominal pain shows a blind-ending rounded structure (arrowheads) attached to the adjacent ileum. Arrow shows site of attachment.

View larger version (120K): [in a new window]   Figure 24a. Meckel diverticulitis in a 7-year-old girl with vague abdominal pain and occasional vomiting. (a) Longitudinal sonogram of the pelvis shows a blind-ending, tubular cystlike structure containing internal echoes from debris. The diverticular wall has the gut signature. (b) Intravenous and oral contrast-enhanced CT scan shows a periumbilical fluid collection (arrowheads) containing a debris-fluid level. The fluid collection connects to a segment of thickened distal small intestine (arrow). (c) Photograph of the opened, resected surgical specimen shows an inflamed Meckel diverticulum with a thickened wall and erythematous mucosa.

View larger version (115K): [in a new window]   Figure 24b. Meckel diverticulitis in a 7-year-old girl with vague abdominal pain and occasional vomiting. (a) Longitudinal sonogram of the pelvis shows a blind-ending, tubular cystlike structure containing internal echoes from debris. The diverticular wall has the gut signature. (b) Intravenous and oral contrast-enhanced CT scan shows a periumbilical fluid collection (arrowheads) containing a debris-fluid level. The fluid collection connects to a segment of thickened distal small intestine (arrow). (c) Photograph of the opened, resected surgical specimen shows an inflamed Meckel diverticulum with a thickened wall and erythematous mucosa.

View larger version (133K): [in a new window]   Figure 24c. Meckel diverticulitis in a 7-year-old girl with vague abdominal pain and occasional vomiting. (a) Longitudinal sonogram of the pelvis shows a blind-ending, tubular cystlike structure containing internal echoes from debris. The diverticular wall has the gut signature. (b) Intravenous and oral contrast-enhanced CT scan shows a periumbilical fluid collection (arrowheads) containing a debris-fluid level. The fluid collection connects to a segment of thickened distal small intestine (arrow). (c) Photograph of the opened, resected surgical specimen shows an inflamed Meckel diverticulum with a thickened wall and erythematous mucosa.