Step 1: Surgical Anatomy
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Meckel diverticulum is a congenital diverticulum that is a result of a remnant omphalomesenteric duct. It is typically located 2 feet from the ileocecal valve, and is present in 2% of the population.
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Meckel diverticulum can contain ectopic pancreatic and gastric mucosa that can predispose to mucosal ulcerations, bleeding, infection, obstruction, and perforations.
Step 2: Preoperative Considerations
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Operative management of the Meckel diverticulum depends on the indications for surgery, the intraoperative findings, and surgeon’s preference. The two options that exist are wide excision of the diverticulum or intestinal resection.
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In the setting of intussusception with the Meckel diverticulum as the lead point, wide excision is acceptable. For bleeding, intestinal resection is preferred because the ulceration is typically on the mesenteric side of the bowel opposite the diverticulum. The resection and anastomosis is identical for that of a hand-sewn small bowel resection described in Chapter 23 , Small Bowel Resection and Anastomosis.
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Incidentally found Meckel diverticulums typically do not require resection.
Step 3: Operative Steps
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The open approach is performed through a transverse right lower quadrant incision. ( Figure 27-1 )
