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Prado de Somosaguas 28223 Madrid, Spain
Hospital General U. Gregorio
Marañón 28007
Madrid, Spain
Various forms of calculi or enteroliths have been reported in Meckel's diverticula as an operative or routine radiographic finding. A preoperative diagnosis of Meckel's diverticulum is frequently made with barium, but is not usually shown on imaging [1]. We present a patient with milk of calcium in a Meckel's diverticulum. To our knowledge, this condition has never been reported.
A 21-year-old woman presented with recurrent episodes of right lower quadrant pain. Abdominal radiographs revealed a circumscribed area of faintly increased radiographic density in the pelvis. The radiographs also showed layering of the density, consistent with the presence of milk of calcium (Figs. 2A and 2B). A barium meal and examination were performed, revealing no evidence of communication with the bowel. Sonography revealed a fluid collection located craniad and posterior to the uterus. The collection contained multiple echoes, which layered dependently with postural changes (Fig. 2C). The preoperative diagnosis was a right ovarian cyst.
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Surgical exploration disclosed a 1.5 x 2.5 cm antimesenteric diverticulum about 10 cm proximal to the ileocecal valve. Microscopically, the diverticulum was lined with gastric mucosa and contained an amorphous calcareous material (Fig. 2D).
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Meckel's diverticulum is the most frequent congenital anomaly of the gastrointestinal tract, involving the small bowel and the terminal ileum. It can be found in approximately 0.3-3% of the population [1, 2].
Most lesions remain asymptomatic throughout life. However, complications may arise, including hemorrhage, intussusception, volvulus, and diverticulitis. In children, rectal bleeding is the most common complication, whereas obstruction from volvulus and intussusception is more common in adults [2, 3]. Approximately 50% of all Meckel's diverticula contain ectopic gastric mucosa; however, pancreatic, duodenal, and colonic mucosa can also be found. The diverticula that most commonly ulcerate and bleed are those that contain ectopic gastric mucosa. Hydrochloric acid and pepsin secreted by the gastric mucosa may cause erosion and ulceration of the adjacent ileal mucosa of the intestine because the gastric mucosa is missing. The incidence of calculi formation in such diverticula is unknown, but the complication is considered rare.
Most Meckel's diverticula have wide necks and contain smooth muscle capable of peristalsis. For this reason, stasis of the intestinal contents is unlikely. The development of enteroliths could be related to the type of mucosal lining of the diverticulum. Therefore, diverticula without functioning gastric or pancreatic mucosa would contain an alkaline environment that favors the precipitation of calcium or other minerals [4]. An extensive lining of gastric mucosa may prevent calcium precipitation and lead to the collection of milk of calcium in the Meckel's diverticulum.
In conclusion, although milk of calcium is a rare complication of Meckel's diverticulum, it is an important differential diagnosis of milk of calcium-containing lesions.
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  A T Johnston, A L Khan, R Bleakney, and R A Keenan Stromal tumour within a Meckel's diverticulum: CT and ultrasound findings Br. J. Radiol., December 1, 2001; 74(888): 1142 - 1144. [Abstract] [Full Text] [PDF]
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