Meckel's diverticulum: Difference between revisions
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*Most common cause of significant lower [[gastrointestinal bleeding (peds)|gastrointestinal bleeding in children]] | *Most common cause of significant lower [[gastrointestinal bleeding (peds)|gastrointestinal bleeding in children]] | ||
*Most common congenital abnormality of the small intestine | *Most common congenital abnormality of the small intestine | ||
* | *Caused by incomplete involution of vitelline duct (occurs by 7 weeks) | ||
*Blind-ending true diverticulum that contains all layers found in the ileum | *Blind-ending true diverticulum that contains all layers found in the ileum | ||
Revision as of 14:40, 10 February 2021
Background
- Most common cause of significant lower gastrointestinal bleeding in children
- Most common congenital abnormality of the small intestine
- Caused by incomplete involution of vitelline duct (occurs by 7 weeks)
- Blind-ending true diverticulum that contains all layers found in the ileum
Rule of 2's
- 2% of population
- 2 ft from ileocecal valve
- 2 inches long
- 2% become symptomatic
- 2 years of age (45%)
- 2 x more common in boys
Clinical presentation
- Rectal bleeding (+/- pain)
- Most common presentation in <5yrs
- May be intermittent or massive
- Obstruction (due to intussusception or volvulus)
- May lead to bowel ischemia, shock
- Diverticulitis
- Umbilical fistula
- 1/3 will perforate
- Traumatic rupture after blunt trauma possible
Differential Diagnosis
Undifferentiated lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fistula
- Nearly 100% mortality if untreated
- Consider in patients with gastrointestinal bleeding and known abdominal aortic aneurysms or aortic grafts
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
Workup
- Meckel's scan (test of choice), also known as technetium-99m pertechnetate scan
Management
- NGT
- Broad-spectrum antibiotics
- IVF
- pRBCs PRN
- Surgery consult