Meckel's diverticulum: Difference between revisions

Latest revision as of 22:13, 31 January 2024

Background

Schematic of Meckel's diverticulum.

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 feet from ileocecal valve
2 inches long
2% become symptomatic
2 years of age (45%)
2 times more common in boys
2 types of epithelium (gastric/pancreatic)

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
- Diverticulosis
- Diverticulitis
Vascular ectasia / angiodysplasia
Inflammatory bowel disease
Infectious colitis
Mesenteric Ischemia / ischemic colitis
Meckel's diverticulum
Colorectal cancer / polyps
Hemorrhoids
- Internal hemorrhoid
- External hemorrhoid
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

Evaluation

Meckel's diverticulum in a surgical specimen.

Workup

Meckel's scan (test of choice), also known as technetium-99m pertechnetate scan

Diagnosis

Management

NGT
Broad-spectrum antibiotics
IVF
pRBCs PRN
Surgery consult

External Links

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+[[File:Diverticule de Meckel.jpg|thumb|Schematic of Meckel's diverticulum.]]
+*Most common cause of significant lower [[gastrointestinal bleeding (peds)|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 feet from ileocecal valve
+*2 inches long
+*2% become symptomatic
+*2 years of age (45%)
+*2 times more common in boys
+*2 types of epithelium (gastric/pancreatic)
-* most common cause of sig LGIB in kids, rule of 2's (2% of pop, 2 ft from ileocecal valve, 45% are 2 years of age, 2 cm long), d/t vitelline duct not disappearing by 7 wks
+==Clinical presentation==
+*[[GI Bleeding (Peds)|Rectal bleeding]] (+/- pain)
+**Most common presentation in <5yrs
+**May be intermittent or massive
+*[[bowel obstruction|Obstruction]] (due to [[intussusception]] or [[volvulus (peds)|volvulus]])
+**May lead to [[ischemic bowel|bowel ischemia]], [[pediatric shock|shock]]
+*[[Diverticulitis]]
+*Umbilical fistula
+**1/3 will perforate
+*Traumatic rupture after blunt trauma possible
-==Diagnosis==
+==Differential Diagnosis==
+{{Lower GI bleeding DDX}}
+==Evaluation==
+[[File:Meckel's Diverticulum AFIP.jpg|thumb|Meckel's diverticulum in a surgical specimen.]]
+===Workup===
+*Meckel's scan (test of choice), also known as technetium-99m pertechnetate scan
-* s/s: rectal bleeding (+/- pain) is the most common presentation in <5 y/o & may be intermittent or massive, obstruction (can cause intuss.), diverticulitis, umbilical fistula, 1/3 perf!
+===Diagnosis===
-* CT may show, xr nl, Meckel's scan is test of choice
-==Treatment==
+==Management==
+*[[NG tube|NGT]]
+*Broad-spectrum [[pediatric antibiotics|antibiotics]]
+*[[IVF]]
+*[[pRBCs]] PRN
+*Surgery consult
+==See Also==
+*[[Abdominal pain (peds)]]
-* NGT, IVF, PRBCs prn, surgery consult
+==External Links==
+==References==
+[[Category:Pediatrics]]
-[[Category:Peds]]
+[[Category:GI]]