Meckel's diverticulum

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

Management

• NGT
• Broad-spectrum antibiotics
• IVF
• pRBCs PRN
• Surgery consult

See Also

• Abdominal pain (peds)