Meckel's diverticulum: Difference between revisions
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==Background== | ==Background== | ||
*Most common cause of significant lower gastrointestinal bleeding in children | *Most common cause of significant lower gastrointestinal bleeding in children | ||
*Most common congenital abnormality of the small intestine | |||
*Due to vitelline duct not disappearing by 7 wks | *Due to vitelline duct not disappearing by 7 wks | ||
*Blind-ending true diverticulum that contains all layers found in the ileum | |||
===Rule of 2's=== | ===Rule of 2's=== | ||
*2% of population | *2% of population | ||
*2 ft from ileocecal valve | *2 ft from ileocecal valve | ||
*2 inches long | |||
*2% become symptomatic | *2% become symptomatic | ||
*2 years of age (45%) | *2 years of age (45%) | ||
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**Most common presentation in <5yrs | **Most common presentation in <5yrs | ||
**May be intermittent or massive | **May be intermittent or massive | ||
*Obstruction ( | *Obstruction (due to intussusception or volvulus) | ||
**May lead to bowel ischemia, shock | |||
*Diverticulitis | *Diverticulitis | ||
*Umbilical fistula | *Umbilical fistula | ||
**1/3 will perforate | **1/3 will perforate | ||
*Traumatic rupture after blunt trauma possible | |||
==Workup== | ==Workup== | ||
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==Management== | ==Management== | ||
*NGT | *NGT | ||
*Broad-spectrum antibiotics | |||
*IVF | *IVF | ||
*pRBCs PRN | *pRBCs PRN | ||
Revision as of 18:16, 30 August 2017
Background
- Most common cause of significant lower gastrointestinal bleeding in children
- Most common congenital abnormality of the small intestine
- Due to vitelline duct not disappearing by 7 wks
- 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
Evaluation
- 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
Workup
- Meckel's scan (test of choice), also known as technetium-99m pertechnetate scan
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
Management
- NGT
- Broad-spectrum antibiotics
- IVF
- pRBCs PRN
- Surgery consult