Meckel's diverticulum: Difference between revisions
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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 (due to [[intussusception]] or [[volvulus (peds)|volvulus]]) | *[[bowel obstruction|Obstruction]] (due to [[intussusception]] or [[volvulus (peds)|volvulus]]) | ||
**May lead to bowel ischemia, [[pediatric shock|shock]] | **May lead to [[ischemic bowel|bowel ischemia]], [[pediatric shock|shock]] | ||
*[[Diverticulitis]] | *[[Diverticulitis]] | ||
*Umbilical fistula | *Umbilical fistula | ||
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==Management== | ==Management== | ||
*NGT | *[[NG tube|NGT]] | ||
*Broad-spectrum [[pediatric antibiotics|antibiotics]] | *Broad-spectrum [[pediatric antibiotics|antibiotics]] | ||
*[[IVF]] | *[[IVF]] | ||
Revision as of 23:02, 29 September 2019
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
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