Meckel's diverticulum

Background

• Most common cause of significant lower gastrointestinal bleeding in children
• Due to vitelline duct not disappearing by 7 wks

Rule of 2's

• 2% of population
• 2 ft from ileocecal valve
• 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 (can cause intussusception)
• Diverticulitis
• Umbilical fistula
  • 1/3 will perforate

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
  • 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

Management

• NGT
• IVF
• pRBCs PRN
• Surgery consult

See Also

Abdominal Pain (Peds)