Meckel's diverticulum: Difference between revisions
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==Background== | ==Background== | ||
[[File:Diverticule de Meckel.jpg|thumb|Schematic of Meckel's diverticulum.]] | [[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 cause of significant lower [[Special:MyLanguage/gastrointestinal bleeding (peds)|gastrointestinal bleeding in children]] | ||
*Most common congenital abnormality of the small intestine | *Most common congenital abnormality of the small intestine | ||
*Caused by incomplete involution of vitelline duct (occurs by 7 weeks) | *Caused by incomplete involution of vitelline duct (occurs by 7 weeks) | ||
*Blind-ending true diverticulum that contains all layers found in the ileum | *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 feet from ileocecal valve | *2 feet from ileocecal valve | ||
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*2 times more common in boys | *2 times more common in boys | ||
*2 types of epithelium (gastric/pancreatic) | *2 types of epithelium (gastric/pancreatic) | ||
==Clinical presentation== | ==Clinical presentation== | ||
*[[GI Bleeding (Peds)|Rectal bleeding]] (+/- pain) | |||
*[[Special:MyLanguage/GI Bleeding (Peds)|Rectal bleeding]] (+/- pain) | |||
**Most common presentation in <5yrs | **Most common presentation in <5yrs | ||
**May be intermittent or massive | **May be intermittent or massive | ||
*[[bowel obstruction|Obstruction]] (due to [[intussusception]] or [[volvulus (peds)|volvulus]]) | *[[Special:MyLanguage/bowel obstruction|Obstruction]] (due to [[Special:MyLanguage/intussusception|intussusception]] or [[Special:MyLanguage/volvulus (peds)|volvulus]]) | ||
**May lead to [[ischemic bowel|bowel ischemia]], [[pediatric shock|shock]] | **May lead to [[Special:MyLanguage/ischemic bowel|bowel ischemia]], [[Special:MyLanguage/pediatric shock|shock]] | ||
*[[Diverticulitis]] | *[[Special:MyLanguage/Diverticulitis|Diverticulitis]] | ||
*Umbilical fistula | *Umbilical fistula | ||
**1/3 will perforate | **1/3 will perforate | ||
*Traumatic rupture after blunt trauma possible | *Traumatic rupture after blunt trauma possible | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Lower GI bleeding DDX}} | {{Lower GI bleeding DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Meckel's Diverticulum AFIP.jpg|thumb|Meckel's diverticulum in a surgical specimen.]] | [[File:Meckel's Diverticulum AFIP.jpg|thumb|Meckel's diverticulum in a surgical specimen.]] | ||
===Workup=== | ===Workup=== | ||
*Meckel's scan (test of choice), also known as technetium-99m pertechnetate scan | *Meckel's scan (test of choice), also known as technetium-99m pertechnetate scan | ||
===Diagnosis=== | ===Diagnosis=== | ||
==Management== | ==Management== | ||
*[[NG tube|NGT]] | |||
*Broad-spectrum [[pediatric antibiotics|antibiotics]] | *[[Special:MyLanguage/NG tube|NGT]] | ||
*[[IVF]] | *Broad-spectrum [[Special:MyLanguage/pediatric antibiotics|antibiotics]] | ||
*[[pRBCs]] PRN | *[[Special:MyLanguage/IVF|IVF]] | ||
*[[Special:MyLanguage/pRBCs|pRBCs]] PRN | |||
*Surgery consult | *Surgery consult | ||
==See Also== | ==See Also== | ||
*[[Abdominal pain (peds)]] | |||
*[[Special:MyLanguage/Abdominal pain (peds)|Abdominal pain (peds)]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
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[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:GI]] | [[Category:GI]] | ||
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Latest revision as of 23:44, 4 January 2026
Background
- 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
- 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
Evaluation
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
See Also