Meckel's diverticulum: Difference between revisions
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==Background== | ==Background== | ||
*Most common cause of significant | *Most common cause of significant lower [[gastrointestinal bleeding (peds)|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%) | ||
*2 x more common in boys | *2 x more common in boys | ||
== | ==Clinical presentation== | ||
*Rectal bleeding (+/- pain) | *[[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 | ||
*Obstruction ( | *[[bowel obstruction|Obstruction]] (due to [[intussusception]] or [[volvulus (peds)|volvulus]]) | ||
*Diverticulitis | **May lead to [[ischemic bowel|bowel ischemia]], [[pediatric shock|shock]] | ||
*[[Diverticulitis]] | |||
*Umbilical fistula | *Umbilical fistula | ||
**1/3 will perforate | **1/3 will perforate | ||
*Traumatic rupture after blunt trauma possible | |||
==Differential Diagnosis== | |||
{{Lower GI bleeding DDX}} | |||
==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 | ||
==Management== | ==Management== | ||
*NGT | *[[NG tube|NGT]] | ||
*IVF | *Broad-spectrum [[pediatric antibiotics|antibiotics]] | ||
*pRBCs | *[[IVF]] | ||
*[[pRBCs]] PRN | |||
*Surgery consult | *Surgery consult | ||
Revision as of 18:08, 6 October 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