Meckel's diverticulum

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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

Lower gastrointestinal bleeding

Management

  • NGT
  • Broad-spectrum antibiotics
  • IVF
  • pRBCs PRN
  • Surgery consult

See Also

Abdominal Pain (Peds)