Meckel's Diverticulum

MD treatemtn

Abx (broad spectrum) Consult GI doc and surgeon

Blood supply of MD

Has its own - omphalomesenteric artery

Clinical presentation of Meckel diverticulum in children < 2 yo

Painless rectal bleeding (hematochezia)

Most common of vitelline duct anomalies

Vitelline Duct Cyst

MD treatment: GI bleed

1. blood transfusion of RBC packed 2. Upper endoscopy if melana 3. Sigmoidoscopy 4. Surgery 5. IF medically stable: meckel scan = Technetium scan

Physical exam findings of MD

1. Asymptomatic painless rectal bleeding -mainly maroon or bright red -can be dark red 2. If inflamed; peritonitis -guarding and rebound tenderness 3. Bowel obstruction

Rare complications of MD

1. Benign tumors - might cause MD to become 2. Malignant tumors 3. Obstruction and perforation due to Foreign bodies -Psyych pt, PICA

Imaging with MD

Abdominal radiographs: limited value -May see ENTEROLITH -helps dx bowel obstruction

Treatment of MD

Depends on presentation Most are acutely ill 1. NPO 2. IV access 3. Crystalloid fluids to correct fluid abnormality

Types of Vitelline Duct Anomalies

Meckels Vitelline cyst Vitelline fistula

Sx of MD

Mostly asymptomatic

Bowel obstruction tx

NG tube (?) Treat hypovolemia with fluids

Where does MD normally form?

Near the ascending colon - near the appendix

MD in Adults presents with

Obstruction and inflammation -mimics appendicitis - periumbilical pain radiating to RLQ -Abdominal mass may be present *less common: hematochezia or melana*

Complications of MD in adults

Once it gets infected, can swell up and cause -bowel obstruction -hemorrhage -diverticulitis

If GI bleed and you suspect MD is cause order?

Order a technetium 99m scan (IF STABLE) -IV injection of isotope -camera shows a "hot spot" *sensitive and specific in kids, not as much in adults*

Does MD present in neonatal period?

Rarely but when it does..likely to cause 1. Intussusception 2. Volvulus 3. Bowel Obstruction

Bloody mucous stool is described as

Red-Currant Jelly -Can be seen in INtussusceptum -MD could be involved in this

Common complications of MD: diverticulitis

more common in OLDER Periumbilical pain radiating to RLQ

Rule of 2's with MD

2 feet proximal to the ileocecal valve 2 call me wide and 3 cm 2% of the population Usually presents < 2 yo At least 2x more symptomatic in boys

Common complications of MD: obstruction

Adults > Peds -Due to omphalmesenteric band -volvulus around the vitelline duct remains -intussusception

Meckel's Diverticulum (MD)

All layers found in the ileum The tip is free in 75% of cases and attached to anterior abdominal wall *most common congenital abnormality of the small intestine*

What is MD often confused with

Appendicitis -sometimes won't know it is an MD until pt is in surgery for appendectomy

DDX for MD

Appendicitis Intussusception Constipation PUD Chron's/UC Volvulus

2 complications of MD

1. GI bleeding in young children 2. Diverticulitis: obstruction, inflammation, perforation

Physical exam of a bowel obstruction caused by MD

Hypoactive bowel sounds Distended abdomen Hypovolemic shock: tachycardia, HOTN

Work up of MD: Labs?

Not too helpful for dx but need to manage tx for GI bleeds *CBC (IDA* Lytes, creatinine, BUN, glucose Coagulation screen Blood type and cross match