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
