MECKELS DIVERTICULUM

painless rectal bleeding

stool may be bright red, dark or maroon red
bleeding is often associated with anemia, and many children will require
transfusion
hemoglobin-positive stools and chronic anemia should be evaluated for a
Meckel diverticulum
crampy abdominal pain, bilious vomiting, and obstipation
pass currant jelly stools and physical examination may demonstrate a
palpable abdominal mass
Meckel diverticulitis is often misdiagnosed as appendicitis due to similar
presenting symptoms, including periumbilical pain that may be associated
with nausea, vomiting, and fever
RULE IN
6 months old
--- present before age of 2 years old
stool is typically described as brick colored or currant jelly colored
Bleeding from a Meckel diverticulum can also be less dramatic, with
melanotic stools
Crampy abdominal pain
RULE OUT
male
---- 2x common in female
Palpable abdominal mass
LEARNING ISSUE
Does the patient had painless rectal bleeding?
---majority of symptomatic Meckel diverticula are lined by an ectopic mucosa, including an acid-
secreting mucosa that causes intermittent painless rectal bleeding by ulceration of the adjacent
normal ileal mucosa
--- bleeding is often associated with anemia, and many children will require transfusion, for this
patient he was transfuse with packed RBC

Did the patient vomit? What is the color?

Bilous vomiting, due to obstruction
Was Tc-99 scan done? Whats the result?
-- most sensitive study is a Meckel radio- nuclide scan, which is performed after intravenous
infusion of technetium-99m pertechnetate
-- sensitivity of the enhanced scan is approximately 85%, with a specificity of approximately 95%.
 RULE IN RULE OUT
6 months old
-- present before age of 2 years old
-- is the most common congenital GI anomaly,
occurring in 2-3% of all infants
Brick red or currant jelly stool
-- due to ischemia or necrosis 2 ft to the ileocecal
valve
Melena
-- suggest a lesion proximal to the right colon
(Meckel’s Diverticulum)
diffuse tenderness greater on the right side than on
the left
-- usually located 2 ft proximal to the ileocecal valve
Anemia
-- for the patient hemoglobin is 5.7 which is low and
normal is 10.5-13.5, and meckels diverticulum
accounts for 50% of all lower GI bleeds in children
younger than 2 years of age