Updated: 12/25/2021

Meckel Diverticulum

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  • Snapshot
    • A 12-month-old child has iron-deficiency anemia refractory to iron therapy. His stool is repeatedly positive for occult blood. The parents bring the child to the ER because they notice some blood in his stool. To solidify the lesson, students are shown a gross pathology specimen.
  • Introduction
    • Congenital outpouching of the small intestine
    • Caused by persistance of vitelline duct
    • Found 2 feet from ileocecal valve in most cases
    • Epithelium may be acid-secreting or pancreatic
    • Presents in the first two years of life
  • Epidemiology
    • Occurs in 2% of the population
    • Most common congenital anomaly of the GI tract
    • Most frequently occurs in children < 2 years old
  • Presentation
    • Symptoms
      • rectal bleeding
      • abdominal distention
    • Physical exam
      • painless rectal bleeding
      • can present with signs of obstruction
  • IMAGING
    • Abdominal X-ray
      • sometimes can be observed with plain films
  • STUDIES
    • Meckel scintigraphy
      • diagnostic golden standard
      • rarely seen on barium study
  • Differential
    • Bowel obstruction, Hirschsprung's disease
  • Treatment
    • Surgical intervention
      • surgical excision of diverticulum
        • indicated when there is active bleeding
        • resection along with adjacent intestinal segment
  • Complications
    • May be complicated by diverticulitis, volvulus, and intussusception
  • Prognosis
    • Very good to excellent
    • Some cases are asymptomatic and discovered incidentally

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(M3.PD.16.22) A 2-year-old boy presents to the emergency department with the complaint of acute onset abdominal pain and vomiting. Upon further questioning you find the patient has no past medical history except for occasional painless rectal bleeding the past couple of weeks. Physical exam is significant for an 8/10 sharp pain in the right lower quadrant. Bowel sounds are hyper-active. Laboratory analysis reveals a white blood cell count of 11,000 per mcL. Nuclear imaging is performed and can be seen in Figure A. What is the likely underlying medical condition that lead to this patient's clinical presentation?

QID: 103313
FIGURES:

Appendicitis

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Gastroenteritis

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Diabetic ketoacidosis (DKA)

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Meckel's diverticulum

100%

(5/5)

Encopresis

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(0/5)

M 10 D

Select Answer to see Preferred Response

(M2.PD.15.35) A 14-month-old boy has iron-deficiency anemia refractory to iron therapy. His stool is repeatedly positive for occult blood. The parents bring the child to the emergency room after they notice some blood in his stool. Which of the following is the diagnostic gold standard for this patient's most likely condition?

QID: 104577

Abdominal CT with contrast

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(5/42)

Tagged red blood cell study

7%

(3/42)

Technetium-99m pertechnetate scan

60%

(25/42)

Colonoscopy

19%

(8/42)

Capsule endoscopy

0%

(0/42)

M 6 C

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Evidence (2)
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