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Updated: Dec 25 2021

Meckel Diverticulum

Images diverticulum.jpg
  • 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
    • Abdominal X-ray
      • sometimes can be observed with plain films
    • 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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