Updated: 9/28/2020

Meckel Diverticulum

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Snapshot
  • A 2-year-old boy with no significant past medical history presents with bright red blood per rectum in his diaper. His parents were immediately concerned and called the pediatrician. The patient is not in much pain but cries when the RLQ is palpated. A technetium-99m scan comes back positive for Meckel’s diverticulum.
Introduction
  • Congenital diverticulum presenting in childhood
    • note, is a “true” diverticulum, with all 3 layers of the gut wall outpouched 
    • note, distinct from diverticulosis (false diverticula) and diverticulitis (inflammation of diverticula)
  • Pathogenesis
    • persistence of vitelline (omphalomesenteric) duct in small intestine
      • due to failed obliteration of the vitelline duct
    • may have ectopic acid-secreting gastric or pancreatic tissue
  • Epidemiology
    • most common congenital anomaly of gastrointestinal tract
  • Rule of 2’s
    • affects 2% of population
    • 2 feet from ileocecal valve
    • 2 inches long
    • 2 types of epithelia tissue: gastric and pancreatic
    • male:female ratio 2:1
    • patients < 2 years old
    • 2% symptomatic
Presentation
  • Symptoms 
    • painless rectal bleeding
      • due to gastric acid secretion causing damage to small bowel tissue
    • normal abdominal exam
    • may serve as lead point for intussusception
      • small bowel obstruction
Evaluation
  • Most commonly discovered as incidental finding on laparotomy
  • Technetium-99m scan aka Meckel scan
    • most accurate test
    • technetium-99m pertechnetate radioisotope is taken up by ectopic gastric mucosa
  • Upper GI series with small bowel follow-through can also detect
Differential Diagnosis
  • Intussusception
  • Appendicitis
  • Hirschsprung’s disease
Treatment
  • Surgical removal
Prognosis, Prevention, and Complications
  • Complications
    • hemorrhage (most common)
    • SBO
    • diverticulitis
    • perforation
Topic Rating

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Questions (8)

(M1.GI.17.4740) A mother brings her 2-year-old son to the pediatrician following an episode of abdominal pain and bloody stool. The child has otherwise been healthy and growing normally. On physical exam, the patient is irritable with guarding of the right lower quadrant of the abdomen. Based on clinical suspicion, pertechnetate scintigraphy demonstrates increased uptake in the right lower abdomen. Which of the following embryologic structures is associated with this patient’s condition? Tested Concept

QID: 108653
1

Metanephric mesenchyme

6%

(14/245)

2

Ductus arteriosus

3%

(7/245)

3

Vitelline duct

70%

(172/245)

4

Paramesonephric duct

7%

(16/245)

5

Allantois

11%

(27/245)

M 1 C

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(M1.GI.14.70) A 1-year-old previously healthy baby boy presents to the emergency department with 3 hours of intermittent abdominal pain, vomiting, and one episode of dark red stools. On exam, his abdomen is tender to palpation, and there are decreased bowel sounds. A CT scan reveals air fluid levels and a cystic mass in the ileum. Gross specimen histology reveals gastric tissue. What is the cause of this patient's problems?
Tested Concept

QID: 106478
1

Obstruction of the lumen of the appendix by a fecalith

2%

(1/43)

2

Abnormal closure of the vitelline duct

74%

(32/43)

3

Twisting of the midgut secondary to malrotation

16%

(7/43)

4

Hypertrophy of the pylorus

0%

(0/43)

5

Ingestion of contaminated water

5%

(2/43)

M 1 B

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(M1.GI.14.64) A concerned father brings his 2 year-old son to the clinic for evaluation. In the past 24 hours, the child has had multiple episodes of painless bloody stools. On physical examination, the child's vital signs are within normal limits. There is mild generalized discomfort on palpation of the abdomen but no rebound or guarding. A technetium-99m (99mTc) pertechnetate scan indicates increased activity in two locations within the abdomen. Cells originating in which organ account for the increased radionucleotide activity? Tested Concept

QID: 106459
1

Stomach

52%

(24/46)

2

Pancreas

13%

(6/46)

3

Small intestine

22%

(10/46)

4

Gallbladder

4%

(2/46)

5

Liver

2%

(1/46)

M 1 B

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(M1.GI.13.33) An 8-month-old boy is brought to the emergency room by his mother who notes that the child has not been passing stool regularly. Palpation and radiographic imaging of the umbilical region reveal the presence of fecal material in an abnormal out-pocketing of bowel. Which of the following is a common complication seen in this condition? Tested Concept

QID: 101927
1

Enlarged rugal folds

9%

(10/112)

2

Dysplasia

3%

(3/112)

3

Ulceration

44%

(49/112)

4

Megacolon

34%

(38/112)

5

Paneth cell metaplasia

6%

(7/112)

M 4 D

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(M1.GI.12.43) A 2-year-old female with abdominal pain undergoes laparoscopic surgery. An outpouching of tissue is excised from the ileum and sent to the laboratory for evaluation. The pathologist notes inflammation and the presence of mucosa, submucosa, and muscle in the walls of the specimen. Which of the following is the most likely diagnosis? Tested Concept

QID: 101937
1

Hirschprung's disease

4%

(8/198)

2

Crohn's disease

8%

(16/198)

3

Meckel's diverticulum

84%

(166/198)

4

Appendicitis

3%

(5/198)

5

Henoch-Schonlein purpura

0%

(0/198)

M 1 E

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(M1.GI.12.2) A 2-year-old male is brought to his pediatrician by his mother because of abdominal pain and blood in the stool. Scintigraphy reveals uptake in the right lower quadrant of the abdomen. Persistence of which of the following structures is the most likely cause of this patient's symptoms? Tested Concept

QID: 101896
1

Urachus

6%

(4/65)

2

Omphalomesenteric duct

60%

(39/65)

3

Paramesonephric duct

5%

(3/65)

4

Allantois

15%

(10/65)

5

Ureteric bud

3%

(2/65)

M 1 D

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Evidence (5)
Topic COMMENTS (7)
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