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Virtual Pediatric Hospital: Paediapaedia: Meckel Diverticulum Paediapaedia: Gastrointestinal Diseases

Meckel Diverticulum

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
The most common presentation is painless hematochezia due to ulceration of the ectopic gastric mucosa contained within the diverticulum and this is the most common cause of painless hematochezia in patients less than 2 years old. Present in 2% of the population and 20% of these get complications, usually prior to 2 years old.

Etiology/Pathophysiology:
Is an omphalomesenteric duct remnant persisting at its junction with the ileum and is the most common developmental abnormality of the GI tract. Fifty one percent have ectopic gastric mucosa within them which can ulcerate, leading to bleeding. Complications include volvulus (in neonates), intussusception, and inflammation of the diverticulum or adjacent bowel.

Pathology:
Not applicable

Imaging Findings:
The plain abdominal film is usually unremarkable.

It is best diagnosed via a Tc-99m Pertechnetate scan. In a normal scan, tracer localizes after injection in the stomach and kidneys and over time it migrates from stomach into small bowel and from the kidneys into ureters and bladders. In a positive scan the patient develops immediate tracer localization in the stomach and in the right lower quadrant. False negative scans are seen in Meckel diverticulum that do not contain ectopic gastric mucosa and in Meckel diverticulum with rapid bleeding that prevents the accumulation of tracer in the diverticulum. False positive Meckel scans can be caused by appendicitis, peptic ulcer, hemangioma, abscess, intussusception, Chron's disease, small bowel lymphoma, dilated or ectopic renal collecting structures, and intestinal duplications.

DDX:
For Rectal Bleeding in a Child:

References:

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