Let’s shift gears a little bit and talk
about another type of presentation.
Here’s a five-year-old girl who’s
coming into the emergency department
with bloody and occasionally
Lab works shows that she’s got a little
bit of an iron deficiency anemia.
She denies pain.
And according to mom, other
than strange stools,
she’s been relatively asymptomatic.
We like to think of the
appendix as an outpouching
of intestinal material
around the cecum.
And in this case, this is
another one that happens
in only a smaller percentage
of the population.
So this is going to be a
The Meckel’s diverticulum is a failed
involution of the vitelline duct.
As you can see on the slide here,
it’s generally an outpouching, a
diverticulum, of the intestine
that’s heading up
towards the umbilicus.
This is the most common true
diverticulum in humans.
And it’s the common congenital
malformation of the GI tract.
So an important rule to
remember is the rule of twos.
This is highly likely to show
up on a multiple choice exam.
So Meckel’s diverticulums occur
in 2% of the population.
They are two times as common in
males than they are as females.
They are generally 2 inches long.
They generally occur 2 feet
before the ileocecal valve.
And so if you can remember
those rules of twos,
you’ll be in good shape on the
exam that you’re going to take.
Generally, these patients will present
with bleeding from their Meckel’s
and we’ll talk about
why in a second.
But you’ll see that they’ll
have melanotic or black stools.
They may have bloody
stools or rectal bleeding.
But in general, they’ll be asymptomatic,
they won’t have pain from this.
It will just be a brisk GI bleed.
Occasionally, they can
develop bowel obstruction
and occasionally, they may
get some anemia as well.
Generally, it’s a slow bleed.
So they may have an iron
deficiency anemia from
simply not replacing
their body iron stores
as they’re making new blood
to replace the old blood.
The bowel obstruction may be from
something called an intussusception
and we’ll learn about that in
another talk but keep that in mind.
The way we test for a Meckel’s diverticulum
is by using a radionucleotide scan,
And we’re going to look for
gastric mucosa that is
outside the stomach.
So you can see here that mucus cells
have taken up the pertechnetate
and they’ve done it as where
the arrow shows on this slide
at the level of a Meckel’s,
which is outside the stomach,
which is the large dark blob that
you can see at the top of the slide.
70% of cases of a Meckel’s
will be found this way.
But that means that 30% of
cases of Meckel’s will not.
So if we suspected a
Meckel’s that will not,
we’ll look for other imaging
modalities like ultrasound,
MRI, and CAT scan like we
did in the appendicitis.
How do we treat a Meckel’s?
Simply just like we did in appendicitis,
this requires a surgical excision.
So in summary, those are two
common problems in children
which are outpouchings or
diverticuli of the intestinal wall
that can cause problems in children.
Meckel’s is a painless bleed whereas the
appendicitis is an acute infection.
Thanks for your attention.