Gastrointestinal · Year 2 · from Gastrointestinal
Case 1: Meckel's Diverticulum
Patient Presentation
Demographics: 18-month-old male
Chief Complaint: Painless rectal bleeding
History of Present Illness: Parents noticed brick-red blood mixed with stool during diaper changes for the past 2 days. The child has had three episodes of bloody stools without apparent abdominal pain, fever, or vomiting. He continues to feed normally and is playful between episodes.
Past Medical History: Born at term, uncomplicated delivery, up-to-date on vaccinations
Physical Examination
- Vital Signs: Temperature 37.0C, HR 120 bpm, BP 85/55 mmHg, RR 24/min
- General: Alert, active, well-hydrated infant
- Abdomen: Soft, non-tender, non-distended, no palpable masses, normal bowel sounds
- Rectal: External exam normal, hemoccult-positive stool
Workup and Results
- CBC: Hemoglobin 9.2 g/dL (decreased from baseline), MCV 78 fL
- BMP: Within normal limits
- Meckel Scan (Technetium-99m pertechnetate scintigraphy): Focal uptake in the right lower quadrant consistent with ectopic gastric mucosa
Technetium-99m pertechnetate scan showing focal uptake in the right lower quadrant (arrow), indicating ectopic gastric mucosa within a Meckel's diverticulum.
Image Source: Case courtesy of Radiopaedia.org
Diagnosis
Meckel's Diverticulum with GI Bleeding
Clinical Correlation to Anatomy
Meckel's diverticulum results from incomplete obliteration of the vitelline (omphalomesenteric) duct during embryonic development. It is a true diverticulum located on the antimesenteric border of the ileum, typically within 2 feet of the ileocecal valve. Approximately 50% contain ectopic tissue, most commonly gastric mucosa, which secretes acid causing ulceration of adjacent ileal mucosa and painless bleeding.
Treatment
- Surgical resection of the diverticulum with adjacent ileal segment
- Laparoscopic approach preferred when feasible
- Blood transfusion if hemodynamically significant