@JoePinero
Quick Case: 17 mo M child presenting with painless bright red rectal bleeding x 1 day. Benign physical exam. Afebrile, with stable vitals and normal labs.
Dx: Meckels Diverticulum
T99 scan for diagnosis (Sensitivity 85-97%, Specificity 97%)
Surgical treatment: Indicated in severe cases, significant blood loss, persistent abdominal pain, refractory to medical treatment. Most common procedure is the trans-umbilical laparoscopic-assisted (TULA) Meckel’s diverticulectomy, which allows the exteriorization of the diverticulum through the navel and the performance of the diverticulectomy outside of the abdomen with its repair in relationship to the enteric defect and morphology
Medical treatment: Indicated in the stable, non-severe cases, supportive care, high dose PPI, IV hydration
Etiology: obliteration defect of the omphalomesenteric duct, and for this reason it is localized on the antimesenteric border of the ileum, up to 100 cm from the ileocecal valve. When the MD is symptomatic, it may be responsible for severe episodes of intestinal bleeding, intussusception, bowel obstruction, or recurrent abdominal pain with repeated vomiting and/or nausea. The presence of heterotopic mucosa, mostly gastric or pancreatic but also colic, is found in 20%-30% of cases
Rule of 2’s:
2% population (most common congenital anomaly of GI tract)
2:1 male:female
2 feet or less from ileocecal valve
2 inches long
2% develop complications (intussusception, bleeding, bowel obstruction, recurrent abominal pain)
Lastly, here is a brief refresher on normal pediatric vital signs
