From the Guidelines
Meckel's diverticulum typically presents as painless rectal bleeding in children, often described as "currant jelly" stools due to its maroon or brick-red appearance, as a result of peptic ulceration of adjacent ileal mucosa caused by acid secretion from ectopic gastric tissue within the diverticulum. This condition can be diagnosed using a Meckel scan, which involves the intravenous administration of 99mTc pertechnetate, as described in the study by 1. The presentation of Meckel's diverticulum can vary, with some common features including:
- Painless rectal bleeding in children under 2 years of age
- Abdominal pain in the right lower quadrant mimicking appendicitis in older children and adults
- Intussusception, where the diverticulum acts as a lead point, causing intermittent abdominal pain, vomiting, and bloody stools
- Small bowel obstruction due to bands connecting the diverticulum to the umbilicus or from volvulus around these bands According to the study by 1, most symptomatic Meckel diverticula are found in children and young adults, but occasionally can be seen in older individuals and can be considered when other tests are negative. The "rule of 2s" is often used to describe Meckel's diverticulum, where it affects 2% of the population, is typically 2 inches long, located within 2 feet of the ileocecal valve, often becomes symptomatic before age 2, and contains 2 types of ectopic tissue (gastric and pancreatic), as supported by the findings of the study by 1. Many cases of Meckel's diverticulum remain asymptomatic throughout life and are discovered incidentally during surgery or imaging for other conditions, highlighting the importance of considering this condition in the differential diagnosis of gastrointestinal bleeding, as noted in the study by 1.
From the Research
Typical Presentation of Meckel's Diverticulum
- Meckel's diverticulum typically presents with gastrointestinal bleeding, bowel obstruction, intussusception, or perforation in less than 5% of cases 2
- The peak age of presentation is 0-4 years, with common symptoms including rectal bleeding or intestinal obstruction 3
- Meckel's diverticulum has a male predominance, with a male to female ratio of approximately 7:3 3
Common Complications
- Gastrointestinal bleeding is a common complication, often due to the presence of ectopic gastric mucosa 4, 2
- Intestinal obstruction can occur due to torsion around the mesodiverticular band or other mechanisms 4, 5
- Inflammation and perforation are also potential complications, although less common 2, 6
Diagnostic Challenges
- Meckel's diverticulum can be difficult to diagnose, as it may remain asymptomatic or mimic other diseases 6
- The sensitivity and specificity of diagnostic tests, such as the Meckel's scan, can vary depending on the presentation and patient population 3
- Laparoscopy can be a useful tool in diagnosis and treatment, particularly in cases where the diagnosis is uncertain or the patient is experiencing complications 4, 2, 5, 3