Meckel’s Diverticulum

General DataI.S.6 mos oldFemaleFilipinoRoman CatholicPandacan, Manila

Bloody stools

History of Present Illness4days PTC fever (T38.8C),Paracetamol drops

no fever, cough, colds, vomitinggood appetite and activityno consult

2 days PTC persistence prompted consult with AMD, Dx: acute viral illness

1 day PTC lysis of fever 2 episode of dark stools, irrritable,

decrease in appetiteER : SFA ileus; no recurrence of

stoolsDx : AVI, resolving; t/c Milk Allergy

History of Present IllnessFew hrs PTC 2 episode of voluminous

maroon colored stoolsAdmitted

Review of SystemGeneral: (-) weight loss, anorexia, easy

fatigabilityHEENT: no trauma, no ear infection, Neck: (-) limitation of motion, mass,

adenopathy Respiratory: (-) shortness of breath, easy

fatigability, wheezing Cardiology: (-) palpitation or cyanosisMusculoskeletal: (-) swelling, deformities

Past Medical HistoryNo bronchial asthma no Primary Tuberculosis infectionno known allergiesThis is the patient’s first admission

Family History(+) Diabetes: maternal grandparents(+) Hypothyroid : motherNo history of cancer

Birth and Nutritional HistoryBorn to a 34 year old G3P2, non-smoker,

non-alcoholic beverage drinker, with regular prenatal check up

Denied illness during pregnancyBorn Full term via Repeat Ceasarian section

at Cardinal Santos Medical CenterNo fetomaternal complicationsNo history of BreastfeedingEnfapro 6oz/bottle x 12 bottles/dayComplimentary feeding (Cerelac): 6 mos old

ImmunizationBCG 1 DOSE

HEPA B 2 DOSES

DPT 2 DOSES

OPV 2 DOSES

Developmental HistoryPresently, sits with support

Upon arrival ERS>(+) maroon

colored stoolO>pale looking,

irritableHR 106 RR28 clear breath soundssoft abdomen, non tendergood pulses

A>Lower GI bleed t/c Meckel’s Diverticulum

P>lab work up PRBC 10cc/kgpost transfusion Hgb 10.6

Laboratory ExaminationCBC 7.7/23.4/9090/N16 L79 M5/170,000Retic count 0.35Stool Exam RBC 30-40Fecal occult Blood PositivePT 10.4 INR 0.83 181% PTT 41.8Urinalysis <1.005 ph7.5PBS: microcytic hypochromicNa 139 K 4.6 Cl 102 Ca 9.3

Laboratory ExamSFA non specific, non obstructive gas patternMeckel's Diverticulum Scintigraphy which

showed radioactive activity on the right lower quadrant which may represent ectopic gastric mucosa.

Upon arrival at PICUs/p Explore

Laparotomy, Resection of Meckel’s diverticulum with end to end anastomosis

OR findings: 1.5cm Meckel’s Diverticulum approx 25cm from appendix

Estimated Blood Loss <20cc

s/p 160 PRBC (20cc/kg)

P> NPOD5NR x 40cc/hrCefazolin 250mg/IV

(125mkd)Ranitidine 10mg/IV q8Nubain 2mg q6Ketorolac 10mg q6

Second PICU DayS> no bleedingO>BP 90/60,

afebrile Stable VSCBC

13.7/39/11680/N50 L40 M8 B1/268K

P> transfer to regular room

Meckel’s Diverticulumremnant of the embryonic yolk sacEmbyonal stage: omphalomesenteric duct

connects the yolk sac to the gut, nutrition5th and 7th wk AOG: duct separates from the

intestineYolk sac + lining epith similar to stomachPartial or complete failure of involution of the

omphalomesenteric duct results in various residual structures.

FrequencyOccurs in 2–3% of all infantsa 3–6 cm outpouching of the ileum along the

antimesenteric border 50–75 cm from the ileocecal valve

1st 2 years of life, 2.5yo

ManifestationsIntermittent painless rectal bleeding Stool: brick colored or currant jelly colored. Bleeding: self-limited, contraction of the

splanchnic vesselsr/o acute appendicitisDiverticulitis can lead to perforation and

peritonitis

DiagnosisMeckel radionuclide scan: IV infusion of

technetium-99m pertechnetate: mucus secreting ectopic gastric mucosa : visualization of the Meckel diverticulum

sensitivity enhanced scan : 85%specificity : 95%. Other methods of detection: abdominal

ultrasound, superior mesenteric angiography, abdominal CT scan, and exploratory laparoscopy.