Abdominal pain is a common presenting symptom with a broad array of potential etiologies. Meckel diverticulum (MD), the most common congenital gastrointestinal malformation, classically presents with painless gastrointestinal bleeding. However, it can also lead to diverticulitis, intussusception, or obstruction, manifesting as abdominal pain.
A 2-year-old boy presented to the emergency department with intermittent abdominal pain, vomiting, and loose stools. Abdominal ultrasound findings were consistent with ileitis and ileocolic intussusception, but no such intussusception was seen during fluoroscopic air enema. The patient was admitted for serial abdominal examinations and subsequently developed an acute abdomen. Emergent laparotomy revealed a perforated MD. Small bowel resection and primary anastomosis were performed and no complications developed.
Why Should an Emergency Physician Be Aware of This?
The presence of an MD can lead to diverticulitis, intussusception, or obstruction, putting the patient at risk of bowel perforation. As such, it is important to consider MD in the differential diagnosis of patients with abdominal pain. In cases in which sonographic findings are ambiguous or transient, additional observation or alternative imaging, such as computed tomography, should be strongly considered.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Acute abdominal pain.Pediatr Rev. 2018; 39: 130-139
- Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002).Ann Surg. 2005; 241: 529-533
- Meckel’s diverticulum in children: a 20-year review.J Pediatr Surg. 1991; 26: 1289-1292
- Diverse presentations in pediatric Meckel’s diverticulum: a review of 100 cases.Pediatr Neonatol. 2014; 55: 369-375
- Inverted Meckel’s diverticulum: two case reports and a review of the literature.World J Gastrointest Surg. 2018; 10: 70-74
- Acute terminal ileitis in children: a retrospective study in pediatric emergency department.Pediatr Emerg Care. 2019; 35: 249-251
- Meckel’s diverticulum: a systematic review.J R Soc Med. 2006; 99: 501-505
- Complications and diagnosis of Meckel’s diverticulum in 776 patients.Am J Surg. 1992; 164: 382-383
- The spectrum of heterotopic gastric mucosa in children detected by Tc-99m pertechnetate scintigraphy.Clin Nucl Med. 2001; 26: 529-535
- Meckel diverticulum: radiologic features with pathologic correlatation.Radiographics. 2004; 24: 565-587
- Radiologist’s perspective for the Meckel’s diverticulum and its complications.Br J Radiol. 2014; 87: 21030743
- Emergency surgery for Meckel’s diverticulum.World J Emerg Surg. 2008; 3: 27
Published online: April 19, 2020
Accepted: March 18, 2020
Received in revised form: February 25, 2020
Received: January 12, 2020
Reprints are not available from the authors.
© 2020 Elsevier Inc. All rights reserved.