PEDIATRICS
■ Abdominal pain
■ Bilious emesis
■ Abdominal distention
■ Hematochezia
DIAGNOSIS
■ Based on clinical suspicion
■ Abdominal radiograph (AXR): No gas beyond the duodenum. The classi-
cal AXR for duodenal obstruction is the “double bubble” sign of air fluid
level in the stomach and proximal duodenum.
■ Upper GI series: Obstruction at the level of the duodenum, with ligament
of Treitz present to the right of the vertebral column and a “corkscrew”
appearance of the jejunum in the right upper quadrant (RUQ).
■ Barium enema shows a mobile cecum present in the RUQ.
TREATMENT
■ IV fluid resuscitation
■ IV antibiotics
■ NGT to decompress proximal bowel
■ Emergent surgical consultation
COMPLICATIONS
■ Recurrent volvulus in 5–10%
■ Short-gut syndrome if large portion of bowel resected
MECKEL’SDIVERTICULUM
Meckel’s diverticulum is a short, blind pouch extending from the ileum, usu-
ally within 100 cm of the ileocecal valve. It may be lined with ectopic
mucosa, such as gastric mucosa, which may ulcerate and bleed, leading to
painless lower GI bleeding in children. In children, roughly 50% of lower GI
bleeding is due to a Meckel’s diverticulum. Fifty percent of cases will present
by 1 year of age; 70% of cases by 2 years of age.
SYMPTOMS/EXAM
■ May be asymptomatic
■ If the diverticulum ulcerates, the child may present with massive lower GI
bleeding.
DIAGNOSIS
A labeled Technetium-99m scan (Meckel scan) may demonstrate the pres-
ence of ectopic gastric mucosa within the Meckel’s diverticulum.
TREATMENT
If symptomatic, surgical excision is indicated.
COMPLICATIONS
■ Massive lower GI bleeding, with resulting anemia and hemorrhagic shock
■ Meckel’s diverticulum can act as the lead point for intussusception.
■ Perforation and peritonitis
Bilious emesis in a neonate is
malrotation until proven
otherwise.Rule of 2s for Meckel’s
diverticulum:
2%prevalence, 2 :1 male to
female ratio, 2 feetproximal
to ileocecal valve and half of
those symptomatic are under
2 yearsold.Classic AXR for duodenal
obstruction: Double bubble
sign.