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TREATMENT

Treatment consists of large-bore IV placement, vigorous fluid resuscitation

with crystalloid and blood products, cardiac monitoring with institution of

vasopressors as needed, and emergent surgical consultation. If the patient is

unstable, do not wait for further diagnostic studies. Emergent laparotomy is

the only life-saving treatment for massive bleeding.

Meckel Diverticulum

This is the most prevalent congenital anomaly of the GI tract. Approximately 2%

of the population is affected. Males are more commonly affected. Most are found

in the ileum within 2 feet of the ileocecal valve. Many contain heterotopic tis-

sues, the most common of which are gastric mucosa and pancreatic acini.

SYMPTOMS/EXAM

Symptoms may include rectal bleeding and abdominal pain, distention, nausea

and vomiting with obstruction, strictures, or intussusception.

DIAGNOSIS

Diagnosis is most often made incidentally during radiographic imaging,

endoscopy, or surgery. Radionuclide scanning and angiography can be used to

locate the source of bleeding during acute hemorrhage from the diverticulum.

TREATMENT

■ Surgical resection of the diverticulum is indicated in patients with compli-

cations.

■ Expectant management in patients with asymptomatic diverticulae found

incidentally is acceptable.

COMPLICATIONS

Intussusception, SBO, bleeding from heterotopic gastric mucosa, strictures

from diverticulitis

Small-Bowel Neoplasms

Primary small-bowel cancers are rare. Adenocarcinomas, carcinoid tumors,

and lymphomas make up the majority of these malignancies. Other benign

neoplasms of the small bowel include adenomas, fibromas, lipomas, and neu-

rofibromas, which are generally found incidentally in the duodenum during

EGD. Most patients with small-bowel cancer are in their fifth and sixth

decades. Risk factors include ingestion of red meat and smoked or cured

foods, Crohn disease, hereditary nonpolyposis, colorectal cancer (HNPCC),

familial adenomatous polyposis (FAP), and Peutz-Jeghers syndrome.

SYMPTOMS/PHYSICALEXAM

■ Most small-bowel neoplasms remain asymptomatic until they are large.

■ Abdominal distention, nausea, and vomiting associated with small-bowel

obstruction.

■ Exam may be benign as only 25% of small intestinal tumors are associated

with abdominal mass. Findings of small-bowel obstruction, cachexia, jaun-

dice, hepatomegaly, and ascites are late findings.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Rule of 2s for Meckel

diverticulum:

2% prevalence, 2:1 male-to-

female ratio, 2 feet proximal

to ileocecal valve, and half of

those symptomatic are

<2 years of age

The small bowel is most

commonly infiltrated by

metastases from distant sites

or by direct invasion of a

malignancy of an adjacent

organ. Melanoma has a

predilection for metastases to

the small intestine.