Most children do not have symptoms, but sometimes painless rectal bleeding occurs or the diverticulum becomes infected.
Doctors base the diagnosis on symptoms, the results of a Meckel scan, and sometimes other imaging tests.
A bleeding diverticulum or one that causes symptoms must be surgically removed.
About 2% of infants are born with a Meckel diverticulum.
Complications of Meckel diverticulum
People can live their whole lives without ever knowing they have a Meckel diverticulum, but occasionally the abnormality causes complications. Although diverticula are equally common among boys and girls, boys are 2 to 3 times more likely to have complications. Complications of Meckel diverticulum include
Over half the time, the diverticulum contains tissue like that of the stomach, pancreas, or both. If stomach tissue is present, it can secrete acid just like the stomach does. This acid may cause ulcers and bleeding of the nearby intestine. Bleeding is more common among children under 5 years of age.
Obstruction can occur at any age but is more common among older children and adults. In children, obstruction is most likely caused by intussusception Intussusception Intussusception is a disorder in which one segment of the intestine slides into another, much like the parts of a telescope. The affected segments block the bowel and block blood flow. The cause... read more of the diverticulum.
A Meckel diverticulum may also become inflamed (diverticulitis Diverticulitis Diverticulitis is inflammation of one or more balloon-like sacs (diverticula). Infection may or may not develop. Diverticulitis usually affects the large intestine (colon). Left lower abdominal... read more ). Acute Meckel diverticulitis can occur at any age, but older children are most affected.
A perforation (hole) in the diverticulum causes peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more , which is a very serious and painful inflammation of the abdominal cavity.
Tumors, including carcinoid tumors Carcinoid Tumors and Carcinoid Syndrome Carcinoid tumors are noncancerous (benign) or cancerous (malignant) growths that sometimes produce excessive amounts of hormone-like substances (such as serotonin), resulting in the carcinoid... read more , are rare and occur mainly in adults.
Symptoms of Meckel Diverticulum
Most children with a Meckel diverticulum have no symptoms, and many adults learn they have the condition only after surgeons discover it while doing surgery for another reason.
The most common symptom among children younger than 5 years is painless rectal bleeding, which comes from ulcers in the small intestine caused by acid secreted by the diverticulum. Because of the bleeding, stools may appear bright red or brick-colored or currant jelly–colored because of a mixture of blood and mucus. Sometimes, stool appears black because of the breakdown of blood. Only rarely is the bleeding so severe that the child needs emergency surgery.
In all ages, obstruction causes cramping abdominal pain, nausea, and vomiting. Diverticulitis caused by a Meckel diverticulum causes severe abdominal pain, abdominal tenderness, and vomiting and can easily be confused with appendicitis Appendicitis in Children Appendicitis is inflammation and infection of the appendix. Appendicitis seems to develop when the appendix becomes blocked either by hard fecal material (called a fecalith) or swollen lymph... read more .
Diagnosis of Meckel Diverticulum
For bleeding, Meckel scan, video capsule endoscopy, and enteroscopy
For pain, computed tomography (CT)
It is often difficult for doctors to diagnose a Meckel diverticulum.
If doctors think bleeding from the rectum is caused by a Meckel diverticulum, they do an imaging study called a Meckel scan Meckel scan Nuclear scans are tests that involve the use of harmless radioactive materials ( see Radionuclide Scanning). The radioactive materials are ingested as part of a meal or in a drink or are given... read more . In this study, a small amount of a harmless radioactive substance is given by vein (intravenously). The substance is picked up by cells in the diverticulum, which can then be seen using a radiation-sensing camera. Video capsule endoscopy Video Capsule Endoscopy Video capsule endoscopy (wireless video endoscopy) is a procedure in which the person swallows a battery-powered capsule. The capsule contains one or two small cameras, a light, and a transmitter... read more (in which the child swallows a small camera that can detect sources of bleeding in the small intestine) and enteroscopy (in which a small flexible viewing tube is gently passed into the small intestine) are other tests the can help doctors identify a diverticulum as the source of bleeding.
Children who have abdominal pain often undergo a CT scan Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT— see also Computed Tomography (CT)) and magnetic resonance imaging (MRI— see also Magnetic Resonance Imaging (MRI)) scans are good tools for assessing the size and location... read more , which can help doctors diagnose a diverticulum and other causes of pain. Doctors may also take x-rays of the abdomen.
Treatment of Meckel Diverticulum
No treatment is needed for a diverticulum that does not cause symptoms.
A bleeding diverticulum or one that causes obstruction or ongoing symptoms must be surgically removed.
If a Meckel diverticulum is found in a child during an operation being done for another reason, it may be removed to prevent future complications.