Meckel's diverticulum history and symptoms: Difference between revisions
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==History and Symptoms== | ==History and Symptoms== | ||
The most common presenting symptom in patients is painless [[rectal bleeding]], followed by less common symptoms of [[intestinal obstruction]], [[volvulus]] and [[intussusception (medical disorder)|intussusception]] in complicated cases. Occasionally, Meckel's diverticulitis may present with all the features of [[acute appendicitis]]. | The most common presenting symptom in patients is painless [[rectal bleeding]], followed by less common symptoms of [[intestinal obstruction]], [[volvulus]] and [[intussusception (medical disorder)|intussusception]] in complicated cases. Occasionally, Meckel's [[diverticulitis]] may present with all the features of [[acute appendicitis]]. | ||
===Common Symptoms=== | ===Common Symptoms=== | ||
* Meckel's diverticulum is usually [[asymptomatic]] and is found incidentally on [[Abdomen|abdominal]] [[imaging]] or surgical exploration performed for a presumptive diagnosis such as [[acute cholecystitis]] (exploratory [[laparotomy]], laproscopy). | * Meckel's diverticulum is usually [[asymptomatic]] and is found incidentally on [[Abdomen|abdominal]] [[imaging]] or surgical exploration performed for a presumptive diagnosis such as [[acute cholecystitis]] (exploratory [[laparotomy]], laproscopy). | ||
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**[[Mechanism (biology)|Mechanism]]: presence of [[Ectopia|ectopic]] [[gastric mucosa]] leads to [[acid]] [[secretion]] within the [[diverticulum]] and [[Ulcer|ulceration]] of the [[Small intestine|small bowel]] | **[[Mechanism (biology)|Mechanism]]: presence of [[Ectopia|ectopic]] [[gastric mucosa]] leads to [[acid]] [[secretion]] within the [[diverticulum]] and [[Ulcer|ulceration]] of the [[Small intestine|small bowel]] | ||
**Site: Downstream or adjacent to the [[diverticulum]] and not within it | **Site: Downstream or adjacent to the [[diverticulum]] and not within it | ||
**May be acute or chronic and insidious | **May be acute or [[Chronic (medical)|chronic]] and insidious | ||
**May be a massive [[Bleeding|bleed]] | **May be a massive [[Bleeding|bleed]] | ||
**Usually painless | **Usually painless | ||
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** Bloody [[Human feces|stool]] or occult [[blood]]<ref name="pmid1985640">{{cite journal |vauthors=Losek JD, Fiete RL |title=Intussusception and the diagnostic value of testing stool for occult blood |journal=Am J Emerg Med |volume=9 |issue=1 |pages=1–3 |year=1991 |pmid=1985640 |doi= |url=}}</ref> | ** Bloody [[Human feces|stool]] or occult [[blood]]<ref name="pmid1985640">{{cite journal |vauthors=Losek JD, Fiete RL |title=Intussusception and the diagnostic value of testing stool for occult blood |journal=Am J Emerg Med |volume=9 |issue=1 |pages=1–3 |year=1991 |pmid=1985640 |doi= |url=}}</ref> | ||
** Current jelly [[Human feces|stools]] (mixture of [[mucus]] and [[blood]]) | ** Current jelly [[Human feces|stools]] (mixture of [[mucus]] and [[blood]]) | ||
** Intermittent pain free intervals in between episodes of pain<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref> | ** Intermittent pain free intervals in between episodes of [[pain]]<ref name="pmid3660243">{{cite journal |vauthors=West KW, Stephens B, Vane DW, Grosfeld JL |title=Intussusception: current management in infants and children |journal=Surgery |volume=102 |issue=4 |pages=704–10 |year=1987 |pmid=3660243 |doi= |url=}}</ref> | ||
*Symptoms of [[bowel obstruction]], more common in adults: | *Symptoms of [[bowel obstruction]], more common in adults: | ||
| Line 41: | Line 41: | ||
*Symptoms of [[diverticular]] inflammation (ie, Meckel's [[diverticulitis]]): may present with features similar to [[Appendicitis|acute appendicitis]] | *Symptoms of [[diverticular]] inflammation (ie, Meckel's [[diverticulitis]]): may present with features similar to [[Appendicitis|acute appendicitis]] | ||
**Alternating [[diarrhea]] and [[constipation]] | **Alternating [[diarrhea]] and [[constipation]] | ||
** | **[[Pain|Painful]] [[Abdominal pain|abdominal cramps]] | ||
** Chills or [[fever]] | ** [[Rigor|Chills]] or [[fever]] | ||
*Symptoms of [[perforation]]:<ref name="urlIntestinal Perforation Clinical Presentation: History, Physical Examination">{{cite web |url=https://emedicine.medscape.com/article/195537-clinical |title=Intestinal Perforation Clinical Presentation: History, Physical Examination |format= |work= |accessdate=}}</ref> | *Symptoms of [[perforation]]:<ref name="urlIntestinal Perforation Clinical Presentation: History, Physical Examination">{{cite web |url=https://emedicine.medscape.com/article/195537-clinical |title=Intestinal Perforation Clinical Presentation: History, Physical Examination |format= |work= |accessdate=}}</ref> | ||
**Severe [[abdominal pain]] intensified by movement | **Severe [[abdominal pain]] intensified by movement | ||
Revision as of 16:06, 2 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
The presentation of Meckel's diverticulum is usually asymptomatic .The hallmark feature in symptomatic patients is the occurrence of painless lower gastrointestinal bleeding. Other symptoms of Meckel's diverticulum arise in complicated cases with features of intestinal obstruction, intussusception, volvulus and perforation. The age of presentation for approximately half of all patients is less than 10 years of age. Patients may also develop symptoms of diverticular inflammation (ie, Meckel's diverticulitis) which has a presentation similar to acute appendicitis.
History and Symptoms
The most common presenting symptom in patients is painless rectal bleeding, followed by less common symptoms of intestinal obstruction, volvulus and intussusception in complicated cases. Occasionally, Meckel's diverticulitis may present with all the features of acute appendicitis.
Common Symptoms
- Meckel's diverticulum is usually asymptomatic and is found incidentally on abdominal imaging or surgical exploration performed for a presumptive diagnosis such as acute cholecystitis (exploratory laparotomy, laproscopy).
- The age of presentation for approximately half of all patients is less than 10 years of age.
Common symptoms of Meckel's diverticulum include:
- Lower gastrointestinal bleeding:
- Mechanism: presence of ectopic gastric mucosa leads to acid secretion within the diverticulum and ulceration of the small bowel
- Site: Downstream or adjacent to the diverticulum and not within it
- May be acute or chronic and insidious
- May be a massive bleed
- Usually painless
- More common in children
- In children: presents as maroon or dark red stools
- In adults: presents as melena as transit time through the colon is increased
- Acute abdominal complaints such as pain in the abdomen may be seen in complicated cases, mimicking the presentation of acute appendicitis
Less Common Symptoms
Less common symptoms of Meckel's diverticulum arise in complicated cases:[1][2]
- Symptoms of intussusception, particularly recurrent or atypical intussusception commonly seen in children:
- Pain: crampy abdominal pain with or without rectal bleeding
- Inconsolable crying
- Drawing up of the legs toward the abdomen[3]
- Vomiting usually after the first episode, initially non-bilious but may convert to bilious as obstruction progresses
- Bloody stool or occult blood[4]
- Current jelly stools (mixture of mucus and blood)
- Intermittent pain free intervals in between episodes of pain[1]
- Symptoms of bowel obstruction, more common in adults:
- Colicky abdominal pain (cramping and intermittent) in nature, with spasms lasting a few minutes
- Vomiting
- Nausea
- Constipation
- Symptoms of diverticular inflammation (ie, Meckel's diverticulitis): may present with features similar to acute appendicitis
- Alternating diarrhea and constipation
- Painful abdominal cramps
- Chills or fever
- Symptoms of perforation:[5]
- Severe abdominal pain intensified by movement
- Chills
- Fever
- Nausea
- Vomiting
References
- ↑ 1.0 1.1 West KW, Stephens B, Vane DW, Grosfeld JL (1987). "Intussusception: current management in infants and children". Surgery. 102 (4): 704–10. PMID 3660243.
- ↑ Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL (1997). "Stool appearance in intussusception: assessing the value of the term "currant jelly"". Am J Emerg Med. 15 (3): 293–8. PMID 9148991.
- ↑ Mandeville K, Chien M, Willyerd FA, Mandell G, Hostetler MA, Bulloch B (2012). "Intussusception: clinical presentations and imaging characteristics". Pediatr Emerg Care. 28 (9): 842–4. doi:10.1097/PEC.0b013e318267a75e. PMID 22929138.
- ↑ Losek JD, Fiete RL (1991). "Intussusception and the diagnostic value of testing stool for occult blood". Am J Emerg Med. 9 (1): 1–3. PMID 1985640.
- ↑ "Intestinal Perforation Clinical Presentation: History, Physical Examination".