Intussusception vs Meckel diverticulum
How to tell Intussusception and Meckel diverticulum apart when a board question makes them look alike.
Intussusception is painful telescoping with target sign; Meckel is painless bleeding from ectopic gastric mucosa.
Side by side
Episodic colicky abdominal pain, vomiting, drawing legs up, currant jelly stool, and target sign from telescoping bowel.
Painless lower GI bleeding in a child from an ileal vitelline duct remnant with ectopic gastric mucosa.
A segment of bowel telescopes into distal bowel, dragging mesentery and causing intermittent obstruction and ischemic mucosal bleeding.
Persistent vitelline duct remnant contains ectopic gastric mucosa that ulcerates adjacent ileal mucosa.
Ultrasound target sign or lead point with episodic pain supports intussusception.
Technetium scan detecting ectopic gastric mucosa supports Meckel diverticulum.
The trap
Both cause hematochezia in young children, but the pain pattern decides. Intussusception is PAINFUL telescoping with episodic colicky abdominal pain (drawing knees up), currant jelly stools (mucus plus blood), and a sausage-shaped right-upper-quadrant mass most common in 6-month to 2-year-old; target sign on ultrasound, treat with air or contrast enema reduction. Meckel diverticulum is PAINLESS rectal bleeding from ectopic gastric mucosa within the diverticulum secreting acid that ulcerates the adjacent ileum, classic in children under 2 years following the rule of 2's (2 percent of population, 2 feet from ileocecal valve, 2 inches long, presents under age 2, can contain 2 tissue types: gastric and pancreatic). Diagnose Meckel with technetium-99m pertechnetate (Meckel scan); treat with surgical resection.
The repair move
For pediatric blood per rectum, ask whether the child has painful obstruction or painless ectopic mucosa bleeding.
Try a free question
CoreA toddler has episodic abdominal pain, vomiting, and currant jelly stools. Ultrasound shows a target sign. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Intussusception. Intussusception is telescoping bowel that causes intermittent colicky pain and target sign.
Why the other choices are tempting
- B. Meckel diverticulum usually causes painless lower GI bleeding from ectopic gastric mucosa.
- C. Midgut volvulus causes acute bilious vomiting and twisting around the mesenteric axis.
- D. Hirschsprung causes delayed meconium and chronic distal obstruction.
- E. Celiac disease causes chronic malabsorption.
Flashcards
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What imaging clue defines intussusception?
A target sign on ultrasound supports telescoping bowel.
What scan detects Meckel diverticulum?
A technetium scan can detect ectopic gastric mucosa.
Quick answers
What is the fastest way to tell Intussusception from Meckel diverticulum?
Intussusception is painful telescoping with target sign; Meckel is painless bleeding from ectopic gastric mucosa.
What is the key clue for Intussusception?
Episodic colicky abdominal pain, vomiting, drawing legs up, currant jelly stool, and target sign from telescoping bowel.
What is the key clue for Meckel diverticulum?
Painless lower GI bleeding in a child from an ileal vitelline duct remnant with ectopic gastric mucosa.
What is the common trap with Intussusception vs Meckel diverticulum?
Both cause hematochezia in young children, but the pain pattern decides. Intussusception is PAINFUL telescoping with episodic colicky abdominal pain (drawing knees up), currant jelly stools (mucus plus blood), and a sausage-shaped right-upper-quadrant mass most common in 6-month to 2-year-old; target sign on ultrasound, treat with air or contrast enema reduction. Meckel diverticulum is PAINLESS rectal bleeding from ectopic gastric mucosa within the diverticulum secreting acid that ulcerates the adjacent ileum, classic in children under 2 years following the rule of 2's (2 percent of population, 2 feet from ileocecal valve, 2 inches long, presents under age 2, can contain 2 tissue types: gastric and pancreatic). Diagnose Meckel with technetium-99m pertechnetate (Meckel scan); treat with surgical resection.