Intussusception vs Meckel diverticulum
How to tell Intussusception and Meckel diverticulum apart when a board question makes them look alike.
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Intermittent colicky pain with ultrasound target sign points to intussusception, while painless bleeding with positive Meckel scan points to Meckel diverticulum.
Side by side
Intussusception causes episodic severe colicky pain with knee-to-chest posture, vomiting, and sometimes currant jelly stool in infants and toddlers.
Meckel diverticulum classically causes painless lower GI bleeding from ectopic gastric mucosa, often in a well-appearing young child.
A proximal bowel segment telescopes into distal bowel causing venous congestion, edema, and intermittent obstruction.
Persistent vitelline duct remnant containing ectopic acid-secreting mucosa ulcerates adjacent ileal tissue and bleeds.
Ultrasound shows target or doughnut sign with concentric bowel rings; air or contrast enema is diagnostic and therapeutic when no peritonitis is present.
Technetium-99m pertechnetate scan demonstrates ectopic gastric mucosa; CBC may show iron-deficiency pattern with recurrent bleeding.
The trap
Bloody stool alone can mislead clinicians toward gastroenteritis or fissure, but episodic pain behavior and sonographic target sign should trigger immediate enema reduction before ischemia develops.
The repair move
Next best step: if intussusception is suspected without peritonitis or shock, start IV fluids and perform urgent pneumatic or contrast enema reduction under radiologic guidance; proceed to surgery if reduction fails or perforation signs appear. If the child instead has painless recurrent hematochezia and Meckel scan positivity, schedule surgical diverticulectomy or segmental ileal resection.
Try a free question
CoreA 16-month-old girl has intermittent severe abdominal pain and one stool streaked with blood. BP 92/56 mm Hg, HR 148/min, temp 37.5 C. Ultrasound shows a target sign and there is no guarding. What is the next best step in management?
Show answer and explanation
Answer: A. Urgent pneumatic enema reduction. Stable intussusception without peritoneal signs is treated first with radiologic enema reduction.
Why the other choices are tempting
- B. Wrong because target-sign colicky syndrome already identifies intussusception pathway.
- C. Wrong because iron alone does not address bowel telescoping risk.
- D. Wrong because colonoscopy is not first-line in this acute toddler emergency.
- E. Wrong because nonintervention risks bowel ischemia.
Flashcards
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Which imaging test is first-line for suspected intussusception in a toddler with episodic abdominal pain?
Abdominal ultrasound is first-line and looks for the target sign.
What symptom pattern best distinguishes Meckel diverticulum from intussusception?
Painless lower GI bleeding favors Meckel, while severe intermittent colicky pain favors intussusception.
Quick answers
What is the fastest way to tell Intussusception from Meckel diverticulum?
Intermittent colicky pain with ultrasound target sign points to intussusception, while painless bleeding with positive Meckel scan points to Meckel diverticulum.
What is the key clue for Intussusception?
Intussusception causes episodic severe colicky pain with knee-to-chest posture, vomiting, and sometimes currant jelly stool in infants and toddlers.
What is the key clue for Meckel diverticulum?
Meckel diverticulum classically causes painless lower GI bleeding from ectopic gastric mucosa, often in a well-appearing young child.
What is the common trap with Intussusception vs Meckel diverticulum?
Bloody stool alone can mislead clinicians toward gastroenteritis or fissure, but episodic pain behavior and sonographic target sign should trigger immediate enema reduction before ischemia develops.