Meckel's Diverticulum

Bleeding

Step 1: View clinicals

An 18 month old boy presents soon after passing a large amount of dark red blood per rectum. During the preceding 2 days, he had passed dark red, jelly like stools several times. No other symptoms were present apart from the fact that he had been lethargic for the past 24 hrs. His birth, medical and family histories are unremarkable.


Step 2: Order all relevant investigations

Full Blood Count

WBC: 7,000/mm3 Hb: 9.6 g/dl (low) Hct: 31% Plt: 320,000/mm3

Clotting profile

INR: 1.0 (normal) APTT: 30 sec (normal) TT: 12 sec (normal)

Urgent colonoscopy

A large amount of altered blood is present the colon, preventing proper visualization of the colonic walls.

Tc 99m pertechnate scan

An area of focal uptake is seen in the right lower quadrant of the abdomen. This focus appears at the same time as gastric activity, and its intensity increases in parallel with gastric activity.


Step 3: Select appropriate management

IV fluids stat
Prophylactic antibiotics
Air enema
Urgent surgery


Score: ★★☆