Child's rectal bleeding linked to congenital intestinal defect
Blood is an alarming sight for parents and sometimes even grabs the attention of experienced pediatricians. When a mother called one of my pediatric partners one evening with concerns about her son's rectal bleeding, the physician carefully reviewed the child's recent history and symptoms.
The first-grader had seen blood during two bowel movements that day, but was not complaining of either rectal or abdominal pain. The list of possible causes of pediatric rectal bleeding is quite long, but often an isolated case of rectal bleeding in a child is simply related to constipation and the passage of large hard stools. Well aware of this, my partner still urged the boy's mother to call if the bleeding recurred that night.
When mom observed blood in the toilet later that same evening, she paged again and the family was sent to the emergency department for further evaluation. Lab work showed a dramatically low blood count, and the combination of painless rectal bleeding and significant blood loss led the medical team to suspect a case of Meckel's diverticulum.
Meckel's diverticulum occurs in only 2 percent to 3 percent of the population, but ranks as one of the most common congenital intestinal defects. In a study published online by Dr. Rory Smoot and his colleagues at the Mayo Clinic, Meckel's is described as a diverticulum or outpouching of the ileum, the last portion of the small intestine. Meckel's results when the vitelline duct does not completely disappear as expected sometime during the fifth to seventh weeks of fetal life.
The Mayo group explains that this anatomic condition is known by its “rule of two” since the Meckel's defect is a top consideration among kids under 2 years of age who experience GI bleeding. In addition, the lesion typically measures 2 inches in length and is found about 2 feet above the ileocecal valve separating the small and large intestines. Meckel's diverticulum is also seen about twice as often in males.
Experts at the American Pediatric Surgical Association note that the vast majority — more than 95 percent — of individuals with Meckel's diverticula will have no symptoms. The intestinal defect tends to be more of a medical issue in the pediatric population with typical symptoms varying with the age of the child.
An affected newborn will most commonly show signs of intestinal obstruction, while a toddler or young child with a Meckel's diverticulum is most often brought to the emergency department after a large GI bleed. In some individuals, a Meckel's diverticulum will present instead with signs of inflammation, mimicking a case of acute appendicitis.
A Meckel's scan can help in diagnosing a bleeding diverticulum. During the scan, a nuclear tracer is injected through an IV and taken up by the lining of the Meckel's diverticulum, highlighting this abnormal intestinal pouch, which is usually found in the lower right abdomen. Treatment of a symptomatic Meckel's diverticulum is surgical and involves removing the troublesome lesion and reconnecting adjacent loops of bowel.
Ÿ Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.