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Meckel's Masquerade: Penetrating the Disguise
Deborah L Callanan1, Megan M O'Brien
1From the Division of Emergency Medicine, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX.
Insights
Meckel's diverticulum can cause acute abdominal pain in children, often mimicking other conditions like appendicitis or intussusception. Increased awareness is crucial for timely diagnosis and treatment of this rare but serious condition.
Area of Science:
- Pediatric Gastroenterology
- Surgical Pediatrics
- Emergency Medicine
Background:
- Abdominal pain is a common pediatric emergency department complaint.
- Appendicitis, intussusception, and bowel obstruction are frequent concerns.
- Meckel's diverticulum is an uncommon cause of acute abdomen, often presenting atypically.
Purpose of the Study:
- To highlight Meckel's diverticulum as a cause of acute abdomen in children.
- To increase physician awareness of this condition beyond its typical presentation.
- To report on pediatric cases with unusual presentations of Meckel's diverticulum.
Main Methods:
- Retrospective case review of pediatric patients presenting with abdominal pain.
- Analysis of clinical presentation, diagnostic workup, and management.
- Focus on cases where Meckel's diverticulum was the underlying cause.
Main Results:
- Four pediatric patients presented with abdominal pain due to Meckel's diverticulum complications over six months.
- None of the patients exhibited painless rectal bleeding, a classic sign.
- Presentations mimicked appendicitis, abdominal masses, intussusception, and constipation.
Conclusions:
- Meckel's diverticulum should be considered in the differential diagnosis of acute abdomen in children.
- The condition can present with varied symptoms, challenging diagnosis.
- Raising awareness of atypical presentations is vital for pediatric emergency care.
Abstract:
Children with abdominal pain are frequently seen in emergency departments. Physicians and parents worry about appendicitis; physicians are also concerned about intussusception and bowel obstruction in patients with previous surgical procedures. Sometimes the patient is ill, and the diagnosis is elusive. In a 6-month period at our pediatric emergency department with an annual census of 57,400 patients, we cared for 4 patients who presented with abdominal pain due to complications of Meckel's diverticulum. None presented with painless rectal bleeding, the complication of which physicians are most aware. We are reporting these patients to raise awareness of Meckel's diverticulum as a cause of acute abdomen in children. Meckel's diverticulum may masquerade as appendicitis, an abdominal mass, intussusception, or a complication of severe constipation.
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