Meckel`s diverticulum
 It is the most common small intestinal malformation .
 it is a vetilline duct anomaly.
Incidence:
 the true incidence is unknown because the majority
are asymptomatic.
 generally it present in 2% of population and only 4%
become symptomatic .
 Heterotopic tissue is the most common cause of
complications .
Clinical presentations:
 most cases are asymptomatic.
 . the symptomatic cases present in three major forms:
1- lower GI bleeding 40%-60%
2- intestinal obstruction 25%
3- diverticulitis 10-20 %
Diagnosis:
depending on patient's presentation
If patient present with rectal bleeding :
1- technetium 99m scan : which helps to detect ectopic
gastric mucosa
2- angiography : its draw back includes:
(1) very invasive.
(2):ulcer should be actively bleed.
3- laparotomy and laparoscopy.
4- wireless capsule endoscopy.
For nonhaemorrhagic patient : these patients can be
investigated according to their complaints such as
plain abdominal radiograph, U/S , and other
investigative techniques.
Treatment:
 patient with bleeding per rectum due to meckel`s
diverticulum, do resuscitation, then after stabilization
of patient condition ,send patient for elective
diverticulectomy plus appendectomy by laparotomy or
laparoscopic approach.
 Other patients treated accordingly.
intussusception
 It is one of the most common causes of intestinal
obstruction in infants and toddlers.
 it occurred when one portion of the bowel enters into
immediately adjacent one commonly it is proximal
into distal.
Etiology:
The primary (idiopathic) type:
 can occur at any age , but mostly between (5-9) months of
life .
 occur with the wake of the upper respiratory tract infection
and episode of gastroenteritis.
Secondary type:
 in this case a definite anatomical lead point had been
found.
 its incidence is 2-12% of cases and usually present after 2
years of age.
 the most frequent lead point is meckel`s diverticulum ,
others include: appendix , polyp, submucosal haemorrhage
,foreign body and tumors.
Clinical presentation :
 : the patient is usually well nourished , healthy infant
and 2/3 of cases are male.
 sudden attacks of acute abdominal crump described as
screaming attacks .
 vomiting : which become bilious due to intestinal obst.
 red current jelly bowel motion appear which is mixture
of blood with mucus secretion due to ischemia.
Physical examination
1- the vital signs are normal initially ,but later tachycardia
fever, dehydration even septic shock may occuer.
2- abdominal exam shows:intraabdominal mass and empty
RIF (dances sign)
3- per rectal (PR) exam shows red current jelly , and even may
touch the intussusception mass.
4- prolapsing mass though the anus ,which is a grave sign and
must be differentiated from simple rectal prolaps.
I
Investigation:
1- plain abdominal x-ray slows :air/fluid level, soft tissue
mass , abnormal gas distribution.
2- U/S shows target sign ( in transverse section) and
psuedokidney sign (in longitudinal view) .
3- contrast enema (diagnostic and therapeutic)shows
claw sign.
4- CT scan : intraluminal mass with layered appearance.
Treatment:
: 1- resuscitation
2- reduction of intuss. Which done either by operative
or nonoperative method.
A- nonoperative method by :
hydrostatic reduction or
pneumatic reduction.
B- operative method by laparotomy.