Meckel's diverticulum differential diagnosis

Jump to: navigation, search

Meckel's diverticulum Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Meckel's Diverticulum from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Meckel's diverticulum differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Meckel's diverticulum differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Meckel's diverticulum differential diagnosis

CDC on Meckel's diverticulum differential diagnosis

Meckel's diverticulum differential diagnosis in the news

Blogs on Meckel's diverticulum differential diagnosis

Directions to Hospitals Treating Meckel's diverticulum

Risk calculators and risk factors for Meckel's diverticulum differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

The common diseases responsible for lower GI bleeding that must be differentiated from Meckel's diverticulum inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, and colorectal carcinoma. Meckel's diverticulitis is a common complication of Meckel's diverticulum in adults and must be differentiated from other causes of abdominal pain and lower gastrointestinal bleeding such as infective colitis, IBD and acute ischemic colitis.

Differentiating Meckel's Diverticulum from other Diseases

The common diseases responsible for lower GI bleeding that must be differentiated from Meckel's diverticulum inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colorectal carcinoma.[1]

Disease Symptoms Other features Diagnosis
Abdominal pain Rectal pain Weightloss Fever Type of GI bleeding Diarrhea Constipation Laboratory findings Radio-Imaging findings
Meckel's diverticulum - - - - Frank blood - - Signs of iron deficiency anemia may be present such as:
Diverticulosis - - - - Red or maroon-colored blood - +
  • Self limiting
  • Seen in elderly
Normal

Globular outpouchings on CT scan

Angiodysplasia - - - - Frank blood - - Normal Normal
Hemorrhoids - + - - Blood on tissues - + - Tortuous dilated vessels on anoscopy
Anal fissures - + - - Blood on tissues - + Normal except mild leucocytosis Anoscopy
Mesenteric Ischemia + - + + Frank blood + -
  • Pain alters with eating habits
  • Associated with other comorbid conditions
Ischemic colitis + - - + Frank blood + - 3 phases
  • Mild moderate diffuse bowel wall thickening
  • Marked hyperenhancement of the mucosa
Crohn's disease + - + + Blood mixed with stools + + Extra intestinal manifestations
Ulcerative colitis + + + + Blood mixed with stools + +
Colon carcinoma + -† + + Occult bleeding + +† + FOBT (fecal occult blood test)

↑ CEA( and CA 19-9

Hypercalcemia 

The following table differentiates Meckel's diverticulitis from other causes of abdominal pain and lower gastrointestinal bleeding:

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Acute diverticulitis LLQ or RLQ (in case of Meckel's diverticulitis) + ± + + ± + Positive in perforated diverticulitis + + Hypoactive
  • CT scan
  • Ultrasound
Inflammatory bowel disease Diffuse ± ± + + + Normal or hyperactive

Extra intestinal findings:

Infective colitis Diffuse + ± + + Positive in fulminant colitis ± ± Hyperactive CT scan
  • Bowel wall thickening
  • Edema
Colon carcinoma Diffuse/localized ± ± + + ±
  • Normal or hyperactive if obstruction present
  • CBC
  • Carcinoembryonic antigen (CEA)
  • Colonoscopy
  • Flexible sigmoidoscopy
  • Barium enema
  • CT colonography 
  • PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction
Hemochromatosis RUQ Positive in cirrhotic patients N
  • >60% TS
  • >240 μg/L SF
  • Raised LFT
    Hyperglycemia
  • Ultrasound shows evidence of cirrhosis
Extra intestinal findings:
Mesenteric ischemia Periumbilical Positive if bowel becomes gangrenous + + + + Positive if bowel becomes gangrenous Positive if bowel becomes gangrenous Hyperactive to absent CT angiography
  • SMA or SMV thrombosis
  • Also known as abdominal angina that worsens with eating
Acute ischemic colitis Diffuse + ± + + + + + + + Hyperactive then absent Abdominal x-ray
  • Distension and pneumatosis

CT scan

  • Double halo appearance, thumbprinting
  • Thickening of bowel
  • May lead to shock
Ruptured abdominal aortic aneurysm Diffuse ± + + + + N
  • Focused Assessment with Sonography in Trauma (FAST) 
  • Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage Diffuse ± ± + + N
  • ↓ Hb
  • ↓ Hct
  • CT scan

References

  1. "Meckel's Diverticulum Overview". Retrieved 2013-04-01. 



Linked-in.jpg