What is Meckel’s diverticulum?
Meckel’s diverticulum is a bulge or small pouch in the lower part of the small intestine. It is congenital, meaning you are born with it.
The bulge (diverticulum) does not come from the small intestine. Rather, it comes from the leftover tissue of the umbilical cord. It may also contain cells resembling stomach or pancreas tissue.
In many people, it doesn’t cause any symptoms. But in some, it can create a blockage of the intestine. Or the stomach cells in the diverticulum can release acid, which causes ulcers and bleeding. About 25% to 50% of people with symptoms are under the age of 10.
Most common symptoms
Parents should not panic when their child has rectal bleeding as Meckel’s is only one cause of rectal bleeding. There are many other common and less serious causes such as polyps, milk protein allergy, hemorrhoids, or a tear in the anus. —Dr. Heather Finlay-Morreale
People with Meckel’s diverticulum often do not have symptoms. Only 2% to 4% of people with this condition have complications.
The most common symptom of Meckel’s diverticulum in children is gastrointestinal bleeding. The diverticulum sometimes contains tissue of the stomach that can release acid. The acid can eat away at the intestines. This leads to bleeding through the rectum. Stool will look like red jelly or be maroon and sticky. There’s usually no pain associated with the bleeding. But children can even become anemic or very ill from the blood loss.
Bloody stool can happen for a few other reasons. If there is no pain with the bleeding, it may be caused by polyps (bulb-like pieces of tissue). Bleeding may also be caused by a tear near the anus (anal fissures)—but that will be very painful. Tests at the hospital will confirm what is causing rectal bleeding. Infants may also have blood in their stool from a milk protein allergy, because the allergic reaction can damage the lining of the intestine.
Meckel’s diverticulum can also cause a blockage in the intestines. This creates severe pain that comes and goes, as well as bloody stool and bloating (swollen belly). A child with a blockage will look very sick.
Causes of Meckel’s diverticulum
Rectal bleeding can be a sign of cancer in adults, but this is extremely rare in children. —Dr. Finlay-Morreale
During the early stages of fetal development, a small duct forms in an area of the small intestine. During normal development, the duct goes away, but in some cases, it doesn’t and turns into the pocket or pouch (Meckel’s diverticulum).
One in 50 children has Meckel’s diverticulum. Most never have any problems. It’s not known why some kids get them and others don’t. But children who have other birth defects are more likely to have a Meckel’s diverticulum too.
Most Meckel’s diverticulum are discovered in young children. However, if you are born with the outpouching, it can cause problems at any age.
If your child has a tiny amount of rectal bleeding with no pain, call their pediatrician. It could be from a milk protein allergy, drinking blood from a cracked nipple, or a tear in the anus. But the doctor can perform tests to find out.
If your child has a significant amount of blood (tablespoon) or severe pain, go to the ER. They may do X-rays to look for a blockage.
If they have more than a tablespoon of blood or are nearly unconscious, call 911.
How do you treat Meckel's diverticulum?
Parents should bring the diaper with the bloody stool or a photo of the stool in the toilet when they see their physician. —Dr. Finlay-Morreale
If a child has rectal bleeding without pain, there are two common reasons: a polyp (small piece of tissue) in the intestine, and Meckel’s diverticulum.
Your doctor might order a blood test to look for anemia and a test called a Meckel’s scan. This uses a special dye that shows a Meckel’s diverticulum. If this is normal, they might order a colonoscopy to look for a polyp.
If a child has symptoms of a blockage, they will get IV fluids and an X-ray or ultrasound. Then, they’ll go right to surgery.
Usually, treatment is a surgery called a diverticulectomy (tissue removal). Sometimes part of the intestine also has to be removed (bowel resection). Often this is done by a pediatric surgeon specialist. This surgery may need to be done at a large children’s hospital. Sometimes, they perform the surgery through a few small holes using cameras. Or they might make an incision in the abdomen.
Children are in the hospital for a few days and are given pain medication. Children start drinking clear fluids first then advance to eating solids before going home.
Is Meckel's diverticulum serious?
Most cases of Meckel’s diverticulum never cause any problems. And if it does cause symptoms, they're usually not life-threatening as long as they are treated right away. If the child has an intestinal blockage from the diverticulum, this can become serious if it's not treated. The obstruction cuts off the blood supply to the intestines. Surgery can fix this.
But in rare cases, Meckel's diverticulum can cause serious complications. Take for instance, if you get a hole in the diverticulum. This causes peritonitis, which is a very serious and painful inflammation in the abdominal cavity.
Also in rare cases, the bleeding from Meckel’s diverticulum can become excessive. Significant blood loss can be life threatening.
After going home, children may need a few days of pain medication. They will have a follow-up appointment with the surgeon. Their stitches may need to be removed. After 2 weeks they can go back to playing sports and other activities.
Heather Finlay-Morreale, MD is a pediatrician working in primary care. She went to medical school at the University of Cincinnati and completed a residency at Tufts and now is an Assistant Professor at the University of Massachusetts Medical School. She is interested in mental health, mindfulness, wellbeing, and social media. She also chronicles her experiences as a chronic pain patient navigating the healthcare world as both a physician and a patient. Her essays have been featured on JAMA Neurology, Pharos, Psychology Today, KevinMD, Doximity, and the Mighty.