Saturday, March 28, 2015

1yr old boy

A 1-year-old boy is brought to the emergency room because of the passage of several maroon-colored stools per rectum. The abdominal exam reveals normal bowel sounds and no masses.

 Which of the following is the most likely diagnosis?

a. Biliary atresia
b. Intussusception
c. Meckel’s diverticulum
d. Zenker’s diverticulum
e. Pyloric stenosis

The answer is C Meckel’s diverticulum rarely causes symptoms, but infants may present with the painless passage of maroon-colored stools. The diverticulum is a remnant of the omphalomesenteric duct and is the most common gastrointestinal tract congenital anomaly (2% of the population). It is usually 2 cm long within 2 ft of the ileocecal valve, and males (usually <2 years old) are affected 2 times more than females. It is made of 2 kinds of ectopic tissues (stomach and pancreas) and has 2 complications (bleeding and inflammation). (Meckel’s diverticulum is called the rule of 2’s.) Pyloric
stenosis is seen in newborns. Patients present with projectile vomiting, abdominal distention, and a palpable olive-sized mass in the RUQ that appears after vomiting. Prominent persistaltic waves are often visible going from the left to the right side of the abdomen.

Intussusception (one segment of the intestine prolapses into another) is the most common cause of obstruction in the first 2 years of life. Infants present with melena, abdominal pain, vomiting, and diarrhea mixed with mucus and blood, giving it a red “currant jelly” appearance. Often a sausage-shaped mass is palpable in the upper midabdominal area.

Biliary atresia is a congenital obstruction or absence of the bile duct system. Newborns (2–3 wk old) present with light-colored stools, dark urine, hepatomegaly, pruritus, and jaundice. Zenker’s diverticulum is a disorder of adults in which the pharyngeal mucosa protrudes through an area of weakness in the musculature proximal to the upper pharyngeal sphincter.

Patients present with halitosis from retention of food and saliva in the diverticulum. 


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