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GI surgery (300 Qs)

A 4-year-old boy presents with significant painless rectal bleeding. He has had several episodes over the past few months. His mother reports that the blood is bright red and is mixed with the stool. The boy is otherwise well, with no abdominal pain, vomiting, or change in bowel habit. On examination, he is afebrile and his abdomen is soft and non-tender. What is the most likely cause of his bleeding?

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  • Explanation: Meckel’s diverticulum is an abnormality from the incomplete obliteration of the vitello-intestinal duct. It is a true diverticulum (contains all bowel layers).
  • Rule of 2s: Affects 2% of the population, is 2 inches long, found 2 feet (60 cm) from the ileocaecal valve, and is 2x more common in males.
  • Lining & Bleeding: While typically lined by ileal mucosa, it can contain ectopic tissue. Ectopic gastric mucosa is most common after ileal mucosa and can secrete acid, causing ulceration and bleeding in the adjacent, non-acid-resistant small bowel.
  • Clinical Presentation: Usually asymptomatic. Complications include obstruction, inflammation (diverticulitis), and painless, significant rectal bleeding (most common in children).
  • Management: Symptomatic diverticula are removed via wedge excision or a formal small bowel resection and anastomosis.