Diverticulitis is the inflammation of small, bulging sacs (diverticula) that form along the wall of the digestive tract. This condition is overwhelmingly common in adults over the age of 50, where these pouches develop over time, usually in the large intestine. Diverticulitis is uncommon in the pediatric population. When it occurs in children, the underlying causes and the location of the inflamed pouches are typically different from the adult form.
Diverticular Disease in Children
Diverticular disease in children is rare and often linked to specific underlying conditions, rather than the age-related changes seen in adults. The most frequent cause is a complication of Meckel’s diverticulum, the most common congenital anomaly of the small intestine. This pouch remains from embryonic development, is present from birth, and is typically found in the lower small bowel.
When Meckel’s diverticulum becomes inflamed, the condition is called Meckel’s diverticulitis and often requires urgent attention. Colonic diverticula—the type seen in adults—can also rarely develop in adolescents. This colonic form is frequently associated with genetic disorders that affect the strength of the intestinal wall, such as Ehlers-Danlos syndrome, Marfan syndrome, or Williams syndrome. These connective tissue disorders cause alterations in the components of the colon wall, making it more prone to forming pouches.
The primary difference in pediatric cases is the underlying mechanism, as children do not have the decades of dietary and lifestyle risk factors contributing to adult diverticulitis. Pediatric colonic diverticulitis most often presents as a solitary lesion, especially in the cecum or ascending colon, rather than the multiple pouches found in the left colon of older adults. This distinction means the disease process and symptoms can vary significantly between the two age groups.
Recognizing Symptoms in Pediatric Patients
Recognizing diverticulitis in children can be challenging because the symptoms often mimic other common childhood abdominal issues. The most consistent symptom is abdominal pain, which can range from mild and gradual to sudden and intense. Since the pain location depends on the type of diverticulitis, it can sometimes mislead parents and even healthcare providers.
Colonic diverticulitis usually causes pain in the lower left quadrant of the abdomen, similar to the adult presentation. Meckel’s diverticulitis, which is more common in younger children, often causes pain in the middle or lower right side of the abdomen. This right-sided pain frequently leads to misdiagnosis, as it can be confused with appendicitis, a much more common condition in children.
Symptoms include fever, nausea, and vomiting. Changes in bowel habits are also common, presenting as either persistent constipation or, less frequently, diarrhea. The severity and persistence of the pain should be noted, especially if accompanied by systemic signs of infection like fever.
A key indicator of Meckel’s diverticulum complication, particularly in children under five, is painless rectal bleeding. The blood may appear bright red, dark red, or maroon, as the pouch often contains acid-secreting tissue that causes ulcers in the small intestine. This bleeding is a separate presentation from the inflammatory process of diverticulitis, but both are complications of the congenital pouch.
Diagnosis and Clinical Management
The diagnostic process for suspected diverticulitis in a child begins with a physical examination and blood tests to look for signs of inflammation and infection. An elevated white blood cell count and increased inflammatory markers, such as C-reactive protein, suggest an acute inflammatory process. Because the clinical presentation is often nonspecific, imaging studies are usually necessary to confirm the diagnosis and pinpoint the location of the inflamed diverticulum.
Ultrasound is frequently the initial imaging tool used in children due to its safety and ability to identify localized inflammation in the cecum or ascending colon. A computed tomography (CT) scan provides a more detailed image, used to visualize the inflamed pouch, assess severity, and check for complications like an abscess or perforation. For Meckel’s diverticulum that is causing bleeding, a specific nuclear medicine test called a Meckel scan may be used to identify the acid-secreting tissue.
Treatment protocols are determined by the severity of the condition. Most cases of uncomplicated colonic diverticulitis in children are managed conservatively with non-operative treatment. This typically involves bowel rest, which may mean a temporary liquid diet, and intravenous (IV) antibiotics to clear the infection. In milder cases, oral antibiotics may be sufficient.
Surgical management is reserved for complicated cases, such as those involving an abscess, perforation of the bowel, or the formation of a fistula. Surgical removal of the pouch is the definitive treatment for symptomatic Meckel’s diverticulitis, as it eliminates the source of potential inflammation, bleeding, or obstruction. While recurrence is possible after conservative treatment, most pediatric cases respond well to non-surgical approaches.