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Meckel's Diverticulum: Review and Management

Am Fam Physician. 2001 Dec 15;64(12):2000-2001.

Meckel's diverticulum results from incomplete obliteration of the omphalomesenteric or vitelline duct. Although several anomalies can occur, 90 percent of vitelline duct abnormalities are Meckel's diverticulum with or without connection to the umbilicus or mesentery. Meckel's diverticulum contains all layers of normal intestinal wall (i.e., it is a true diverticulum) and is usually located within 100 cm of the ileocecal valve. It is the most common congenital anomaly of the gastrointestinal tract, with a male to female ratio of 3:2. Yahchouchy and associates reviewed the complications and management of Meckel's diverticulum.

The lifetime complication rate for Meckel's diverticulum is approximately 4 percent, with complications most often caused by ectopic tissue or bands. More than 50 percent of those who develop symptoms are younger than 10 years. Symptoms have also been found to be more common in males than in females. Complications can include obstruction or inflammation, bleeding (often because of heterotopic gastric mucosa), and tumors (with a high incidence of carcinoids).

The diagnosis of Meckel's diverticulum can be made by small bowel enema (conventional or enteroclysis variant). Computed tomography and ultrasonography generally are not helpful because it is often difficult to distinguish between diverticulum and intestinal loops. Radionuclide scanning and arteriography may be useful when bleeding is present. Laparoscopy has been reported to be a helpful tool in diagnosing the anomaly.

Symptomatic Meckel's diverticulum is treated with surgical resection using open or laparoscopic techniques. The indications for incidental diverticulectomy in patients with asymptomatic Meckel's diverticulum are unclear, and there are no definite intraoperative anatomic or biologic criteria to predict the likelihood of future complications. Recent epidemiologic studies compared patients who underwent surgery for Meckel's diverticulum–related complications over time with early and late diverticulectomy-associated complications in patients who underwent prophylactic removal of incidentally discovered Meckel's diverticulum. Among the patients with complications, the incidence of surgery increased steadily through the age of 80 years. The study findings showed that the risk of complications was higher in patients with Meckel's diverticulum than in those who underwent prophylactic removal of the anomaly.

The authors concluded that because the risk of complications from Meckel's diverticulum does not decrease with age, the benefits of incidental diverticulectomy outweigh the morbidity and mortality of surgery.

Yahchouchy EK, et al. Meckel's diverticulum. J Am Coll Surg. May 2001;192:658–62.


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