Most Common Manifestation of Meckel's Diverticulum
Painless rectal bleeding is the most common manifestation of Meckel's diverticulum, particularly in younger patients. 1
Clinical Presentations by Age Group
- Painless rectal bleeding (hematochezia) is the classic presentation, especially in children and young adults 1, 2
- Patients with gastrointestinal bleeding from Meckel's diverticulum are more frequently under 40 years of age 3
- Diverticulitis and small bowel obstruction are more common presentations in adults over 40 years 3
Epidemiology and Pathophysiology
- Meckel's diverticulum is present in approximately 2% of the general population 1
- About 50% of diverticula contain ectopic gastric mucosa 2
- Gastric mucosal secretions can cause peptic ulceration resulting in bleeding 2
- The diverticulum contains all intestinal wall layers, including muscularis propria 1
Presentation Patterns
- Bleeding occurs in approximately 30% of symptomatic cases 3
- Small bowel obstruction occurs in about 35% of complicated cases 3
- Diverticulitis accounts for approximately 35% of complications 3
- Perforation can occur but is less common 4
Diagnostic Approach
- Radionuclide Meckel scan using 99mTc pertechnetate is the diagnostic test of choice for suspected bleeding from Meckel's diverticulum 1
- The scintiscan has been shown to be true positive in 84.2% of cases 2
- CT enterography can help identify Meckel's diverticulum when bleeding is not the primary presentation 1
- Negative upper GI endoscopy and colonoscopy in a patient with GI bleeding should prompt consideration of Meckel's diverticulum 1
Management Considerations
- Laparoscopic approach is effective as both diagnostic and therapeutic modality in symptomatic cases 5
- Segmental small bowel resection is typically performed for complicated Meckel's diverticulum 4
- Exploratory laparoscopy plays a central role in cases of acute abdomen with uncertain diagnosis 3
Clinical Pearls and Pitfalls
- The correct diagnosis of complicated Meckel's diverticulum in adults is difficult due to the lack of specific clinical presentation 3
- The site of ectopic gastric tissue activity is mainly at the umbilical quadrant in over 50% of cases 2
- Complications are more common in the pediatric age group than in adults, but diagnosis is often missed in adults 6
- In cases of unexplained lower GI bleeding, especially in younger patients, Meckel's diverticulum should be considered even when initial studies are negative 1