What is the most common manifestation of Meckel's (Meckel's diverticulum) diverticulum?

Most Common Manifestation of Meckel's Diverticulum

Painless rectal bleeding is the most common manifestation of Meckel's diverticulum, particularly in younger patients and children. 1

Clinical Presentations by Age Group

• In pediatric patients, gastrointestinal bleeding (particularly painless rectal bleeding or hematochezia) is the classic presentation, often due to ulceration from acid secretion by ectopic gastric mucosa 1, 2
• In adults, the presentation pattern differs significantly:
  • Intestinal obstruction (35.1%) 3
  • Diverticulitis (35.1%) 3
  • Gastrointestinal bleeding (29.8%) 3
• Age distribution shows significant differences in presentation patterns:
  • Patients with gastrointestinal bleeding are more frequently <40 years old 3
  • Patients with diverticulitis are more frequently >40 years old 3

Pathophysiology of Bleeding

• Approximately 50% of Meckel's diverticula contain ectopic gastric mucosa 4
• Gastric mucosal secretions cause peptic ulceration of adjacent normal ileal mucosa, resulting in bleeding 4
• Heterotopic tissue (gastric, pancreatic, or both) is found in 53% of symptomatic pediatric cases and 16% of symptomatic adult cases 2, 3

Mechanisms of Other Presentations

• Intestinal obstruction can occur due to:
  • Volvulus around a fibrous band connecting the diverticulum to the umbilicus 1
  • Intussusception (common in children) 2
  • Entrapment of small bowel beneath a mesodiverticular band 1
• Diverticulitis occurs when the diverticulum becomes inflamed, similar to appendicitis 3

Diagnostic Approach

• For suspected bleeding from Meckel's diverticulum:
  • 99mTc pertechnetate scintigraphy (Meckel scan) is the diagnostic test of choice with 84.2% true positive rate for detecting ectopic gastric mucosa 1, 4
• For suspected complications like diverticulitis or obstruction:
  • CT scan of abdomen and pelvis with contrast is highly accurate 1
  • CT enterography can help identify Meckel's diverticulum when bleeding is not active 5
• In cases of acute abdomen with uncertain diagnosis:
  • Exploratory laparoscopy plays a central role, as correct preoperative diagnosis is achieved in only 40% of cases 3, 6

Epidemiological Considerations

• Meckel's diverticulum is present in approximately 2% of the general population 1, 7
• Male predominance in symptomatic cases with male:female ratio of 2.6:1 2
• Most symptomatic cases occur before 10 years of age 7
• Complications are more common in males than females 7

Clinical Pearls

• Consider Meckel's diverticulum in any patient with unexplained GI bleeding after negative upper GI endoscopy and colonoscopy 1
• In pediatric patients with rectal bleeding, Meckel's diverticulum should be high on the differential diagnosis 2
• The peak age for symptomatic presentation in children is 1-2 years 4