What are the typical presentations of Meckel's (Meckel's diverticulum) diverticulum?

Presentations of Meckel's Diverticulum

Painless rectal bleeding is the classic presentation of Meckel's diverticulum, particularly in younger patients and children. 1

Common Clinical Presentations

• Painless rectal bleeding is most commonly seen in children and young adults, resulting from ulceration of ileal mucosa adjacent to acid-secreting ectopic gastric mucosa 1
• Small bowel obstruction can occur through several mechanisms:
  • Volvulus around a fibrous band connecting the diverticulum to the umbilicus 1, 2
  • Entrapment of small bowel beneath a mesodiverticular band 1, 2
  • Intussusception with the diverticulum serving as a lead point 3
• Diverticulitis presents with symptoms similar to appendicitis, including abdominal pain, nausea, and fever 4, 5
• Perforation can occur, especially in cases of diverticulitis, leading to peritonitis 6, 5

Age-Related Presentation Patterns

• In children:
  • Obstruction is the most common presentation 7
  • Bleeding is also frequently observed 3
• In adults:
  • Bleeding is the most common presentation 7
  • Obstruction and diverticulitis are also common 4

Diagnostic Considerations

• Meckel's diverticulum is present in approximately 2% of the population but remains asymptomatic in most individuals 1, 6
• When symptomatic, it presents with a male predominance with a male-to-female ratio of approximately 3:1 7
• Symptomatic presentations are more common in patients younger than 50 years 7
• Diverticula longer than 2 cm are more likely to become symptomatic 7

Rare Presentations

• Giant Meckel's diverticulum (>5 cm) can present with severe complications including obstruction with fecalith and perforation 5
• Neoplasms arising within Meckel's diverticulum are rare but can occur 6
• Enteroliths may form within the diverticulum and cause symptoms 7

Clinical Pearls

• Consider Meckel's diverticulum in any young patient with unexplained lower gastrointestinal bleeding, especially when upper GI endoscopy and colonoscopy are negative 1
• The condition may mimic acute appendicitis, inflammatory bowel disease, or other causes of small bowel inflammation 3
• Symptoms are often nonspecific, making diagnosis challenging without appropriate imaging 4
• The presence of histologically abnormal tissue (ectopic gastric or pancreatic mucosa) significantly increases the risk of symptoms 7