Meckel's Diverticulitis: Surgical Resection is the Definitive Treatment
For a young adult with Meckel's diverticulitis, surgical resection is the definitive treatment, as this condition represents a symptomatic complication requiring operative intervention to prevent recurrence and further complications.
Critical Distinction: Meckel's vs. Colonic Diverticulitis
The provided guidelines 1, 2 address colonic diverticulitis, which is an entirely different entity from Meckel's diverticulitis. Meckel's diverticulum is a congenital abnormality of the small bowel (terminal ileum), not the colon, and requires a fundamentally different management approach 3, 4, 5.
Understanding Meckel's Diverticulitis
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, occurring in 2% of the population, located on the antimesenteric border of the terminal ileum 3, 5.
The lifetime risk of developing complications is 4.2%, with risk declining significantly with age and approaching zero after age 70 3.
In young adults, the most common complications are diverticulitis and various forms of small-bowel obstruction (including volvulus and intussusception), while gastrointestinal bleeding from ectopic gastric mucosa is more common in children 3, 6, 7.
Surgical Management Algorithm
For Symptomatic Meckel's Diverticulitis (Your Patient)
Immediate surgical resection is indicated 3, 4, 6:
Exploratory laparoscopy is the preferred diagnostic and therapeutic approach when Meckel's diverticulitis is suspected but not definitively diagnosed preoperatively, as correct preoperative diagnosis occurs in only 40% of adult cases 6.
Intestinal resection is performed in 89% of complicated cases, while simple diverticulectomy is reserved for uncomplicated cases (11%) 6.
The surgical approach should include:
Postoperative Outcomes
Morbidity after resection of symptomatic Meckel's diverticulum is 11.1-17.6%, with mortality of 6.0-7.5% 3.
Common postoperative complications include wound infections and anastomotic leaks (occurring in approximately 4-8.5% of cases) 6, 7.
Diagnostic Considerations
CT imaging with IV contrast is the preferred diagnostic modality in adults, though it may be interpreted as "complicated diverticulitis" and requires surgical correlation 4.
Meckel's scan (nuclear medicine study) has 85% sensitivity for detecting ectopic gastric mucosa but is less useful in diverticulitis without bleeding 7.
Clinical presentation mimics acute appendicitis in most cases of Meckel's diverticulitis, with acute abdominal pain and peritoneal signs 4, 6, 7.
Age-Specific Considerations for Your Young Adult Patient
Patients under 40 years with Meckel's diverticulum should undergo resection even if discovered incidentally, as the risk-benefit ratio favors surgery in this age group 3.
Diverticulitis is significantly more common in patients over 40 (statistically significant, p=0.02), making your young adult patient's presentation somewhat atypical but still requiring the same surgical management 6.
Critical Pitfalls to Avoid
Do not apply colonic diverticulitis management guidelines (observation, selective antibiotics) to Meckel's diverticulitis—these are completely different diseases requiring different treatments 1, 3, 4.
Do not delay surgical consultation while attempting conservative management, as symptomatic Meckel's diverticulitis requires operative intervention 3, 6.
Do not assume negative imaging rules out Meckel's diverticulitis, as preoperative diagnosis is challenging and exploratory laparoscopy may be necessary 6.
Do not perform simple diverticulectomy if significant inflammation is present, as intestinal resection with margins is required to prevent complications 6.