From the Research
Meckel diverticulum repair is indicated for symptomatic cases, particularly when patients present with gastrointestinal bleeding, intestinal obstruction, diverticulitis, or perforation, as these conditions can significantly impact morbidity, mortality, and quality of life. The decision to operate on a Meckel diverticulum should be guided by patient age, diverticulum characteristics, and histological features, as highlighted in a case report of a 61-year-old male presenting with acute abdominal pain and signs of small bowel obstruction, where an internal hernia caused by a Meckel diverticulum adherent to the retroperitoneum was found 1.
Indications for Repair
The main indications for Meckel diverticulum repair include:
- Gastrointestinal bleeding, which can manifest as painless rectal bleeding in children due to acid secretion from ectopic gastric mucosa causing ulceration
- Intestinal obstruction, which may occur from intussusception, volvulus, or internal hernia formation involving the diverticulum
- Diverticulitis, presenting with right lower quadrant pain mimicking appendicitis
- Perforation, which is a surgical emergency
Asymptomatic Cases
Asymptomatic Meckel diverticula discovered incidentally during surgery are generally not removed in adults unless risk factors are present, such as diverticula longer than 2 cm, narrow necks, presence of ectopic tissue, or fibrous bands, as discussed in a review of the management of incidental and symptomatic Meckel's diverticulum 2. In children under 5 years, incidentally discovered diverticula are often removed due to higher lifetime risk of complications.
Surgical Approach
The surgical approach may be open or laparoscopic, with complete resection of the diverticulum and repair of the ileal defect, as reported in a case of giant Meckel's diverticulum causing intestinal obstruction, which was successfully managed by surgical resection and anastomosis created with an endoscopic stapler device 3. The decision to operate should balance the risk of potential complications against surgical risks, considering the patient's age, diverticulum characteristics, and overall health status, as emphasized in a study on intestinal obstruction and ischemia by necrotic annular Meckel's diverticulum 4.
Recent Guidelines
Recent studies, including a 2024 case report, highlight the importance of considering Meckel diverticulum as a potential etiology for acute small bowel obstruction in patients without prior abdominal surgeries, and the need for clinicians to maintain a high index of suspicion for Meckel diverticulum in atypical presentations 1. The management of Meckel diverticulum should be tailored to individual risk factors and intraoperative findings, as discussed in a review of the many faces of Meckel's diverticulum 2.