eMedicine Specialties > General Surgery > Abdomen

Meckel Diverticulum: Follow-up

Author: Nafisa K Kuwajerwala, MD, Staff Surgeon, Breast Oncology, William Beaumont Hospital
Coauthor(s): Yvan J Silva, MD, FRCS(C), FACS, Professor of Surgery, Program Director of Surgery, North Oakland Medical Centers, Wayne State University School of Medicine; Venkata Subramanian Kanthimathinathan, MD, Staff Physician, Department of General Surgery, Loma Linda University Medical Center
Contributor Information and Disclosures

Updated: Aug 19, 2008

Future and Controversies

Management strategies for patients with an asymptomatic Meckel diverticulum found at laparotomy performed for other reasons, especially in adults younger than 30 years, remain controversial.

In 1976, Soltero and Bill reported that the lifetime risk of complications from Meckel diverticulum is 4.2%, and the risk decreases with age.2 Their data indicated that 800 asymptomatic diverticula would have to be removed to save the life of one patient. On that basis, they opposed surgical excision.

Miltiadis et al stated that resection of incidentally found Meckel diverticulum protected patients from future surgery caused by complications of Meckel diverticulum. This helps reduce morbidity and mortality, especially in elderly patients.

Cullen et al reported that prophylactic diverticulectomy is warranted to eliminate the possibility of future deaths.1 Thus, they advocate diverticulectomy for asymptomatic disease even in the older age group.

Incidental discovery of Meckel diverticulum at laparoscopy or laparotomy requires a decision whether to resect. Most surgeons generally do not resect a Meckel diverticulum with a wide mouth. On the other hand, a diverticulum with a narrow neck, which may obstruct or twist, can be easily resected at the neck without need for segmental resection. A diverticulum deemed to be abnormal because of inflammation, thickening, or intramural pathology should be resected with a decision for local or segmental resection based on the pathology.

Thus, selected cases of incidentally discovered diverticulum in adults and most asymptomatic diverticulum found in children may be removed.

 


More on Meckel Diverticulum

Overview: Meckel Diverticulum
Workup: Meckel Diverticulum
Treatment: Meckel Diverticulum
Follow-up: Meckel Diverticulum
Multimedia: Meckel Diverticulum
References
[ CLOSE WINDOW ]

References

  1. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ 3rd. Surgical management of Meckel's diverticulum. An epidemiologic, population-based study. Ann Surg. Oct 1994;220(4):564-8; discussion 568-9. [Medline].

  2. Soltero MJ, Bill AH. The natural history of Meckel's Diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period. Am J Surg. Aug 1976;132(2):168-73. [Medline].

  3. Bemelman WA, Hugenholtz E, Heij HA, Wiersma PH, Obertop H. Meckel's diverticulum in Amsterdam: experience in 136 patients. World J Surg. Sep-Oct 1995;19(5):734-6; discussion 737. [Medline].

  4. Chu UB, Beals DA, Schwartz RW. Laparoscopic management of Meckel's diverticulum. Curr Surg. Sep-Oct 2001;58(5):458-61. [Medline].

  5. Crosthwaite GL, Leather AJ. Laparoscopy: the ultimate diagnostic tool for a bleeding Meckel's diverticulum. Aust N Z J Surg. Apr 1997;67(4):223-4. [Medline].

  6. Cserni G. Gastric pathology in Meckel's diverticulum. Review of cases resected between 1965 and 1995. Am J Clin Pathol. Dec 1996;106(6):782-5. [Medline].

  7. DiGiacomo JC, Cottone FJ. Surgical treatment of Meckel's diverticulum. South Med J. Jun 1993;86(6):671-5. [Medline].

  8. Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D. Complications of Meckel's diverticula in adults. Can J Surg. Oct 2006;49(5):353-7. [Medline].

  9. Fa-Si-Oen PR, Roumen RM, Croiset van Uchelen FA. Complications and management of Meckel's diverticulum--a review. Eur J Surg. Jul 1999;165(7):674-8. [Medline].

  10. Farr CM, Iqbal R, Bezmalinovic Z, Gladen HE, Stern R. Bleeding Meckel's diverticulum in an adult. J Clin Gastroenterol. Apr 1989;11(2):208-10. [Medline].

  11. Haubrich WS. Meckel of Meckel's diverticulum. Gastroenterology. Mar 1998;114(3):542. [Medline].

  12. Heider R, Warshauer DM, Behrns KE. Inverted Meckel's diverticulum as a source of chronic gastrointestinal blood loss. Surgery. Jul 2000;128(1):107-8. [Medline].

  13. Heyman S. Meckel's diverticulum: possible detection by combining pentagastrin with histamine H2 receptor blocker. J Nucl Med. Oct 1994;35(10):1656-8. [Medline].

  14. Huang FC, Ko SF, Lee SY. Meckel's diverticulum mimicking infantile colic: sonographic detection. J Clin Ultrasound. Jul-Aug 2000;28(6):314-6. [Medline].

  15. Hughes JA, Hatrick A, Rankin S. Computed tomography findings in an inflamed Meckel diverticulum. Br J Radiol. Aug 1998;71(848):882-3. [Medline].

  16. Karadeniz Cakmak G, Emre AU, Tascilar O, Bektas S, Ucan BH, Irkorucu O, et al. Lipoma within inverted Meckel's diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage: a case report and review of literature. World J Gastroenterol. Feb 21 2007;13(7):1141-3. [Medline].

  17. Lin PH, Koffron AJ, Heilizer TJ, Theodoropoulus P, Pasikhov D, Lujan HJ. Gastric adenocarcinoma of Meckel's diverticulum as a cause of colonic obstruction. Am Surg. Jul 2000;66(7):627-30. [Medline].

  18. Martin JP, Connor PD, Charles K. Meckel's diverticulum. Am Fam Physician. Feb 15 2000;61(4):1037-42, 1044. [Medline].

  19. Matsagas MI, Fatouros M, Koulouras B, Giannoukas AD. Incidence, complications, and management of Meckel's diverticulum. Arch Surg. Feb 1995;130(2):143-6. [Medline].

  20. McKay R. High incidence of symptomatic Meckel's diverticulum in patients less than fifty years of age: an indication for resection. Am Surg. Mar 2007;73(3):271-5. [Medline].

  21. Meckel J. Ueber die Divertikel am Darmkanal. Arch die Physiol. 1809;9:421.

  22. Molmenti EP, Thompson RW. Images in clinical medicine. Meckel's diverticulum. N Engl J Med. Jan 7 1999;340(1):31. [Medline].

  23. Moore T, Johnston AO. Complications of Meckel's diverticulum. Br J Surg. Jun 1976;63(6):453-4. [Medline].

  24. Neidlinger NA, Madan AK, Wright MJ. Meckel's diverticulum causing cecal volvulus. Am Surg. Jan 2001;67(1):41-3. [Medline].

  25. Sharieff KA, Lee T. Intrauterine perforations of Meckel's diverticulum in a premature infant with trisomy 18. Surg Rounds. 2000;23(8):470-476.

  26. Turgeon DK, Barnett JL. Meckel's diverticulum. Am J Gastroenterol. Jul 1990;85(7):777-81. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Meckel's diverticulum, diverticula, diverticulitis, ulcer, intussusception, Littré hernia, Littre hernia, peritonitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Nafisa K Kuwajerwala, MD, Staff Surgeon, Breast Oncology, William Beaumont Hospital
Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Yvan J Silva, MD, FRCS(C), FACS, Professor of Surgery, Program Director of Surgery, North Oakland Medical Centers, Wayne State University School of Medicine
Yvan J Silva, MD, FRCS(C), FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Venkata Subramanian Kanthimathinathan, MD, Staff Physician, Department of General Surgery, Loma Linda University Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.