eMedicine Specialties > General Surgery > Abdomen

Meckel Diverticulum: Treatment

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

Treatment

Surgical Therapy

  • Surgical dissection and excision depends on the evident pathology. In asymptomatic Meckel diverticulum, excision is generally performed if the neck of the diverticulum is narrow or if stasis is present. Tangential excision with suture closure of the base is performed. In complicated cases, the diverticulum must be resected. Four possible surgical procedures are outlined, as follows:
    • Diverticulectomy with suture closure of the base
    • Wedge resection of the intestinal wall containing the diverticulum with suture closure
    • Segmental resection of the intestine, including the diverticulum and end-to-end anastomosis
    • Division of the fibrous band with or without diverticulectomy
  • In cases of hemorrhage, wedge or segmental resection ensures adequate excision of the part containing gastric and ulcerated ileal mucosa.
  • In cases of intestinal obstruction, the viability of the bowel wall delineates the extent of excision.
  • Segmental resection is also advised in children with broad-based diverticula in whom the risk of ileal stenosis is greater if diverticulectomy or wedge resection is performed.
  • Umbilical sinus and fistula may require excision of the umbilicus. Because Meckel diverticulitis often mimics appendicitis, examine the distal ileum for it when the appendix is discovered to be normal during exploration for suspected appendicitis.
  • All procedures are carried out either by hand-sewn technique or by staplers, depending on the preference of the surgeon.
    • The widespread use of staplers in surgery in recent years enables faster resection of Meckel diverticulum without opening the bowel's lumen, avoiding potentially septic and postoperative complications. Meckel diverticulum, which fits well into the stapling device, is easy to remove and has a low complication rate, especially when removing an incidentally found Meckel diverticulum.
    • Surgical principles include ensuring adequate blood supply to the resectional margins, recognition of bowel viability, suture line tension, and potential for intestinal stenosis due to narrowing.
    • Recently laparoscopic techniques are increasingly being used for Meckel diverticulectomy and intestinal resection. With advancements in technology, therapeutic interventions, such as intracorporeal resection or laparoscopic-assisted extracorporeal resection, can easily be performed. Currently, laparoscopic management of Meckel diverticulum is limited to symptoms of abdominal pain and GI bleeding. For symptoms of obstruction, diagnostic laparoscopy is not recommended because of difficulties in establishing pneumoperitoneum.

Preoperative Details

  • The preoperative, intraoperative, and postoperative management follows the general principles of abdominal surgery and includes the use of perioperative antibiotics.

Complications

Symptomatic patients have a 10-12% incidence of early postoperative complications, such as ileus, suture line or intestinal anastomotic leak, intra-abdominal abscess, and pulmonary embolism.

Late postoperative complications occur in 6-8% of patients and consist of small bowel obstruction due to intestinal adhesions. The reported mortality rate for surgery in symptomatic patients is 2-5%.

In incidental diverticulectomy for asymptomatic disease, the morbidity rate is 2%, the late postoperative complication rate is 2%, and the mortality rate is 1%.

More on Meckel Diverticulum

Overview: Meckel Diverticulum
Workup: Meckel Diverticulum
Treatment: Meckel Diverticulum
Follow-up: Meckel Diverticulum
Multimedia: Meckel Diverticulum
References
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References

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  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].

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Further Reading

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Keywords

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

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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

 
 
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