Pediatric Meckel Diverticulum Follow-up

Updated: Oct 20, 2017
  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Carmen Cuffari, MD  more...
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Follow-up

Complications

Because the diagnosis of Meckel diverticulum can be quite elusive, a high index of suspicion is warranted to correctly and expeditiously diagnose this condition. Complicated Meckel diverticulum can lead to significant morbidity and mortality, most often because of a delay in diagnosis. For example, a higher frequency of intestinal infarction has been encountered in patients who present with complete intestinal obstruction. Causes of mortality include strangulation, perforation, and exsanguination because of delay in resuscitation.

Once a complication arises and surgery is required, the operative mortality and morbidity rates have both been estimated at 12%. The cumulative long-term risk of postoperative complications in this cohort was found to be 7%. If the Meckel diverticulum is removed as an incidental finding, the risk of mortality and morbidity and long-term complications are much less (1%, 2%, and 2%, respectively).

A case study described a case of internal herniation and intestinal obstruction due to Meckel diverticulum. This rare presentation was due to internal herniation of bowel loops into a sac formed by mesentery of Meckel diverticulum and adhesion band. [57]

As many as 5% of complicated Meckel diverticulum contain malignant tissue.

Neuroendocrine tumors arising from Meckel diverticulum are very rare. A recent case report described Cushing syndrome due to ectopic adrenocorticotropic hormone (ACTH) secretion from a Meckel diverticulum. A somatostatin analogue scintigraphy was used to allow localization of the ectopic ACTH tumor source. Pathological analysis of the resected submucosal tumor of Meckel diverticulum confirmed a neuro-endocrine tumor with immunohistochemistry positive for ACTH. Surgical resection lead to complete resolution of symptoms. [58]