Overview
Meckel's diverticulum is a congenital anomaly of the small intestine, often asymptomatic but capable of causing complications such as bleeding, inflammation, obstruction, and formation of enteroliths 124.Diagnosis
Imaging: Computed tomographic enterography is increasingly reliable for detecting Meckel's diverticulum, especially in cases of obscure gastrointestinal bleeding 1.
Limitations: Conventional CT, endoscopy, enteroclysis, angiography, push enteroscopy, and capsule endoscopy have lower diagnostic yields 1.
Special Tests: Tc-99m pertechnetate scans may be negative despite the presence of a diverticulum 1.
Histopathology: Definitive diagnosis often requires surgical resection and histopathological examination 1.Management
Surgical Intervention: Segmental resection of the small bowel is the standard treatment when complications arise 14.
Indications for Surgery: Hemorrhage, inflammation, obstruction, or presence of enteroliths 24.
Conservative Management: Generally not recommended for symptomatic cases; watchful waiting is not advised without clear resolution of symptoms 1.Special Populations
Pediatrics: Segmental dilatation of the ileum with associated Meckel's diverticulum can present in children with anemia, requiring careful preoperative assessment 5.
Comorbidities: No specific guidelines provided for elderly or comorbid patients; management typically follows general principles with surgical intervention for complications 14.Key Recommendations
Utilize computed tomographic enterography for diagnosing Meckel's diverticulum in cases of obscure gastrointestinal bleeding (Evidence: Moderate 1).
Perform surgical segmental resection for symptomatic Meckel's diverticulum, including those with enteroliths, to prevent complications (Evidence: Expert opinion 4).
Consider the potential for associated anomalies like segmental ileal dilatation in pediatric patients presenting with gastrointestinal symptoms (Evidence: Weak 5).References
1 Lee JM, Jeen CD, Kim SH, Lee JS, Nam SJ, Choi HS et al.. Meckel's diverticulum detected by computed tomographic enterography: report of 3 cases and review of the literature. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2014. link
2 Agaoglu N. Meckel's diverticulum enterolith: a rare cause of acute abdomen. Acta chirurgica Belgica 2009. link
3 Khatri HL, Singh RB, Sharma R, Aggarwal N, Singh K. Embryogenesis of a sac containing a Meckel's diverticulum. Pediatric surgery international 1997. link
4 Olson J. The case for the single case report. The Journal of the Arkansas Medical Society 1991. link
5 Morewood DJ, Cunningham ME. Case report: segmental dilatation of the ileum presenting with anaemia. Clinical radiology 1985. link80057-x)
6 Lawhon NC. Ureteral diverticulum. Southern medical journal 1980. link