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Emergency Medicine76 papers

Meckel's diverticulitis

Last edited: 4/14/2026

Overview

Meckel's diverticulitis refers to inflammation of a Meckel's diverticulum, a congenital anomaly of the gastrointestinal tract most commonly found in the ileum. It can present with symptoms similar to acute diverticulitis but may also involve complications such as bleeding, perforation, and abscess formation.

Diagnosis

  • Clinical Presentation: Abdominal pain, nausea, vomiting, and signs of peritonitis in severe cases 114.
  • Imaging: CT abdomen is crucial for diagnosis, often showing characteristic features like localized inflammation around the ileum 121.
  • Grading: Not specifically detailed in abstracts; generally follows acute diverticulitis grading systems (e.g., Hinchey classification) 14.

    • Management

  • Medical Management: Initial treatment often involves bowel rest, broad-spectrum antibiotics (e.g., piperacillin-tazobactam, metronidazole), and supportive care 16.
  • Surgical Intervention: Indicated for complications such as perforation, abscess, or failure of medical management 1314.
    • - Hartmann's Procedure: Commonly used for perforated cases, involving resection with end colostomy 311. - Primary Anastomosis with Diverting Ileostomy: Alternative to Hartmann's, with outcomes comparable in some studies 1116.
  • Stoma Reversal: Considered safe after initial recovery, with varying rates of successful reversal 3.

    • Special Populations

  • Elderly: Increased risk of complications and may require more cautious surgical approaches 14.
  • Comorbidities: Presence of comorbidities like organ dysfunction influences surgical strategy, favoring procedures like Hartmann's 3.

    • Key Recommendations

  • Initial Medical Management: Use broad-spectrum antibiotics and bowel rest for uncomplicated cases (Evidence: Moderate 6).
  • Surgical Intervention for Complications: Perform emergency surgery for complications such as perforation or abscess (Evidence: Strong 13).
  • Consider Hartmann's Procedure: For perforated cases, Hartmann's procedure is a viable option with reasonable stoma reversal rates (Evidence: Moderate 311).
  • Evaluate for Stoma Reversal: Postoperatively assess patients for safe stoma reversal following Hartmann's procedure (Evidence: Moderate 3).
  • Tailor Approach Based on Comorbidities: Surgical strategies should consider patient comorbidities and overall health status (Evidence: Expert opinion 314).

    • References

    1 Karam E, Sabbagh C, Beyer-Bergeot L, Zerbib P, Bridoux V, Manceau G et al.. Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study. Techniques in coloproctology 2024. link 2 Godet C, Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Valérie B et al.. Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals. Surgery 2024. link 3 Salusjärvi JM, Koskenvuo LE, Mali JP, Mentula PJ, Leppäniemi AK, Sallinen VJ. Stoma reversal after Hartmann's procedure for acute diverticulitis. Surgery 2023. link 4 Hossain N, Naidu V, Hosny S, Khalifa M, Mathur P, Al Whouhayb M. Hospital Presentations of Acute Diverticulitis During COVID-19 Pandemic may be More Likely to Require Surgery due to Increased Severity: A Single-Centre Experience. The American surgeon 2022. link 5 Beyer-Berjot L, Maggiori L, Loiseau D, De Korwin JD, Bongiovanni JP, Lesprit P et al.. Emergency Surgery in Acute Diverticulitis: A Systematic Review. Diseases of the colon and rectum 2020. link 6 Poola S, Ritchie M. Antibiotics for Uncomplicated Diverticulitis. American family physician 2020. link 7 Aicher BO, Hernandez MC, Betancourt-Ramirez A, Grossman MD, Heise H, Schroeppel TJ et al.. Colorectal resection in emergency general surgery: An EAST multicenter trial. The journal of trauma and acute care surgery 2020. link 8 Garcia-Granero A, Argüelles BG, Gallardo CM, Carreño O, Giner F, Pellino G et al.. Short article: Outcome of medical and surgical management for perforated jejunal diverticulitis. European journal of gastroenterology & hepatology 2019. link 9 Varma S, Mehta A, Canner JK, Azar F, Efron DT, Efron J et al.. Surgery After an Initial Episode of Uncomplicated Diverticulitis: Does Time to Resection Matter?. The Journal of surgical research 2019. link 10 Goldstone RN, Cauley CE, Chang DC, Kunitake H, Ricciardi R, Bordeianou L. The Effect of Surgical Training and Operative Approach on Outcomes in Acute Diverticulitis: Should Guidelines Be Revised?. Diseases of the colon and rectum 2019. link 11 Lee JM, Bai P Chang J, El Hechi M, Kongkaewpaisan N, Bonde A, Mendoza AE et al.. Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients. Journal of the American College of Surgeons 2019. link 12 van Dijk ST, Bos K, de Boer MGJ, Draaisma WA, van Enst WA, Felt RJF et al.. A systematic review and meta-analysis of outpatient treatment for acute diverticulitis. International journal of colorectal disease 2018. link 13 Spiridakis KG, Intzepogazoglou DS, Flamourakis ME, Sfakianakis EE, Gkionis IG, Strataki KG et al.. Acute diverticulitis in patients under 50 years of age. Il Giornale di chirurgia 2018. link 14 Roig JV, Sánchez-Guillén L, García-Armengol JJ. Acute diverticulitis and surgical treatment. Minerva chirurgica 2018. link 15 Valizadeh N, Suradkar K, Kiran RP. Specific Factors Predict the Risk for Urgent and Emergent Colectomy in Patients Undergoing Surgery for Diverticulitis. The American surgeon 2018. link 16 Cauley CE, Patel R, Bordeianou L. Use of Primary Anastomosis With Diverting Ileostomy in Patients With Acute Diverticulitis Requiring Urgent Operative Intervention. Diseases of the colon and rectum 2018. link 17 Floch MH, Longo WE. United States Guidelines for Diverticulitis Treatment. Journal of clinical gastroenterology 2016. link 18 Stam MA, Draaisma WA, Consten EC, Broeders IA. Recurrences and Ongoing Complaints of Diverticulitis; Results of a Survey among Gastroenterologists and Surgeons. Digestive surgery 2016. link 19 Lembcke B. The gastroenterologist's view. Digestive diseases (Basel, Switzerland) 2012. link 20 de Korte N, Klarenbeek BR, Kuyvenhoven JP, Roumen RM, Cuesta MA, Stockmann HB. Management of diverticulitis: results of a survey among gastroenterologists and surgeons. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2011. link 21 al-Damegh S. Radiological diagnosis and management of diverticulitis. West African journal of medicine 1998. link 22 Zarling EJ, Piontek F, Klemka-Walden L, Inczauskis D. The effect of gastroenterology training on the efficiency and cost of care provided to patients with diverticulitis. Gastroenterology 1997. link 23 Valerio S, Fornasiero G, Antoniazzi G, Bassi E. Ureterocolic fistula: a case report. Archivos espanoles de urologia 1992. link 24 Gage TP, Eagan J, Gagnier M. Diverticulitis complicated by candidal pylephlebitis. Southern medical journal 1985. link 25 Young ID, Rickett AB, Clarke M. High incidence of Meckel's syndrome in Gujarati Indians. Journal of medical genetics 1985. link 26 Crawfurd MdA, Jackson P, Kohler HG. Meckel's syndrome (dysencephalia splanchno-cystica) in two Pakistani sibs. Journal of medical genetics 1978. link

    Original source

    1. [1]
      Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study. — Karam E, Sabbagh C, Beyer-Bergeot L, Zerbib P, Bridoux V, Manceau G et al. Techniques in coloproctology (2024)
    2. [2]
      Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals. — Godet C, Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Valérie B et al. Surgery (2024)
    3. [3]
      Stoma reversal after Hartmann's procedure for acute diverticulitis. — Salusjärvi JM, Koskenvuo LE, Mali JP, Mentula PJ, Leppäniemi AK, Sallinen VJ Surgery (2023)
    4. [4]
      Hospital Presentations of Acute Diverticulitis During COVID-19 Pandemic may be More Likely to Require Surgery due to Increased Severity: A Single-Centre Experience. — Hossain N, Naidu V, Hosny S, Khalifa M, Mathur P, Al Whouhayb M The American surgeon (2022)
    5. [5]
      Emergency Surgery in Acute Diverticulitis: A Systematic Review. — Beyer-Berjot L, Maggiori L, Loiseau D, De Korwin JD, Bongiovanni JP, Lesprit P et al. Diseases of the colon and rectum (2020)
    6. [6]
      Antibiotics for Uncomplicated Diverticulitis. — Poola S, Ritchie M American family physician (2020)
    7. [7]
      Colorectal resection in emergency general surgery: An EAST multicenter trial. — Aicher BO, Hernandez MC, Betancourt-Ramirez A, Grossman MD, Heise H, Schroeppel TJ et al. The journal of trauma and acute care surgery (2020)
    8. [8]
      Short article: Outcome of medical and surgical management for perforated jejunal diverticulitis. — Garcia-Granero A, Argüelles BG, Gallardo CM, Carreño O, Giner F, Pellino G et al. European journal of gastroenterology & hepatology (2019)
    9. [9]
      Surgery After an Initial Episode of Uncomplicated Diverticulitis: Does Time to Resection Matter? — Varma S, Mehta A, Canner JK, Azar F, Efron DT, Efron J et al. The Journal of surgical research (2019)
    10. [10]
      The Effect of Surgical Training and Operative Approach on Outcomes in Acute Diverticulitis: Should Guidelines Be Revised? — Goldstone RN, Cauley CE, Chang DC, Kunitake H, Ricciardi R, Bordeianou L Diseases of the colon and rectum (2019)
    11. [11]
      Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients. — Lee JM, Bai P Chang J, El Hechi M, Kongkaewpaisan N, Bonde A, Mendoza AE et al. Journal of the American College of Surgeons (2019)
    12. [12]
      A systematic review and meta-analysis of outpatient treatment for acute diverticulitis. — van Dijk ST, Bos K, de Boer MGJ, Draaisma WA, van Enst WA, Felt RJF et al. International journal of colorectal disease (2018)
    13. [13]
      Acute diverticulitis in patients under 50 years of age. — Spiridakis KG, Intzepogazoglou DS, Flamourakis ME, Sfakianakis EE, Gkionis IG, Strataki KG et al. Il Giornale di chirurgia (2018)
    14. [14]
      Acute diverticulitis and surgical treatment. — Roig JV, Sánchez-Guillén L, García-Armengol JJ Minerva chirurgica (2018)
    15. [15]
      Specific Factors Predict the Risk for Urgent and Emergent Colectomy in Patients Undergoing Surgery for Diverticulitis. — Valizadeh N, Suradkar K, Kiran RP The American surgeon (2018)
    16. [16]
      Use of Primary Anastomosis With Diverting Ileostomy in Patients With Acute Diverticulitis Requiring Urgent Operative Intervention. — Cauley CE, Patel R, Bordeianou L Diseases of the colon and rectum (2018)
    17. [17]
      United States Guidelines for Diverticulitis Treatment. — Floch MH, Longo WE Journal of clinical gastroenterology (2016)
    18. [18]
      Recurrences and Ongoing Complaints of Diverticulitis; Results of a Survey among Gastroenterologists and Surgeons. — Stam MA, Draaisma WA, Consten EC, Broeders IA Digestive surgery (2016)
    19. [19]
      The gastroenterologist's view. — Lembcke B Digestive diseases (Basel, Switzerland) (2012)
    20. [20]
      Management of diverticulitis: results of a survey among gastroenterologists and surgeons. — de Korte N, Klarenbeek BR, Kuyvenhoven JP, Roumen RM, Cuesta MA, Stockmann HB Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland (2011)
    21. [21]
      Radiological diagnosis and management of diverticulitis. — al-Damegh S West African journal of medicine (1998)
    22. [22]
      The effect of gastroenterology training on the efficiency and cost of care provided to patients with diverticulitis. — Zarling EJ, Piontek F, Klemka-Walden L, Inczauskis D Gastroenterology (1997)
    23. [23]
      Ureterocolic fistula: a case report. — Valerio S, Fornasiero G, Antoniazzi G, Bassi E Archivos espanoles de urologia (1992)
    24. [24]
      Diverticulitis complicated by candidal pylephlebitis. — Gage TP, Eagan J, Gagnier M Southern medical journal (1985)
    25. [25]
      High incidence of Meckel's syndrome in Gujarati Indians. — Young ID, Rickett AB, Clarke M Journal of medical genetics (1985)
    26. [26]
      Meckel's syndrome (dysencephalia splanchno-cystica) in two Pakistani sibs. — Crawfurd MdA, Jackson P, Kohler HG Journal of medical genetics (1978)
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