Meckel's Diverticulum in Adults: Surgical Concerns

Abstract

Since Meckel's diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Treatment of symptomatic MD is definitive surgery, including diverticulectomy, wedge, and segmental resection. The type of procedure depends on: (a) the integrity of diverticulum base and adjacent ileum; (b) the presence and location of ectopic tissue within MD. The presence of ectopic tissue cannot be accurately predicted intraoperatively by palpation and macroscopic appearance. When present, its location can be predicted based on height-to-diameter ratio. Long diverticula (height-to-diameter ratio >2) have ectopic tissue located at the body and tip, whereas short diverticula have wide distribution of ectopic tissue including the base. When indication of surgery is simple diverticulitis, diverticulectomy should be performed for long and wedge resection for short MD. When indication of surgery is complicated diverticulitis with perforated base, complicated intestinal obstruction and tumor, wedge, or segmental resection should be performed. When the indication of surgery is bleeding, wedge and segmental resection are the preferred methods for resection. Regarding management of incidentally discovered MD, routine resection is not indicated. The decision making should be based on risk factors for developing future complications, such as: (1) patient age younger than 50 years; (2) male sex; (3) diverticulum length >2 cm; and (4) ectopic or abnormal features within a diverticulum. In this case, diverticulectomy should be performed for long and wedge resection for short MD.

Intestinal obstruction caused by internal herniation as a complication of Meckel's diverticulum

“…For all other Meckel diverticula without a palpable mass, a simple diverticulectomy should be sufficient. Blouhos et al aimed to make a decision algorithm concerning optimal treatment of symptomatic Meckel's diverticulum (8). They state that the type of surgery depends on (a) integrity of diverticulum base and adjacent ileum and (b) the presence and location of ectopic tissue.…”

Predictive model of heterotopy in Meckel's diverticulum in children

“…Although it is universally accepted that a complicated MD must be removed, the resection of an incidentally discovered uncomplicated MD remains controversial . Zani et al reported a complication rate of 1.3% in incidentally discovered uncomplicated MDs left in situ compared to a complication rate of 5.3% after resection and opposed resection .…”

“…Zani et al reported a complication rate of 1.3% in incidentally discovered uncomplicated MDs left in situ compared to a complication rate of 5.3% after resection and opposed resection . Analogous studies opposed the resection of an incidentally discovered uncomplicated MD . Other studies reported a 1.2–2% complication risk after MD resection compared with a lifetime morbidity risk 6.4–7% and recommended resection of all MDs encountered .…”

“…In search for criteria to rationalize the decision whether to remove an incidentally discovered uncomplicated MD or not, some researchers took into account a variety of parameters; the MD dimensions were the most studied among them . According to Park et al , MDs with a length >2 cm were more prone to future complications .…”

“…A complicated MD must always undergo resection. However, the surgical approach of an incidentally discovered uncomplicated MD during abdominal surgery for other morbidities is often a matter of dispute . Although current tendency in surgery advocates resection of any MD, there are studies that consider the risk of complications after resection of an uncomplicated MD to be higher than MD‐related morbidity risk …”