Original Article

Meckel Diverticulum: Ten-year Experience in Adults

Authors: Patrick A. Stone, MD, Matthew J. Hofeldt, MD, John E. Campbell, MD, Geetha Vedula, BA, John A. DeLuca, MD, Sarah K. Flaherty, BS

Abstract

Objectives: Meckel diverticulum, a congenital gastrointestinal anomaly, is well studied in pediatrics, but less so in the adult population. At the Charleston Area Medical Center (CAMC), in addition to the removal of Meckel diverticula in symptomatic patients, diverticula are commonly removed when found incidentally during other procedures. We present our experience over the past ten years with this condition, unusual in the adult population.


Methods: From 1992 to 2002 at the Charleston Area Medical Center, Meckel diverticula were removed from 47 patients older than 18 years of age. We reviewed the age, sex, indication for removal, pathologic findings, and perioperative complications of these cases.


Results: Diverticula were removed most often from female patients (31 female, 66%; 16 male, 34%). The removal of the diverticulum was incidental in 35 patients (74.5%) and symptomatic in 12 (25.5% percent). Symptomatic patients presented with: obstruction (n = 4), acute bleeding (n = 1) and diverticulitis (n = 7). Female patients were significantly less likely than male patients to be symptomatic (4 of 31, 13% among females, and 8 of 16, 50% among males; P < 0.05). Heterotopic mucosa was identified in six patients, two of whom were symptomatic at the time of removal. Gastric mucosa was found in all six of the diverticula with ectopic mucosa, although one of the six had a mixed gastric and pancreatic cell population. One asymptomatic patient had a malignancy identified as a 1.5 cm carcinoid with no evidence of metastatic disease. An adenomyoma was found incidentally in one patient upon pathologic evaluation. Hospital complications that could possibly be attributed to removal of diverticula included two wound infections and two anastomotic leaks requiring exploration (8.5% morbidity). Complications were experienced by two asymptomatic females, one asymptomatic male, and a symptomatic male. There were no mortalities.


Conclusions: Meckel diverticulum is found infrequently in the adult population. Adults rarely become symptomatic, but symptoms that do arise are associated with significant morbidity. Complications directly attributable to diverticulum removal are uncommon; however, those that do occur are often life threatening. Therefore, incidental removal of asymptomatic diverticula, particularly in women, is not recommended.


Key Points


* Meckel diverticulum is a rare disorder in adults.


* Adults with Meckel diverticulum are often asymptomatic, but symptoms that do arise are associated with significant morbidity.


* Complications from diverticulum removal are uncommon, but are often life threatening; incidental removal of asymptomatic diverticula, particularly in women, is therefore not recommended.

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References

1. Yamaguchi M, Takeuchi S, Awazu S. Meckel diverticulum: investigation of 600 patients in Japanese literature. Am J Surg 1978;136:247–249.
 
2. Moore KL. The Developing Human: Clinically Oriented Embryology, Philadelphia, WB Saunders Co., 1988, ed 4, pp 235–237.
 
3. Meckel JF. Ueber die Divertikel am Darmkanal. Arch Die Physio 1809;9:421–453.
 
4. Turgeon DK, Barnett JL. Meckel diverticulum. Am J Gastroenterol 1990;85:777–781.
 
5. Salzer H. Uber das Offene Meckelesche Divertikel. Wien Klien Wochnenschr 1904;17:614–617.
 
6. Deetz E. Perforationsperitonitis von einem Darmdivertikel mit Magenscleimhautbau ausgenhend.Deutsh Ztsch Chir 1907;88:482–493.
 
7. Gramen K. Chronischen Ulcus in einem Meckelshen Divertikel mit Perforation und Diffuser Peritonitis.Nord Med Ark Kirurgi 1915;48:1.
 
8. Weinstein EC, Docherty MB, Waugh JM. Neoplasms of Meckel diverticulum. Int Abstracts Surg1963;116:103–111.
 
9. Perne AS. Meckel diverticulum. N Engl J Med 1959;260:690.
 
10. Peoples JB, Lichtenberger EJ, Dunn MM. Incidental Meckel diverticulectomy in adults. Surgery1995;118:649–652.
 
11. Groebli Y, Bertin D, Morel P. Meckel diverticulm in adults: retrospective analysis of 119 cases and historical review. Eur J Surg 2001;167(7):518–524.
 
12. Leijonmarck CE, Bonman-Sandelin K, Frisell J, et al. Meckel diverticulum in the adult. Br J Surg1986;73:146–149.
 
13. Cullen JJ, Kelly KA, Moir CR, et al. Surgical management of Meckel's diverticulum. Ann Surg1994;220(4):564–569.
 
14. Root GT, Baker CP. Complications associated with Meckel diverticulum. Am J Surg 1967;11:285–288.
 
15. Rutherford RB, Akers DR. Meckel diverticulum: a review of 148 pediatric patients with specific reference to the pattern of bleeding and to mesodiverticular vascular bands. Surgery 1966;59:618–626.
 
16. Weinstein EC, Cain JC, Remine W. Meckel diverticulum: 55 years of clinical and surgical experience. JAMA 1962;182:251–253.
 
17. Mackey WC, Dineen P. A fifty-year experience with Meckel diverticulum. Surg Gynecol Obset1983;156:56–64.
 
18. Lin S, Suhocki PV, Ludwig KA, et al. GI bleeding in adult patients with Meckel diverticulum: the role of technetium 99m pertechnetate scan. South Med J 2002;95(11):1338–1341.
 
19. Soltero MJ, Bill AH. The natural history of Meckel diverticulum and its relation to incidental removal.Am J Surg 1976;132:168–173.