Meckels Diverticulum: Symptoms, Types, Causes and Treatment

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, affecting about 2% of the population. While most people with Meckel’s diverticulum never experience any problems, for others, this small pouch in the lower small intestine can lead to significant symptoms or complications — especially in children. Understanding the presentation, pathology, and treatment options is crucial for both patients and healthcare professionals.

Symptoms of Meckel's Diverticulum

Meckel's diverticulum is often called a "great mimic" because its symptoms can resemble other abdominal conditions. In fact, the majority of individuals remain asymptomatic throughout their lives, and the diverticulum is discovered incidentally during imaging or surgery for unrelated reasons. However, when symptoms do occur, they can range from mild discomfort to life-threatening complications.

Symptom	Frequency/Population	Typical Presentation	Sources
Bleeding	Common in children	Painless rectal bleeding, melena	3 4 5 7 12
Obstruction	All ages	Abdominal pain, vomiting, distension	1 2 3 4 5 6 10 12
Diverticulitis	More in adults	Pain, fever, peritonitis	1 2 5 6 7 13 16
Perforation	Less common	Acute abdomen, peritonitis	3 4 5 6 7 11
Tumor	Rare	Obstruction, bleeding, mass effect	2 7 11

Table 1: Key Symptoms

Symptom Overview

Meckel's diverticulum is typically silent. Only about 4–5% of those with the anomaly develop symptoms during their lifetime, and these are more common among males and younger patients, particularly children under the age of 10 1 3 4 5 7 12.

Bleeding

• Who gets it: Most often seen in children, especially boys.
• Presentation: Sudden, painless rectal bleeding or melena (black, tarry stools) is classic. This bleeding is due to ulceration of the nearby small intestine, usually from acid produced by ectopic gastric tissue within the diverticulum 3 4 5 8.
• Diagnosis: A technetium-99m pertechnetate scan (Meckel’s scan) is highly sensitive for detecting ectopic gastric mucosa in symptomatic patients 4 5 14.

Obstruction

• Who gets it: Seen in both children and adults.
• Presentation: Symptoms can include abdominal pain, vomiting, and abdominal distension. Causes of obstruction include intussusception (where the intestine telescopes into itself), volvulus (twisting), or entrapment by mesodiverticular bands 2 3 4 5 6 10 12.
• Unique cases: Meckel’s can also be a lead point for intussusception or cause hernias (Littre's hernia) 2 5.

Diverticulitis and Perforation

• Who gets it: More common in adults, but can occur at any age.
• Presentation: Localized pain (often mimicking appendicitis), fever, and peritonitis if perforation occurs 1 2 5 6 13 16.
• Complications: Perforation can lead to severe infection (peritonitis) and sepsis 3 4 5 13.

Tumors

• Who gets it: Rare, usually in adults.
• Presentation: May present with mass effect, bleeding, or bowel obstruction 2 7 11.

Nonspecific Presentation

• Challenge: Symptoms often mimic other abdominal emergencies such as appendicitis, making preoperative diagnosis difficult 2 5 6 7 10.
• Note: Some cases are only identified during surgery for other conditions 1 2 5.

Types of Meckel's Diverticulum

Not all Meckel’s diverticula are the same. Differences in their structure, tissue composition, and complications help determine how they present and how they should be treated.

Type	Defining Feature	Clinical Importance	Sources
True Diverticulum	All gut wall layers	Typical Meckel's structure	8 9 16
Ectopic Gastric	Gastric tissue present	Causes ulceration/bleeding	3 4 5 8
Ectopic Pancreatic	Pancreatic tissue	May cause obstruction	3 4 5 8
Mixed Ectopic	Both gastric/pancreatic	Variable symptoms	4 8

Table 2: Types of Meckel's Diverticulum

True Diverticulum

• Definition: Meckel’s is a true diverticulum, meaning it contains all layers of the intestinal wall, unlike acquired diverticula which lack some layers 8 16.
• Location: Usually found within 90 cm of the ileocecal valve on the antimesenteric border of the ileum 8.

Ectopic Tissue Types

Ectopic Gastric Tissue

• Prevalence: Present in about 30–53% of cases 4 5 8.
• Clinical significance: Acid secretion from this tissue can cause ulcers in adjacent ileal mucosa, leading to bleeding or perforation—especially in children 3 4 5 8.

Ectopic Pancreatic Tissue

• Prevalence: Less common than gastric, but may be found alone or with gastric tissue 4 5 8.
• Complications: Can form a palpable nodule and serve as a lead point for intussusception, especially in children 3 4 5 8.

Mixed or Rare Ectopia

• Description: Some Meckel’s diverticula contain both gastric and pancreatic tissue, or rarely, colonic tissue 3 4.
• Impact: Clinical effects depend on the type and location of ectopic tissue.

Morphological Variations

• Long vs. Short Diverticula: Longer diverticula (>2 cm) are more likely to harbor ectopic tissue at the tip, while shorter, broad-based diverticula may have ectopic tissue throughout, including the base 1 16.
• Bands: Some Meckel’s diverticula are attached to the umbilicus or mesentery by fibrous bands, increasing the risk of obstruction 8 10.

Clinical Implications

• Symptomatic vs. Incidental: Diverticula containing ectopic tissue, with longer length, or found in younger or male patients, are more likely to become symptomatic 1 3 4 16.
• Surgical Decision-making: The type and location of ectopic tissue can dictate the extent of surgical resection required 16.

Causes of Meckel's Diverticulum

Understanding why Meckel’s diverticulum forms starts with embryology. The condition is rooted in early development, but certain factors increase the risk of complications later in life.

Cause	Mechanism/Description	Clinical Relevance	Sources
Vitelline Duct	Failure to regress in fetal life	Fundamental cause	8 10 13
Ectopic Mucosa	Gastric/pancreatic tissue in MD	Drives symptoms/complications	3 4 5 7 8
Male Sex	Higher frequency and risk	Influences presentation	1 3 4 5 12
Diverticulum Size	>2 cm length increases risk	More likely symptomatic	1 16

Table 3: Causes of Meckel's Diverticulum

Embryological Origin

• Vitelline (Omphalomesenteric) Duct: Meckel’s diverticulum results from incomplete obliteration of the vitelline duct, a fetal structure that connects the developing gut to the yolk sac 8 10 13.
• Timing: Normally, this duct disappears by the 7th week of gestation. Failure to do so leads to the persistence of the diverticulum on the small intestine 8 10.

Ectopic Tissue

• Origin: During fetal development, cells destined to form stomach or pancreas can become misplaced in the diverticulum, resulting in ectopic (heterotopic) mucosa 3 4 5 7 8.
• Significance: Ectopic gastric mucosa can secrete acid, leading to ulceration and bleeding. Ectopic pancreatic tissue may cause inflammation or act as a lead point for intussusception 3 4 5 8.

Risk Factors for Symptomatic Disease

• Gender: Males are more likely to develop symptoms and complications 1 3 4 5 12.
• Diverticulum Length: Diverticula longer than 2 cm are associated with a higher risk of symptoms, possibly due to increased likelihood of containing ectopic tissue 1 16.
• Age: Symptoms are more common in younger individuals, especially children under age 10 1 3 4 5 12.

Treatment of Meckel's Diverticulum

While most Meckel’s diverticula are discovered incidentally and require no intervention, symptomatic or complicated cases demand prompt and effective treatment. Surgical management has evolved, with less invasive approaches now widely used.

Treatment Option	Indication	Key Features/Outcomes	Sources
Diverticulectomy	Symptomatic MD	Removal of diverticulum only	13 14 15 16
Wedge/Segmental Resection	Inflammation, bleeding, tumor	Removal incl. adjacent ileum	13 14 16
Laparoscopic Surgery	Preferred for most cases	Less pain, faster recovery	14 15 12
Observation	Incidental, low-risk MD	No surgery, monitor only	1 13 16

Table 4: Treatment Approaches

Indications for Surgery

• Absolute Indications: All symptomatic or complicated Meckel's diverticula (bleeding, obstruction, diverticulitis, perforation, suspicion of tumor) require surgical removal 13 14 16.
• Incidental Findings: Resection of an incidentally discovered Meckel's diverticulum is debated. Surgery is favored if risk factors exist: age <50, male sex, length >2 cm, or presence of ectopic tissue 1 16.

Surgical Techniques

Diverticulectomy

• Procedure: Simple removal of the diverticulum, suitable when the base and adjacent ileum are healthy 13 14 15 16.
• Minimally Invasive: Laparoscopic diverticulectomy is increasingly common, offering less postoperative pain and faster recovery than open surgery 12 14 15.

Wedge or Segmental Resection

• Indications: Used when the base is inflamed or perforated, or when bleeding/ectopic tissue involves the adjacent ileum 13 14 16.
• Method: Removes the diverticulum and a segment of the small intestine, with re-anastomosis.

Laparoscopy

• Advantages: Minimally invasive, diagnostic as well as therapeutic, safe with low complication rates 12 14 15.
• Pediatric Use: Especially suited for children with non-obstructive symptoms like bleeding 14.

Outcomes and Prognosis

• Complications: Surgical risks are low, but can include infection, anastomotic leak, or adhesions 5 12 14.
• Prognosis: Most patients recover fully post-resection, especially with minimally invasive approaches 14 15.

Observation

• When Appropriate: Short, broad-based, asymptomatic diverticula without risk factors can be left alone 1 13 16.
• Follow-up: Patients should be educated on symptoms that may indicate complications in the future.

Conclusion

Meckel’s diverticulum remains an enigmatic but important entity in gastrointestinal medicine. While its presence is most often harmless, its potential to cause significant complications—especially in children—demands awareness and a thoughtful approach.

Key Takeaways:

• Meckel's diverticulum is the most common congenital GI tract anomaly, but most cases are asymptomatic 8.
• Symptomatic cases often present with bleeding (especially in children), obstruction, diverticulitis, or, rarely, tumors 1 2 3 4 5 7 12.
• Risk factors for complications include male sex, length >2 cm, younger age, and presence of ectopic tissue 1 3 4 5 12 16.
• Treatment is surgical for symptomatic cases, with minimally invasive laparoscopy increasingly preferred 12 14 15.
• Incidental diverticula found without risk factors may be safely observed 1 13 16.

Understanding the diverse presentations and management options ensures that patients receive timely, effective care—turning a hidden anomaly into a manageable diagnosis.