Meckel’s diverticulum: misdiagnosis and late presentation

Abstract

Asma Mian,1 Nasir Butt,1 Frederic Bertino,1 Erik Shipley,1 R Shane Tubbs,2 Marios Loukas11Department of Anatomical Sciences, School of Medicine, St George’s University, Grenada, West Indies; 2Pediatric Neurosurgery, Children’s Hospital, Birmingham, AL, USAAbstract: Meckel’s diverticulum (MD) is a congenital anomaly of the gastrointestinal (GI) tract, occurring due to the incomplete obliteration of the omphalomesenteric duct during embryogenesis. Depending on the patient’s age and symptomatology at presentation, scintigraphy is often the initial test of choice to detect MD. However, an increased incidence of false positive and negative tests has made MD difficult to diagnose in older children as well as in adults. MD can present in the older population with symptoms such as GI bleeding and anemia, which may mimic other GI pathologies, such as appendicitis, Crohn’s disease, and Littré’s hernia. Early diagnosis and appropriate management of symptomatic diverticula are vital to the prevention of complications, such as malignancy. The management of symptomatic MD is accomplished through diverticulectomy. Robijn et al proposed a scoring system based on the evaluation of the risk of complications of a nonresected MD against the complications that arise from resection. They suggested that patients with an asymptomatic MD and a risk score 6 indicates the need for resection. The aim of this study was to provide a review of the literature on MD, with an emphasis on the late presentation and misdiagnosis of this congenital anomaly.Keywords: congenital anomaly, omphalomesenteric duct, vitelline duct, GI bleeding, appendicitis, Crohn’s disease