Emergency Presentations of Meckel's Diverticulum in Adults.

Abstract

Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract in humans that is commonly encountered during surgical practice as the cause of the patient's presentation or as an incidental finding during other unrelated procedures. Most clinical symptoms are caused due to its complications. The mean age of the involved patients was 24.79 years with slight male predominance, 62.9% males compared to 37.1% females. The mean length of the diverticulum was 55.21 cm. The most common emergency presentation was right lower quadrant abdominal pain in 31% of the patients, intestinal obstruction in 28.6%, acute lower abdominal pain and guarding and acute abdomen in 18.6% and 15.7% of patients, respectively, bleeding per rectum in 2.9%, acute right upper quadrant abdominal pain in 1.4%, and obstructed paraumbilical hernia containing the diverticulum in one patient. Perforation of the Meckel's diverticulum was reported in 18.6%. Histopathological examination showed acute inflammation in the wall of the diverticulum in 37.1%, lymphoid hyperplasia in 24.3%, hemorrhagic necrosis in 22.9%, and chronic inflammation in 8.6%. Ectopic mucosa was detected in 50% of the cases, gastric mucosa was detected in 42.86%, ectopic pancreatic mucosa was detected in 5.71%, and both gastric and pancreatic types in 1.43%. Long diverticula are more liable to develop complications. At surgery, inspection and palpation of the wall of the diverticulum must be done for any evidence of inflammation, necrosis, perforation, or abnormal thickening of the walls of the diverticulum. Resection of the segment of the bowel that contains the diverticulum with primary anastomosis is preferable to other procedures due to the risk of leaving behind an abnormal heterotopic mucosa.