Does an Incidental Meckel's Diverticulum Warrant Resection?

Abstract

Meckel's diverticulum (MD) is the most common gastrointestinal malformation. The management of symptomatic Meckel's diverticulum has been undecidedly resection; however, the management of incidental Meckel's diverticulum has been fraught in comparison. As a systematic literature review, PubMed, PubMed Central (PMC), and MEDLINE were used. The search phrase utilized was "Meckel Diverticulum/Surgery [Mesh]" and resection incidental. The search was completed on July 18, 2020 and was limited to 1980 until the day of the search. Searches resulted in 62 initial articles on PubMed. On initial screening, 23 of these articles met the criteria. The references of these 23 articles were screened for relevant studies, yielding a total of 31 studies of which all were assessed for quality. Four articles made a recommendation for no resection. Twelve studies made a recommendation for resection. Ten studies concluded that resection should be completed in the presence of risk factors. Lastly, five studies made no clear recommendation. In recent literature, there has been a shift towards resection for all or in those with high-risk factors. In the future, it will be necessary for researchers to determine if resection is recommended for all patients with incidental MD or in those with risk factors. If only in those with risk factors, it will be important that research is completed to create evidence-based guidelines to support the risk factors.

Emergency Presentations of Meckel’s Diverticulum in Adults

“…In our study, the mean length of the diverticulum was 55.21 cm (SD 26.37), supporting the fact that longer diverticula are more liable to develop complications. [4][5][6][7].…”

Obstructive acute abdomen due to Meckel's diverticulum in adult: Case report

“…In the case reported herein, video-surgery was not an option due to unavailability in the unit. The presence of the diverticulum is usually an incidental diagnosis, and its resection is debatable when asymptomatic [7] , [11] . When complications arise, such as torsion, obstruction, volvulus or perforation, its removal is mandatory.…”

“…A literature review motivated authors to compile the main reasons that justify a resection of Meckel's diverticula found accidentally, based on factors that would increase the risk of future complications, such as patients 50 years old or younger, male, presence of a diverticulum greater than 2 cm wide, proof of the existing ectopic mucosa, narrow base aspect, and connection of the diverticulum with the umbilical scar through a connective tissue (relative indication). On the other hand, there are situations that discourage such intervention, including patients with advanced age, diffuse or local peritonitis, perforation of the appendix or intestinal loop, damage to other abdominal organs and patients who were victims of trauma in multiple organs [7] , [8] , [13] .…”

“…As for the management of MD, there are divergences between the literature and the authors, especially concerning cases of incidental findings of diverticula during surgeries for unrelated reasons. Some authors are in favor of resection in cases of intra-operative findings of MD during elective and non-severe surgeries, while others believe that the chances of complications are higher, opting for non-resection [6] , [7] . There are also authors who have specific criteria to recommend resection based on the development of long-term complications.…”

Re: Neuroendocrine tumour within a Meckel's diverticulum

“…1 We agree entirely on this point and would like to add a recent observation from the systemic review that there is a recent shift in the evidence towards prophylactic resection of Meckel's diverticulum. 4…”