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Meckel's diverticulum in the adult
Abstract:
The management of Meckel's diverticulum (MD) incidentally detected in adults remains controversial. To assess the risk involved in excision of such diverticula and the incidence of complications arising from MD in adult life, we analysed 260 cases of MD found at laparotomy in a baseline population during a 15-year period. There were 148 symptomless and 112 symptom-producing diverticula, with intestinal obstruction as the most common complication. Assuming a 2 per cent general incidence of MD, the complication rate in these adult patients was 0.03 per cent per year. The calculated lifetime risk of complication from MD was 3.7 per cent at age 16 years, falling to zero in old age. Excision of an incidentally detected MD entailed a 6 per cent rate of major complications. Twenty-eight symptomless diverticula were not excised, and follow-up revealed no complications in these cases. In adults an incidentally discovered, symptomless Meckel's diverticulum should be left in place.
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For incidentally found Meckel
Area of Science:
- Gastroenterology
- Surgical Research
- Clinical Epidemiology
Background:
- The management of incidentally detected Meckel's diverticulum (MD) in adults is debated.
- Complications from MD can arise in adult life, necessitating risk assessment.
Purpose of the Study:
- To evaluate the risks associated with the surgical excision of incidentally found Meckel's diverticula in adults.
- To determine the incidence of complications arising from Meckel's diverticulum during adult life.
Main Methods:
- Analysis of 260 adult cases of Meckel's diverticulum identified during laparotomy over 15 years.
- Categorization of diverticula into symptomatic and asymptomatic groups.
- Assessment of complication rates for both conservative management and surgical excision.
Main Results:
- Intestinal obstruction was the most frequent complication of symptomatic MD.
- The complication rate for adult MD was 0.03% per year, with a calculated lifetime risk of 3.7% at age 16.
- Surgical excision of incidentally found MD carried a 6% major complication rate, while non-excised asymptomatic cases showed no complications.
Conclusions:
- In adults, an incidentally discovered, asymptomatic Meckel's diverticulum should not be surgically removed.
- The risks of major complications from excision outweigh the potential risks of leaving asymptomatic MD in place in adults.