Clinical and Anatomical Spectrum of Meckel's Diverticulum: A Systematic Review and Meta-Analysis

Introduction: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete involution of the vitelline duct during the fifth to seventh week of gestation. This study aimed to assess the prevalence, anatomical features, clinical manifestations, and heterotopic tissue of MD through a comprehensive meta-analysis of studies reporting on this anomaly. Methods: A systematic search of PubMed, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Contents Connect, and the Korean Journal Database was conducted up to March 2024 following PRISMA guidelines. Original studies with extractable data on Meckel's diverticulum were included, while case reports, reviews, and studies with incomplete data were excluded. Outcomes included prevalence, anatomical features, clinical manifestations, complications, and postoperative outcomes. The study quality was assessed using CATAM and AQUA tools. Results: The results of the present meta-analysis comprised 172 studies. The pooled prevalence of MD was 1.56% (95% CI: 0.98-2.28%). Nausea and vomiting were the most frequent symptoms in the pediatric group, with an incidence of 52.34% (95% CI: 38.59-65.92%). In adults, wound infections or dehiscence or anastomotic leakage were the most common postoperative outcomes, with a pooled prevalence of 6.20% (95% CI: 4.02-8.79%). Conclusions: This systematic review and meta-analysis provide a comprehensive quantitative synthesis of MD characteristics. Symptomatic cases most frequently presented with intestinal obstruction, diverticulitis, and bleeding, each showing distinct age-related trends. Ectopic gastric mucosa was identified in over 40% of pediatric MD. Postoperative outcomes were generally favorable, particularly in elective settings, with low rates of morbidity and mortality. It is hoped that the findings of this study will aid clinicians in diagnosing, risk-stratifying, and managing patients with MD, particularly in guiding surgical decisions for incidentally discovered cases.