Meckel Diverticulitis

Meckel diverticulitis is inflammation of a Meckel diverticulum, usually from luminal obstruction, enterolith, foreign material or local ulceration. Progressive inflammation can cause gangrene, perforation, abscess or generalised peritonitis.

Clinically it is frequently indistinguishable from acute appendicitis before surgery.

Typical presentation is lower abdominal or periumbilical pain with fever, nausea and local tenderness.

Pain may be central or right sided depending on diverticular position.

Perforation produces increasing guarding, generalised peritonitis, ileus and sepsis.

The diagnosis should be considered when presumed appendicitis is found to have a normal appendix at laparoscopy.

CT abdomen with IV contrast: may identify an inflamed blind ending structure arising from the antimesenteric ileum with surrounding inflammatory change.

The diagnosis is frequently confirmed intraoperatively.

Begin standard intra abdominal sepsis management when complicated disease is suspected.

A practical adult regimen is:

Ceftriaxone 2 g IV every 24 hours plus metronidazole 500 mg IV every 12 hours.

Simple diverticulitis with a healthy narrow base can undergo diverticulectomy.

Use segmental ileal resection when inflammation reaches the base, the diverticulum is short and broad, adjacent bowel is compromised, perforation is close to the ileum or a tumour cannot be excluded.

Laparoscopic resection is appropriate in stable patients.

Generalised peritonitis, perforation or haemodynamic deterioration requires urgent source control.

After adequate source control for established complicated intra abdominal infection, approximately 4 days of antibiotics is sufficient in most improving patients. Persistent sepsis should trigger assessment for uncontrolled contamination rather than automatic continuation of antibiotics.