Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

asymptomatic

1st line – treatment not required

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ACUTE
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asymptomatic
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incidental finding on imaging
1st line – 

treatment not required

No treatment is normally required for Meckel's diverticulum that is discovered incidentally on an imaging study.[7]

1st line – consider excision of diverticulum

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ACUTE
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asymptomatic
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detected during surgery for other reasons
1st line – 

consider excision of diverticulum

In general, in a child or young adult, if Meckel's diverticulum is found during a nonacute operation, it should be removed, particularly if it is narrow-necked, provided the patient's general condition and the nature of the primary operation are appropriate.[22] Other features that further suggest the need for a prophylactic excision include long diverticulum (>2 cm), ectopic tissue or palpable abnormalities, male sex.[4][14][18]​​​[43][44]

While it may be reasonable to resect the diverticulum in young and otherwise healthy patients undergoing an elective surgery, some have suggested that in patients aged >50 years, an incidental Meckel's diverticulum without ectopic tissue should generally be left alone.[4]​ However, Meckel's diverticulum may be a 'hot spot' for ileal malignancy, with the risk of malignancy increasing with age.[20]​ Based on this observation, some have suggested that all incidental Meckel's diverticula should be resected, irrespective of age. Further studies are needed to validate this approach, considering that the incidence of Meckel's diverticulum-associated ileal malignancy remains very low at 1.44 per 10 million population. Although publications increasingly favour resection, the intraoperative decision should be individualised based on the patient's condition and primary reason for surgery.[45]

symptomatic

1st line – excision of diverticulum and opposing region of ileum

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ACUTE
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symptomatic
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bleeding
1st line – 

excision of diverticulum and opposing region of ileum

Definitive treatment of a bleeding Meckel's diverticulum is surgical excision of the diverticulum.[3][5][13][14][18]​​[26]

The opposing region of the ileum should also be excised because the bleeding is typically not coming from the diverticulum itself but from the adjacent ileum, owing to ileal ulceration caused by gastric secretions from the ectopic tissue within the Meckel's diverticulum.

Consider – blood transfusion

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ACUTE
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symptomatic
|
bleeding
Consider – 

blood transfusion

Additional treatment recommended for SOME patients in selected patient group

Patients who are haemodynamically unstable as a result of blood loss from a bleeding Meckel's diverticulum may require urgent blood transfusion.

1st line – excision of diverticulum and lysis of adhesions

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ACUTE
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symptomatic
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obstruction
1st line – 

excision of diverticulum and lysis of adhesions

In a patient with bowel obstruction, once the diagnosis of Meckel's diverticulum has been confirmed, either on imaging or during exploratory abdominal surgery, treatment is by excision of the diverticulum and lysis of any related adhesions.[3][13][14][18]​​[24][26]

1st line – excision of diverticulum or small bowel segmental resection

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ACUTE
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symptomatic
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perforation and peritonitis
1st line – 

excision of diverticulum or small bowel segmental resection

The surgery depends on the extent of pathology. Simple excision of the diverticulum is appropriate if only the tip of the diverticulum is inflamed.[3][13][14]​​[24][26]

If the pathology is extremely extensive, a small bowel segmental resection may be required. Simple excision of the diverticulum is usually sufficient if the base alone is inflamed. A normal appendix should generally be removed in this circumstance.

Antibiotics are usually given preoperatively, and for at least 24 hours postoperatively, depending on clinical signs (e.g., fever) and laboratory criteria (e.g., leukocytosis). Start with intravenous antibiotics and then switch to oral if administering for more than 48 hours postoperatively. Check local protocols and seek advice from microbiology colleagues on the choice of antibiotic, as this will be guided by local resistance patterns.

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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