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Meckel Diverticulum
A Geriatric Disease Masquerading as Common Gastrointestinal Tract Disorders
Alexander A. Feller, MD;
Jonathon Movson, MD;
Samir A. Shah, MD
Arch Intern Med. 2003;163:2093-2096.
Background Meckel diverticulum (MD) is traditionally considered a pediatric disease that is associated with intestinal hemorrhage or perforation. Symptomatic MD is rarely a consideration in the geriatric population.
Objective To notify clinicians of the clinical variety and diagnostic uncertainty of MD in the elderly, we report 7 cases of complicated MD that presented as common disorders of the gastrointestinal (GI) tract in patients older than 65 years.
Methods A retrospective record review at 2 university-affiliated hospitals revealed 7 patients older than 65 years with MD and abdominal complaints necessitating laparotomy. The patients represented a subset of 27 adults (age range, 21-89 years; mean age, 39 years) with symptomatic MD who required surgery during a 7-year period.
Results The presenting complaints represented a variety of common GI presentations, including nausea, vomiting, and acute abdominal pain (n = 3); acute abdominal pain with peritonitis (n = 2); crampy abdominal pain lasting several weeks (n = 1); and rectal bleeding (n = 1). Meckel diverticulum was a preoperative consideration in only 2 of 7 cases. The preoperative diagnoses were consistent with common disorders of the GI tract in the elderly, including small-bowel obstruction (n = 2), ischemic colitis (n = 1), unrelenting bleeding in the GI tract (n = 1), perforated viscus (n = 1), diverticulitis (n = 1), and appendicitis (n = 1). In contradistinction to the pediatric age group, only 1 of 7 patients had an MD with ectopic mucosa.
Conclusions Many different mechanisms can be responsible for complications due to MD in the geriatric population. Misdiagnosis occurs frequently in the elderly because of the poor sensitivity of diagnostic tests, nonspecificity of complaints, and lack of recognition that this anomaly can present in this age group. Clinicians must be cognizant of this common pediatric disease and its varied guises when they are evaluating unexplained acute or intermittent abdominal pain, nausea and vomiting, rectal bleeding, peritonitis, or obstruction in geriatric patients.
From the Departments of Medicine (Dr Feller) and Radiology (Dr Movson) and the Department of Medicine, Division of Gastroenterology (Dr Shah), Brown Medical School, Providence, RI. Dr Feller is now with the Department of Medicine, Yale University School of Medicine, New Haven, Conn. The authors have no relevant financial interest in this article.
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