Management of incidentally found Meckel's diverticulum a new approach: resection based on a Risk Score.

Abstract. The management of incidentally found Meckel's diverticulum (MD) remains unclear. The risk for future complications of a non-resected MD must be weighed against the risk of complications for a resected MD in order to justify a prophylactic resection. Morbidity-rates after resection of incidentally found MD are much lower than those after resection of symptomatic MD. Several risk factors which increase the risk for future complications of an asymptomatic MD have been described in the literature. We suggest that an asymptomatic MD should be removed in cases where there is a higher risk of it becoming symptomatic in the future, on condition that the resection can be done with presumed low morbidity. Based on the literature data we propose a scoring system in order to base the decision for surgery on more objective grounds and weighted criteria. This Risk Score is based on 4 risk factors: male sex, patients younger than 45 years, diverticula longer than 2 cm and the presence of a fibrous band. We suggest resection of an asymptomatic MD with a Risk Score of > or = 6 points. A transverse diverticulectomy is preferable in most cases. In short, broad based MD, or in the case of a palpable mass at the base, a wedge-shaped excision is the best alternative.