Demystifying Meckel's diverticulum - a guide for the gastroenterologist.

PURPOSE OF REVIEW: Meckel's diverticulum (MD) is a common congenital ileal diverticulum. Whilst mostly asymptomatic, 4-9% develop complications, such as small bowel obstruction, diverticulitis or bleeding. In 1933, Charles Mayo wrote that MD is 'frequently suspected, often looked for and seldom found', and it continues to pose a diagnostic challenge today. With advancements in small bowel imaging and endoscopy, this review outlines the gastroenterologist's approach to MD.

RECENT FINDINGS: There are a number of strategies for diagnosing MD. Meckel's scan has a sensitivity of 80-92% in children but 62-88% in adults. The diagnostic yield of small bowel capsule endoscopy (SBCE) is only up to 50%. Device-assisted enteroscopy (DAE) has a sensitivity of 84-100% for MD but is invasive. The definitive treatment for symptomatic MD is surgical resection, but the management of asymptomatic cases are controversial. A recent systematic review favoured resection of incidental MD.

SUMMARY: A high index of suspicion and a multimodality combination of SBCE, Meckel's scan, CT and DAE is often required to diagnose MD. Complicated MD is treated by surgical resection. Management of incidental MD remains debated, although current evidence appears to favour resection.