title: Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002).
abstract: OBJECTIVE
  Through a comprehensive review of the Mayo Clinic experience with patients who had Meckel diverticulum, we sought to determine which diverticula should be removed when discovered incidentally during abdominal surgery.
  
  
  BACKGROUND
  Meckel diverticula occur so infrequently that most articles have reported either small series or isolated cases. From these limited series, various conclusions have been reported without clearly indicating which incidental diverticula should be removed.
  
  
  METHODS
  Medical records were reviewed of 1476 patients found to have a Meckel diverticulum during surgery from 1950 to 2002. Preoperative diagnosis; age; sex; date of surgery; and intraoperative, macroscopic, and microscopic findings from operative and pathology reports were recorded. Logistic regression analysis was used to determine which clinical or histologic features were associated with symptomatic Meckel diverticulum. The features analyzed were age; sex; length, base width, and ratio of length to base width of the diverticulum; and the presence of ectopic tissue or abnormal tissue (inflammation or enteroliths).
  
  
  RESULTS
  Among the 1476 patients, 16% of the Meckel diverticula were symptomatic. The most common clinical presentation in adults was bleeding; in children, obstruction. Among patients with a symptomatic Meckel diverticulum, the male-female ratio was approximately 3:1. Clinical or histologic features most commonly associated with symptomatic Meckel diverticula were patient age younger than 50 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 2.6-4.8; P < 0.001), male sex (OR, 1.8; 95% CI, 1.3-2.4; P < 0.001); diverticulum length greater than 2 cm (OR, 2.2; 95% CI, 1.1-4.4; P = 0.02), and the presence of histologically abnormal tissue (OR, 13.9; 95% CI, 9.9-19.6; P < 0.001).
  
  
  CONCLUSIONS
  After analyzing our data, we neither support nor reject the recommendation that all Meckel diverticula found incidentally should be removed, although the procedure today has little risk. If a selective approach is taken, we recommend removing all incidental Meckel diverticula that have any of the 4 features most commonly associated with symptomatic Meckel diverticulum.
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Wolff
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
authors.forename: Erin E
authors.initials: EE
authors.lastname: Walsh
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008467:Meckel Diverticulum / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications
references.citation: Br J Surg. 1980 Mar;67(3):216-9
references.pmid: 7362966
references.citation: Surgery. 1995 Oct;118(4):649-52
references.pmid: 7570318
references.citation: Arch Surg. 1950 Jul;61(1):158-69
references.pmid: 15426555
references.citation: Surg Gynecol Obstet. 1983 Jan;156(1):56-64
references.pmid: 6600203
references.citation: Gastrointest Endosc. 2001 Jul;54(1):19A-20A
references.pmid: 11508254
references.citation: World J Surg. 1995 Sep-Oct;19(5):734-6; discussion 737
references.pmid: 7571672
references.citation: Am J Surg. 1978 Aug;136(2):247-9
references.pmid: 308325
references.citation: Arch Surg. 1947 Jan;54(1):10-36
references.pmid: 20286075
references.citation: JAMA. 1962 Oct 20;182:251-3
references.pmid: 13999637
references.citation: Am J Surg. 1947 Apr;73(4):468-85
references.pmid: 20290582
references.citation: Am J Surg. 1976 Aug;132(2):168-73
references.pmid: 952346
references.citation: Surg Gynecol Obstet. 1989 Dec;169(6):537-42
references.pmid: 2814770
references.citation: Ann Surg. 1994 Oct;220(4):564-8; discussion 568-9
references.pmid: 7944666
references.citation: Acta Chir Scand. 1969;135(6):530-3
references.pmid: 5368943