One lesion, two different stories: the changing clinical face of symptomatic Meckel’s diverticulum in children and adults

Authors

Abstract

AimSymptomatic Meckel's diverticulum (MD) is a rare but serious cause of acute abdomen. This study compared clinical features, diagnostic approaches, and outcomes of complicated MD in pediatric and adult patients.
MethodsA retrospective review was conducted on 45 patients undergoing surgery for MD between 2017 and 2025. Patients were classified as pediatric (<18 years, n = 29) or adult (≥18 years, n = 16). Demographics, presentation, diagnostics, operative findings, pathology, and outcomes were analyzed using SPSS 28.0.
ResultsMale predominance was observed in both groups. Adults experienced significantly longer time to diagnosis (8.5 vs. 3.9 days, p = 0.003). Gastrointestinal bleeding was more frequent in children (41.4% [including isolated bleeding (27.6%) and bleeding combined with abdominal pain (13.8%)] vs. 6.2%), whereas abdominal pain with or without vomiting predominated in adults (93.7%). Comorbidities were significantly higher in adults (75% vs. 13.8%, p < 0.01). Perforation occurred more frequently in adults (37.5% vs. 3.4%, p = 0.008). Ultrasound was the primary diagnostic modality in pediatrics (100%), while computed tomography was universal in adults (100%, p < 0.001). The laparoscopic approach was more common in children (55.2% vs. 25%). Adults demonstrated larger diverticular base dimensions (2.6 vs. 1.6 cm, p < 0.001) and prolonged hospital stays (14.7 vs. 8.2 days, p < 0.001). One mortality occurred in each group.
ConclusionPediatric symptomatic MD typically presents with bleeding and obstruction, while adult cases are characterized by diagnostic delay, comorbidities, and elevated risk of perforation and diverticulitis. Age-specific diagnostic algorithms and timely surgical intervention are essential to minimize morbidity and mortality.

Keywords

Introduction

Meckel's diverticulum (MD) is the most common congenital gastrointestinal system anomaly resulting from incomplete closure of the embryonic vitelline duct (omphalomesenteric duct).¹ Although its prevalence in the general population is reported to be approximately 2%, most cases are asymptomatic and are usually detected incidentally during surgery or autopsy for other reasons. In a significant proportion of symptomatic MD cases, inflammatory processes (Meckel's diverticulitis [MD]) are the main complication and can lead to acute abdominal symptoms. MD can be clinically confused with acute appendicitis, Crohn's disease, diverticulitis due to other causes, or intestinal obstruction, leading to delays in diagnosis and increased morbidity/mortality risk.^2,3
Although there are numerous studies in the literature on MD and its complications, most of these studies have focused on either pediatric or adult populations.^4,5 In the pediatric population, MD is one of the leading causes of lower gastrointestinal bleeding, especially in the first 2 years of life, and is associated with the presence of ectopic gastric mucosa. In adults, symptomatic MD is less common, but differences such as longer time to diagnosis, presence of comorbidities, and higher perforation rates have been reported. Comprehensive studies directly comparing the potential differences in clinical presentation, diagnostic challenges, spectrum of complications, and treatment outcomes between these two age groups are limited.
This retrospective cohort study compares pediatric and adult cases of Meckel's diverticulum requiring surgery at a single center in terms of demographic characteristics, presenting complaints, diagnostic processes (imaging and laboratory), intraoperative findings and surgical techniques, pathological features, complications, hospital stay durations, and mortality. For the purpose of this study, we included all major complications leading to surgery, namely acute diverticulitis, significant hemorrhage, and mechanical intestinal obstruction secondary to the diverticulum. The limited number of comprehensive studies in the literature that include detailed comparisons of pediatric and adult patient groups highlights the original value of this study. The data obtained are intended to contribute to increasing the level of clinical suspicion in both age groups, improving diagnostic approaches, and determining age-specific treatment strategies.

Materials and Methods

Study Design and Ethical ApprovalWe evaluated consecutive patients diagnosed with Meckel’s diverticulum who underwent surgical treatment at a tertiary University Hospital between January 2017 and January 2025. All patient data were fully anonymized prior to analysis in compliance with applicable data protection regulations. The study protocol conformed to the ethical principles of the Declaration of Helsinki. Given the retrospective nature of the study and the use of de-identified data, the requirement for written informed consent was waived by the institutional review board.
Inclusion and Exclusion CriteriaEligible participants were patients of any age presenting with an acute abdomen attributable to complicated Meckel’s diverticulum, including acute diverticulitis, overt gastrointestinal bleeding originating from the diverticulum, or bowel obstruction caused by the diverticulum or associated fibrous bands, who subsequently underwent surgery with histopathological confirmation of Meckel’s diverticulum. Exclusion criteria comprised asymptomatic or incidentally detected diverticula, patients managed nonoperatively, absence of pathological confirmation, and incomplete clinical records (Figure 1).
Data CollectionData were extracted from hospital information systems using a standardized form. Demographic characteristics (age, sex, comorbidities) and presenting complaints (abdominal pain, vomiting, gastrointestinal bleeding, symptom duration) were recorded. Laboratory variables included WBC count, CRP, hemoglobin, fecal occult blood, and stool culture. Imaging modalities (USG, CT, MRI, Meckel scintigraphy) and colonoscopy findings were documented. Surgical data included time to surgery, operative method, distance from the ileocecal valve, intraoperative findings, type of procedure, and any additional interventions. Pathology reports provided diverticulum size, ectopic tissue, tumor presence, and final diagnosis. Postoperative outcomes included complications, length of stay, and mortality.
GroupingPatients were categorized as:
Pediatric Group: <18 years (n = 29), Adult Group: ≥18 years (n = 16).
Ethical ApprovalThis study was approved by the Ethics Committee of Göztepe Prof. Dr. Süleyman Yalçın City Hospital (Date: 2025-09-11, No: 0155).
Statistical AnalysisAnalyses were performed using SPSS v28. Continuous variables were expressed as median (min–max) or mean ± SD; categorical variables as number and percentage. Normality was assessed with the Shapiro–Wilk. Independent Samples t-test or Mann–Whitney U test was used for continuous variables, and Chi-square or Fisher’s Exact test for categorical comparisons. Statistical significance was set at p < 0.05. Due to the exploratory design and multiple comparisons, p-values were interpreted cautiously and considered hypothesis-generating. No formal sample size calculation was performed due to the retrospective design.
Post-hoc power analysis for the primary outcome (adult vs. pediatric perforation rate: 37.5% vs. 3.4%) indicated that the current sample size provided approximately 85% power at α = 0.05, supporting the statistical robustness of this key finding. Other secondary comparisons should be interpreted with caution given the small adult group (n = 16) and exploratory design.
Reporting GuidelinesThis study is reported in accordance with the STROBE guidelines.

Results

A total of 45 patients were included in the study, comprising 29 pediatric and 16 adult patients. Male predominance was observed in both groups, with no significant difference between them (87.5% vs. 89.6%, p = 1.00). Adults had significantly higher rates of comorbidities, particularly diabetes mellitus, inflammatory bowel disease, and hypertension (each 25%, p < 0.05). Pediatric-specific comorbidities such as nephrotic syndrome and neonatal jaundice were rare and showed no statistical difference. Detailed demographic characteristics and baseline clinical findings are summarized in.
Clinical presentation differed between groups (p = 0.058). Adults most commonly presented with abdominal pain alone (50.0%) or abdominal pain accompanied by vomiting (43.7%). In contrast, pediatric patients demonstrated a more heterogeneous symptom profile, with abdominal pain alone (41.3%) and isolated gastrointestinal bleeding (27.6%) being the most frequent presentations. Laboratory analysis showed significantly higher WBC counts in children (13.2 vs. 8.7 × 10³/µL, p = 0.015), whereas adults had significantly higher CRP levels (32.3 vs. 14.9 mg/L, p = 0.028). Positive stool culture results were more frequent in adults (31.2% vs. 3.4%), although this difference did not reach statistical significance (p = 0.087).
Marked differences were observed in diagnostic imaging utilization. Ultrasonography was performed in all pediatric patients (100%) and in 68.7% of adults (p = 0.003). Pathological findings were detected by ultrasonography in 75.8% of pediatric cases. Computed tomography was performed in all adult patients (100%) and detected pathological findings in 93.8% of cases (p < 0.001). Meckel scintigraphy was positive in all pediatric patients with gastrointestinal bleeding, but yielded no positive results in adults. Colonoscopy was performed significantly more frequently in adults (56.2% vs. 10.3%, p = 0.002). Intraoperative findings showed significantly higher perforation rates in adults (37.5% vs. 3.4%, p = 0.008), while fibrous bands were observed only in pediatric patients (27.5% vs. 0%, p = 0.037). Bleeding tended to be more common in children (30.9% vs. 6.2%, p = 0.070), though this did not reach statistical significance. There were no significant differences in diverticulitis or intussusception rates.
Adults had a significantly larger diverticular base diameter (2.6 vs. 1.6 cm, p < 0.001). Pathologically, diverticulitis was the predominant diagnosis in both groups, and one adult patient was diagnosed with a gastrointestinal stromal tumor. Postoperative hospital stay was significantly longer in adults (14.7 vs. 8.2 days, p < 0.001). Mortality occurred in one patient in each group.
The detailed data are provided in Supplementary Table 1 and Table 2.

Discussion

This study demonstrates clear and clinically meaningful differences between pediatric and adult patients undergoing surgical treatment for MD, particularly in clinical presentation, diagnostic strategies, intraoperative findings, and postoperative outcomes. These distinctions reflect underlying age-specific pathophysiological mechanisms and highlight the need to tailor diagnostic suspicion, imaging choices, and management algorithms according to patient age.
A major finding of this study is the substantial divergence in presenting symptoms between the two age groups. In pediatric patients, bleeding was significantly more frequent, occurring either alone (27.6%) or in combination with abdominal pain (13.8%), whereas it was much rarer in adults (6.2%, p < 0.01). This observation aligns with widely recognized evidence in the literature describing that bleeding in children with MD is strongly associated with the presence of ectopic gastric mucosa. The gastric mucosa within the diverticulum secretes hydrochloric acid and pepsin, leading to ulceration of the adjacent ileal mucosa; this mechanism is more pronounced during childhood due to the narrower diverticular base and the higher secretory activity of ectopic mucosa.⁶ While our results do not imply that MD is the leading cause of lower gastrointestinal bleeding in the general pediatric population, they reinforce that among children with symptomatic MD, bleeding is the predominant clinical mode of presentation. In contrast, adults typically presented with abdominal pain alone (50.0%) or abdominal pain accompanied by vomiting (43.7%), suggesting that mechanical complications such as diverticulitis, obstruction, or perforation predominate in adulthood. This pattern is consistent with the tendency for the diverticular base to widen over time, predisposing to fecalith formation, bacterial overgrowth, and subsequent inflammatory complications. Additionally, comorbidities such as diabetes or vascular disease may predispose adults to ischemic necrosis and exacerbate local inflammation.⁷ These differences collectively highlight the age-dependent pathophysiological evolution of MD, with bleeding from ectopic mucosa seen mainly in children and mechanical or inflammatory complications predominating in adults.
Equally important are the differences observed in diagnostic processes. Time to diagnosis was significantly longer in adults than in children (8.5 vs. 3.9 days, p = 0.003), a delay that likely stems from the lower index of suspicion for MD in adults, the nonspecificity of symptoms, and symptom masking by comorbidities such as inflammatory bowel disease. Literature suggests that diagnostic delay increases the risk of perforation in adult MD,⁸ a finding mirrored in our results with a high perforation rate in adults (37.5%, p = 0.008). In contrast, pediatric patients were diagnosed more rapidly, aided by more specific symptoms, such as overt bleeding, and more frequent emergency department visits.
Imaging patterns also differed markedly between groups. Pediatric patients uniformly underwent ultrasonography (USG), and pathological findings were detected in 75.8% of cases, confirming USG as a high-utility, radiation-free option in children.⁹ In adults, however, USG use was significantly lower (68.7%, p = 0.003), likely due to reduced sensitivity caused by increased abdominal adipose tissue.¹⁰ Children benefit from a thin abdominal wall and minimal fat, which facilitates visualization of mesenteric inflammation or free fluid, whereas adult adiposity and longer bowel segments limit USG effectiveness.¹¹ Accordingly, adults uniformly underwent CT imaging, which detected pathological findings in 93.8% of cases (p < 0.001), reaffirming CT as the diagnostic standard in adult MD. CT’s superiority lies in its ability to identify perforation, abscess formation, and fat stranding, all of which are especially relevant in adults with more severe or delayed presentations. Meckel scintigraphy was positive in all pediatric bleeding cases but negative in adults, consistent with the known limitations of scintigraphy in adults. This discrepancy may be explained by the higher activity of ectopic gastric mucosa in children and the reduced sensitivity of scintigraphy when inflammation disrupts blood flow in adults.¹² Notably, Srisan et al. (2025) conducted a directly comparable pediatric-versus-adult analysis of MD, similarly reporting higher bleeding rates in children and higher perforation rates in adults, consistent with our findings. However, our cohort demonstrated a higher adult perforation rate (37.5% vs. approximately 15% in Srisan et al.), potentially reflecting differences in referral patterns, diagnostic delay, or comorbidity burden between the two single-center cohorts.¹² The convergence of results across both studies reinforces the robustness of age-stratified clinical patterns in symptomatic MD. Colonoscopy, performed more frequently in adults (56.2% vs. 10.3%, p = 0.002), was useful for detecting secondary features such as terminal ileal narrowing, which are more common in adults with comorbid conditions, including inflammatory bowel disease.¹³
Laboratory parameters further reflected age-based physiological differences. Higher WBC levels in children (13.2 vs. 8.7 × 10^3/µL, p = 0.015) suggest a more vigorous leukocyte response to acute inflammation. Conversely, adults had significantly higher CRP levels (32.3 vs. 14.9 mg/L, p = 0.028), likely resulting from more prolonged symptom duration and comorbidities.¹⁴ Children mount a rapid leukocyte-driven response, whereas adults—particularly those with chronic illnesses such as diabetes—demonstrate a more pronounced acute phase reaction.¹⁵ Stool culture positivity was more common in adults (31.2% vs. 3.4%, p = 0.087), potentially reflecting longer exposure to hospital environments and higher rates of bacterial colonization associated with perforation and diverticulitis.¹⁶
Intraoperative findings also differed substantially. Adults had a significantly higher perforation rate (37.5% vs. 3.4%, p = 0.008), a finding consistent with delayed diagnosis, a wider diverticular base (2.6 cm vs. 1.6 cm, p < 0.001), and comorbid conditions that predispose to ischemia.¹⁷ Chronic diseases such as diabetes and atherosclerosis may impair local microvascular perfusion, increasing tissue necrosis and perforation risk. Literature reports perforation rates of 15–40% in adult MD, underscoring the clinical relevance of our findings. The rarity of perforation in children is consistent with rapid diagnosis and the absence of comorbidities.¹⁸ Conversely, fibrous bands were significantly more common in pediatric patients (27.5% vs. 0%, p = 0.037). These bands, remnants of the omphalomesenteric duct, predispose children to obstruction, volvulus, and intussusception due to increased intestinal mobility and anatomical configuration.¹⁹ The higher trend toward bleeding in children is attributable to the higher prevalence of ectopic gastric mucosa, while adults are less affected due to lower mucosal activity and inflammation-dominant disease progression.²⁰
Postoperative outcomes also differed significantly. Adults had longer hospital stays (14.7 vs. 8.2 days, p < 0.001), reflecting the burden of perforation, comorbidities, open surgery, and postoperative complications such as peritonitis and sepsis.²¹ Children more often underwent laparoscopic surgery (55.2%), which is associated with less tissue trauma, lower infection rates, and faster recovery. The absence of comorbidities and a lower rate of perforation also contributed to shorter hospitalization in children. Mortality occurred in one patient from each group, demonstrating that perforation and comorbidities substantially elevate mortality risk. The identification of a gastrointestinal stromal tumor (GIST) in one adult patient underscores the importance of routine pathological examination, especially in adults.

Limitations

This study has limitations, including its retrospective single-center design, small sample size (notably in adults), heterogeneity of symptoms, and variable follow-up durations, all of which may affect generalizability.

Conclusion

Meckel’s diverticulitis behaves differently across age groups. Children predominantly experience bleeding and obstruction, whereas adults more often present with delayed diagnosis, inflammation, and perforation. These findings highlight the importance of age-adjusted diagnostic pathways: USG and scintigraphy in children and CT and colonoscopy in adults. Clinicians should consider MD in the differential diagnosis of acute abdomen across all ages and adjust diagnostic strategies based on age-driven pathophysiology and presentation.

Declarations

Abbreviations

CI: confidence interval
CRP: c-reactive protein
CT: computed tomography
GIST: gastrointestinal stromal tumor
MD: meckel's diverticulum
MRI: magnetic resonance imaging
SD: standard deviation
STROBE: strengthening the reporting of observational studies in epidemiology
USG: ultrasonography
WBC: white blood cell

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About This Article

Received:

February 16, 2026

Accepted:

April 3, 2026

Published Online:

April 8, 2026