In children, GI bleeding related to Meckel's diverticulum often manifests as painless, acute episodes of hematochezia or chronic melena with stools resembling currant jelly. In contrast, adults usually present with less obvious signs, which makes the diverticulum a common suspect only in the absence of an identifiable source of bleeding. The major challenge in differential diagnosis arises due to similar presentations with other GI conditions like diverticulitis, Crohn’s disease, or peptic ulcers, necessitating specific diagnostic imaging and tests such as a Meckel's scan, CT angiography, or endoscopic procedures, to accurately identify the source of bleeding .

Heterotopic gastric mucosa in a Meckel’s diverticulum secretes acid, leading to the ulceration of adjacent small bowel mucosa, which causes gastrointestinal bleeding. To diagnose this, a Meckel's scan can be used as the first-line test in hemodynamically stable patients, especially children, as it utilizes technetium-labeled compounds that bind to gastric mucosa, allowing for scintigraphy to visualize ectopic gastric tissue. Arteriography and CT angiography are other diagnostic options, particularly when the bleed is significant enough to warrant transfusion. Capsule endoscopy and double-balloon enteroscopy can also be used to visualize the source of bleeding and confirm the diagnosis .

Meckel's diverticulum is the most common congenital gastrointestinal tract anomaly, with a prevalence of approximately 2% of the population. It is more common in males than females, with a ratio of 2:1. Symptoms typically present between ages 2-4, but the condition can be asymptomatic for many individuals. Additionally, the presence is notably higher in children with major malformations involving organs such as the umbilicus, GI tract, nervous system, and heart. These patterns are summarized by the 'rule of 2s': it affects about 2% of the population, presents twice as commonly in males, and symptoms often appear by the age of 2 .

Littre’s hernia occurs when a Meckel's diverticulum becomes incarcerated within a hernia, usually an inguinal hernia. This association complicates the clinical picture by presenting a risk of strangulation, incarceration, or obstruction, leading to acute abdominal symptoms. Such scenarios necessitate surgical intervention to relieve the obstruction and reduce the hernia. Clinically, this association is significant because it highlights the importance of surgical evaluation in patients with abdominal hernias presenting with symptoms of obstruction, as untreated Littre's hernia can lead to ischemia and perforation .

For symptomatic Meckel's diverticulum, surgical intervention is often necessary due to complications like GI bleeding, SBO, or diverticulitis. Surgical management involves resection of the diverticulum, possibly including segmental small bowel resection to address ulcerated areas or severely inflamed sections. The decision to proceed with surgery is influenced by the clinical presentation, such as the presence of peritonitis or sepsis, which may necessitate urgent intervention. Other factors include patient age, overall health, and the presence of physical abnormalities like fibrous bands or heterotopic mucosa, which increase the risk of future complications. Additionally, emergency surgery is advised if there are signs of perforation or ischemia .

In asymptomatic adults, an incidentally discovered Meckel's diverticulum carries a lifelong risk of complications such as GI bleeding or obstruction, although these events are infrequent. The decision to intervene surgically depends on several factors, including patient age, the size of the diverticulum (over 2 cm increases risk), palpable abnormalities, and the presence of fibrous bands or ectopic tissue that could enhance future complication risks. While no treatment is required for all cases, resection may be considered for individuals under 50, particularly with diverticular abnormalities, to mitigate future complications. Older patients or those with comorbid conditions are less likely to need intervention unless abnormalities are present .

In cases of suspected small bowel obstruction (SBO) potentially caused by Meckel's diverticulum, a CT scan is the most commonly used diagnostic tool, as it can identify obstruction, inflammation, and perforation. However, it correctly diagnoses the diverticulum in only about 50% of cases. If imaging is equivocal, diagnostic laparoscopy may be employed as it allows direct visualization and can differentiate between Meckel's diverticulum and similar conditions such as appendicitis. Laparoscopy not only confirms diagnosis but also offers a therapeutic intervention option if necessary .

Technetium-99m pertechnetate scintigraphy, or Meckel’s scan, is particularly valuable in diagnosing Meckel’s diverticulum due to its non-invasiveness and specificity in detecting ectopic gastric mucosa through radioisotope binding. This test is most effective in hemodynamically stable pediatric patients, as it offers a high detection rate of ectopic tissue characteristic of the diverticulum. However, its utility is limited by false negatives in cases without ectopic gastric tissue. Compared to arteriography and CT angiography, it is less invasive and does not require exposure to iodinated contrast but is not suitable in cases with slow or intermittent bleeding where more sensitive methods, like CT angiography, might be required .

Meckel's diverticulum can lead to several major complications such as gastrointestinal bleeding, Meckel’s diverticulitis, and small bowel obstruction (SBO). Gastrointestinal bleeding occurs if the diverticulum contains ectopic gastric mucosa which secretes acid, leading to ulceration and downstream bleeding. Meckel's diverticulitis results from acute inflammation; the opening of the diverticulum may become obstructed by a fecalith or other material, causing inflammation that can lead to ischemia and perforation. SBO can occur due to mechanisms like intussusception, where the bowel telescopes into itself using the diverticulum as a lead point, or volvulus, where intestines twist around fibrous bands connected to a diverticulum. Clinically, these complications can manifest as painless lower GI bleeding (acute hematochezia or chronic melena), symptoms similar to appendicitis (abdominal pain and possible perforation), and symptoms of obstruction such as nausea, vomiting, and abdominal distention .

Meckel’s diverticulum originates from the failure of the omphalomesenteric (vitelline) duct to completely involute during gestational weeks five and six. This embryological remnant results in a true diverticulum that contains all layers of the intestinal wall, arising from the antimesenteric border of the ileum, typically within two feet of the ileocecal valve. Anatomically, it frequently leads to complications due to features like ectopic gastric mucosa, which secretes acid, causing ulceration and bleeding. Functionally, it can act as a lead point for intussusception or be involved in small bowel obstruction due to adhesions or torsion associated with its anomalous fibrous connections .