Meckel's diverticulum medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]


Initially, the medical management of a symptomatic case of Meckel's diverticulum is directed toward management of clinical manifestations of complications. Intravenous lines for fluid and electrolyte therapy, nasogastric decompression for patients with symptoms and signs of intestinal obstruction, proton-pump inhibitors and Aluminum hydroxide for patients with gastrointestinal bleeding are preferred. The process of initial resuscitation in patients with lower gastrointestinal bleeding due to Meckel's diverticulum) is similar to the steps followed in any case of lower GI bleeding.

Medical Therapy

Initial Resuscitation in patients with lower gastrointestinal bleed due to Meckel's diverticula

The process of initial resuscitation in patients with lower gastrointestinal bleeding due to any pathology (including Meckel's diverticulum) is similar and includes the steps enlisted below.

Initial Evaluation

Role of Nasogastric tube (NGT)

Workup and Initial Management
Initial Evaluation
  • Airway, Breathing, Circulation
Supportive Therapy
  • Ensure patent and protected airway
  • 2 large-bore, peripheral intravenous lines
Blood transfusion

Assessment of severity of bleeding

Bleeding severity Vital signs Blood loss
Minor Normal <10%
Moderate Postural hypotension 10-20%
Severe Shock >25%

Fluid resuscitation

Blood transfusion

Indications for transfusion
Age Target Hematocrit
Elderly patient ( >45) 30%
Younger patient (<45) 25%
Patients with portal hypertension 28%

Triage and consultations

Evaluation setting Patient catagories
ICU Patients with high-risk features
Outpatient Patients with low-risk features
Regular Ward Most other patients can be admitted to a regular medical ward
  • : Low-risk features include a young, otherwise healthy patient with minor, self-limited rectal bleeding suspected to be from an anal source)
  • ♦: Requires continuous electrocardiogram monitoring and pulse oximetry.

Risk stratification

High-risk features

Medical Therapy

Pharmacotherapy is only used as an adjuvant therapy for patients with lower GI bleed due to Meckel's diverticulum. Epinephrine is used alone or in conjunction with other surgical techniques. Local injection of epinephrine stops bleeding by both pressure tamponade and the vasoconstrictor effect. In patients with re-bleeding, surgery should be considered.[21][16][17][18]


Major contraindications


During vasopressin infusion, patients must be monitored for:


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  2. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ (1994). "Surgical management of Meckel's diverticulum. An epidemiologic, population-based study". Ann. Surg. 220 (4): 564–8, discussion 568–9. PMC 1234434. PMID 7944666.
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  7. Rattan KN, Singh J, Dalal P, Rattan A (2016). "Meckel's diverticulum in children: Our 12-year experience". Afr J Paediatr Surg. 13 (4): 170–174. doi:10.4103/0189-6725.194671. PMC 5154221. PMID 28051045.
  8. Choi SY, Hong SS, Park HJ, Lee HK, Shin HC, Choi GC (2017). "The many faces of Meckel's diverticulum and its complications". J Med Imaging Radiat Oncol. 61 (2): 225–231. doi:10.1111/1754-9485.12505. PMID 27492813.
  9. Chabowski M, Szymanska-Chabowska A, Dorobisz T, Janczak D, Jelen M, Janczak D (2016). "A massive bleeding from a gastrointestinal stromal tumor of a Meckel's diverticulum". Srp Arh Celok Lek. 144 (3–4): 219–21. PMID 27483571.
  10. Srisajjakul S, Prapaisilp P, Bangchokdee S (2016). "Many faces of Meckel's diverticulum and its complications". Jpn J Radiol. 34 (5): 313–20. doi:10.1007/s11604-016-0530-x. PMID 26932405.
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