Feller Alexander A, Movson Jonathon, Shah Samir A
Department of Medicine, Brown Medical School, Providence, RI 02904, USA.
Arch Intern Med. 2003 Sep 22;163(17):2093-6. doi: 10.1001/archinte.163.17.2093.
Meckel diverticulum (MD) is traditionally considered a pediatric disease that is associated with intestinal hemorrhage or perforation. Symptomatic MD is rarely a consideration in the geriatric population.
To notify clinicians of the clinical variety and diagnostic uncertainty of MD in the elderly, we report 7 cases of complicated MD that presented as common disorders of the gastrointestinal (GI) tract in patients older than 65 years.
A retrospective record review at 2 university-affiliated hospitals revealed 7 patients older than 65 years with MD and abdominal complaints necessitating laparotomy. The patients represented a subset of 27 adults (age range, 21-89 years; mean age, 39 years) with symptomatic MD who required surgery during a 7-year period.
The presenting complaints represented a variety of common GI presentations, including nausea, vomiting, and acute abdominal pain (n = 3); acute abdominal pain with peritonitis (n = 2); crampy abdominal pain lasting several weeks (n = 1); and rectal bleeding (n = 1). Meckel diverticulum was a preoperative consideration in only 2 of 7 cases. The preoperative diagnoses were consistent with common disorders of the GI tract in the elderly, including small-bowel obstruction (n = 2), ischemic colitis (n = 1), unrelenting bleeding in the GI tract (n = 1), perforated viscus (n = 1), diverticulitis (n = 1), and appendicitis (n = 1). In contradistinction to the pediatric age group, only 1 of 7 patients had an MD with ectopic mucosa.
Many different mechanisms can be responsible for complications due to MD in the geriatric population. Misdiagnosis occurs frequently in the elderly because of the poor sensitivity of diagnostic tests, nonspecificity of complaints, and lack of recognition that this anomaly can present in this age group. Clinicians must be cognizant of this common pediatric disease and its varied guises when they are evaluating unexplained acute or intermittent abdominal pain, nausea and vomiting, rectal bleeding, peritonitis, or obstruction in geriatric patients.
梅克尔憩室（MD）传统上被认为是一种与肠道出血或穿孔相关的儿科疾病。有症状的MD在老年人群中很少被考虑。
为了让临床医生了解老年患者中MD的临床多样性和诊断不确定性，我们报告了7例复杂MD病例，这些病例表现为65岁以上患者常见的胃肠道（GI）疾病。
对两家大学附属医院进行回顾性病历审查，发现7例65岁以上患有MD且因腹部不适需要剖腹手术的患者。这些患者是27例有症状MD的成年人（年龄范围21 - 89岁；平均年龄39岁）中的一部分，他们在7年期间需要手术治疗。
主要症状表现为各种常见的胃肠道症状，包括恶心、呕吐和急性腹痛（n = 3）；伴有腹膜炎的急性腹痛（n = 2）；持续数周的痉挛性腹痛（n = 1）；以及直肠出血（n = 1）。7例病例中只有2例术前考虑到梅克尔憩室。术前诊断与老年患者常见的胃肠道疾病一致，包括小肠梗阻（n = 2）、缺血性结肠炎（n = 1）、胃肠道持续出血（n = 1）、脏器穿孔（n = 1）、憩室炎（n = 1）和阑尾炎（n = 1）。与儿科年龄组不同，7例患者中只有1例的MD有异位黏膜。
老年人群中MD并发症可能由多种不同机制引起。由于诊断测试敏感性差、症状不具特异性以及未认识到该异常可出现在这个年龄组，老年患者中误诊频繁发生。当临床医生评估老年患者不明原因的急性或间歇性腹痛、恶心和呕吐、直肠出血、腹膜炎或梗阻时，必须认识到这种常见的儿科疾病及其各种表现形式。
