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S1825 National Trends in Clinical Presentation and Complications of Meckel’s Diverticulum in Adults in the United States: A Population-Based Study

2023; Lippincott Williams & Wilkins; Volume: 118; Issue: 10S Linguagem: Inglês

10.14309/01.ajg.0000956940.94718.fc

1572-0241

Waqas Rasheed, Gnanashree Dharmarpandi, Muhammad Anil, Shahana Ishfaque, Muhammad Anees, Sarah Naveed Qureshi,

Gastrointestinal disorders and treatments

Introduction: Meckel’s diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract. According to previous studies, MD varies in presentation between children and adults, but the rate of particular presentations and complications is not well known. In children, it is well known that the most common presentation of MD is gastrointestinal bleeding, but the applicability of this to adults has been under question. This study aims to investigate the most common complications of MD in adults in the US using the largest inpatient database. Methods: This retrospective study utilized the National Inpatient Sample (NIS) database from 2016-2020. We included adult patients (age ≥18 years) with MD hospitalized between 2016-2020 and created a table of biodemographic and hospital characteristics using the chi-square test for categorical variables and student’s t-test for continuous variables (Table 1). We also presented the annual trend in inpatient outcomes of MD in a graph (Figure 1). Results: We identified 24,280 adult patients with a mean age of 54.11 years, mostly white men admitted to large teaching hospitals in the southern region of the US (Table 1). Most patients presented with intestinal obstruction, followed by gastrointestinal bleeding and the rates of these complications have increased over the last 2 years. Intestinal perforation and volvulus were identified less frequently. MD-related inpatient mortality has improved over the last few years (Figure 1). Conclusion: Meckel’s diverticulum most commonly presented in adults with intestinal obstruction, followed by gastrointestinal bleeding. Gastrointestinal bleeding due to MD is thought to be related to ulceration of the small bowel due to acid secretion by ectopic gastric mucosa within the diverticulum, with the site of bleeding being downstream from the diverticulum. Intestinal obstruction due to MD in children results from intussusception and volvulus. In adults, the obstruction is likely related to torsion of the diverticulum, abdominal wall hernia with incarceration of diverticulum, or diverticulitis resulting in obstruction of the bowel lumen. The risk factors for some of the causes of intestinal obstruction such as abdominal wall hernia and diverticulitis are more common in adults and this likely results in intestinal obstructions as the most common presentation of MD.Figure 1.: National trends in complications of meckel's diverticulum. Table 1. - Biodemographic and hospital characteristics of Meckel's Diverticulum related adult hospitalizations in the United States in 2016-2020 Patient and hospital characteristics MD (n or %) P-value Number of hospitalizations (n) 24,280 Mean age in years (SE) 54.11 (19.06) < 0.001 Age 18-30 years 3,360 (13.84%) < 0.001 30-40 years 2,970 (12.23%) 40-50 years 3,180 (13.10%) 50-60 years 4,910 (20.22%) 60-70 years 4,340 (17.87%) 70-80 years 3,330 (13.71%) >80 years 2,190 (9.02%) Gender Male 14,785 (60.91%) < 0.001 Female 9,490 (39.09%) Race White 19,105 (81.65%) < 0.001 Black 1,075 (4.59%) Hispanic 1,845 (7.88%) Asian or Pacific Islander 595 (2.54%) Others 780 (3.33%) Median household income national quartile for patient ZIP Code $1-$43,999 5,640 (23.55%) < 0.001 $44,000-$55,999 6,110 (25.52%) $56,000-$73,999 6,645 (27.75%) $74,000 or more 5,550 (23.18%) Insurance type Medicare 8,425 (35.82%) < 0.001 Medicaid 2,910 (12.37%) Private including HMO 11,015 (46.83%) Others 1,170 ( 4.97%) Elixhauser Comorbidity Index (ECI) 0 5,145 (21.19%) < 0.001 1 4,815 (19.83%) 2 4,315 (17.77%) ≥ 3 10,005 (41.21%) Bed size of hospital Small 5,070 (20.88%) 0.040 Medium 6,840 (28.17%) Large 12,370 (50.95%) Hospital teaching status Non-Teaching Hospital 7,870 (32.41%) < 0.001 Teaching Hospital 16,410 (67.59%) Region of hospital Northeast 4,065 (16.74%) < 0.001 Midwest 6,615 (27.24%) South 8,475 (34.91%) West 5,125 (21.11%)