The presentation of Meckel’s diverticulum is usually asymptomatic. The hallmark feature in symptomatic patients is the occurrence of painless lower gastrointestinal bleeding. Other symptoms of Meckel’s diverticulum arise in complicated cases with features of intestinal obstruction, intussusception, volvulus and perforation. The age of presentation for approximately half of all patients is less than 10 years of age. Patients may also develop symptoms of diverticular inflammation (ie, Meckel’s diverticulitis) which has a presentation similar to acute appendicitis.

The most common presenting symptom in patients is painless rectal bleeding, followed by less common symptoms of intestinal obstruction, volvulus and intussusception in complicated cases. Occasionally, Meckel’s diverticulitis may present with all the features of acute appendicitis.^[1][2][3][4]

• Meckel’s diverticulum is usually asymptomatic and is found incidentally on abdominal imaging or surgical exploration performed for a presumptive diagnosis such as acute cholecystitis (exploratory laparotomy, laparoscopy).
• The age of presentation for approximately half of all patients is less than 10 years of age.

Common symptoms of Meckel’s diverticulum include:

• Lower gastrointestinal bleeding:^[5]
  • Mechanism: presence of ectopic gastric mucosa leads to acid secretion within the diverticulum and ulceration of the small bowel^[6][3]
  • Site: Downstream or adjacent to the diverticulum and not within it
  • May be acute or chronic and insidious
  • May be a massive bleed
  • Usually painless
  • More common in children
  • In children: presents as maroon or dark red stools
  • In adults: presents as melena as transit time through the colon is increased
• Acute abdominal complaints such as pain in the abdomen may be seen in complicated cases, mimicking the presentation of acute appendicitis

Less common symptoms of Meckel’s diverticulum arise in complicated cases:^{[1][3][7][8][9][10]}

• Symptoms of intussusception, particularly recurrent or atypical intussusception commonly seen in children:
  • Pain: crampy abdominal pain with or without rectal bleeding
  • Inconsolable crying
  • Drawing up of the legs toward the abdomen^[11]
  • Vomiting usually after the first episode, initially non-bilious but may convert to bilious as obstruction progresses
  • Bloody stool or occult blood^[12]
  • Current jelly stools (mixture of mucus and blood)
  • Intermittent pain free intervals in between episodes of pain^[7]

• Symptoms of bowel obstruction, more common in adults:
  • Colicky abdominal pain (cramping and intermittent) in nature, with spasms lasting a few minutes
  • Vomiting
  • Nausea
  • Constipation
• Symptoms of diverticular inflammation (ie, Meckel’s diverticulitis): may present with features similar to acute appendicitis^{[13][2][14][15]}
  • Alternating diarrhea and constipation
  • Painful abdominal cramps 
  • Chills or fever
• Symptoms of perforation:^[16]
  • Severe abdominal pain intensified by movement
  • Chills
  • Fever
  • Nausea
  • Vomiting