Meckels diverticulum most commonly presents as:

A. Gastrointestinal bleeding.

DISCUSSION: It is estimated that only 4% of patients who possess a Meckel's diverticulum will become symptomatic during their lifetimes. The most common clinical presentation is incidental identification during abdominal exploration. Symptomatic presentations are secondary to hemorrhage, small bowel obstruction, diverticulitis, perforation, associated umbilical abnormalities, and tumors. Over half of patients presenting with symptoms are under the age of 2. The most common clinical problem associated with Meckel's diverticulum is gastrointestinal bleeding presenting as bright red blood per rectum. The usual source of the bleeding is a chronic acid-induced ileal ulcer in the ileum adjacent to a Meckel's diverticulum that contains gastric mucosa. Another common symptom associated with a Meckel's diverticulum is intestinal obstruction. The cause of this obstruction may be volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or rarely, incarceration of the diverticulum in an inguinal hernia (Littre's hernia). Volvulus is usually an acute event and if allowed to progress, may result in strangulation of the involved bowel. In intussusception, a broad-based diverticulum invaginates and then is carried forward by peristalsis.