This study was conducted to compare the clinicopathologic characteristics of incidentally found and symptomatic cases of Meckel's diverticulum with the aim of arriving at a recommendation regarding the management of incidental cases. A retrospective chart review was performed over a period of 24 years. Incidental group had 52 patients and symptomatic group had 128 patients(71%). Obstruction (42.9%) was the most common presentation, followed by diverticulitis (41.4%). Gastrointestinal hemorrhage was found in 33.6% and was commonly associated with obstruction. If the diverticulum has umbilical connection, mesodiverticular band or heterogeneous on palpation, and if patient has no contraindication for diverticulectomy, we advocate prophylactic resection to avoid future life threating complications.