Perforated Meckel’s Diverticulum: A Case Report
DOI:
https://doi.org/10.59188/jcs.v3i10.2701Keywords:
Meckel’s Diverticulum, Acute Abdomen, PerforationAbstract
Meckel’s diverticulum is a true diverticulum that consists of all layers of bowel normally found in a normal small bowel wall. The three most common presentations in children are intestinal bleeding (30–56%), intestinal obstruction (14–42%), and diverticular inflammation (6–14%). Complications result in more severe symptoms, such as acute abdomen and signs of peritonitis. These presentations are not specific to Meckel’s diverticulum and can be found in many other conditions, making the diagnosis difficult. A five-year-old child came to the emergency department with complaint of acute abdominal pain, especially in the right lower quadrant. The pain was accompanied by vomiting. On physical examination, patient was febrile and signs of peritonitis were found. Abdominal plain film revealed the probability of focal inflammation in the right lower region of the abdomen, with partial intestinal obstruction. Ultrasonography showed a presence of a mass in right iliac region with the size of 24x20x23 mm, with normal appendix. During exploratory laparotomy, a necrotic and perforated Meckel’s diverticulum was found, with associated purulent matter. Diverticulectomy with segmental resection of ileum followed by end-to-end anastomosis were done. Diagnosis of Meckel’s diverticulum requires a high index of suspicion, especially in the pediatric population. It is important for clinicians to be aware of unusual presentations of Meckel’s diverticulum.
References
Abizeid, G. A., & Aref, H. (2017). Case report: preoperatively diagnosed perforated Meckel’s diverticulum containing gastric and pancreatic-type mucosa. BMC Surgery, 17, 1–4.
An, J., & Zabbo., C. P. (2024). Meckel Diverticulum. StatPearls Publishing.
Boyle, J. T. (2004). Abdominal pain. Pediatric Gastrointestinal Disease. 4th Ed. Hamilton: BC Decker Inc, 225–243.
Chen, J.-J., Lee, H.-C., Yeung, C.-Y., Chan, W.-T., Jiang, C.-B., Sheu, J.-C., & Wang, N.-L. (2014). Meckel’s diverticulum: factors associated with clinical manifestations. International Scholarly Research Notices, 2014(1), 390869.
Choi, S., Hong, S. S., Park, H. J., Lee, H. K., Shin, H. C., & Choi, G. C. (2017). The many faces of Meckel’s diverticulum and its complications. Journal of Medical Imaging and Radiation Oncology, 61(2), 225–231.
Coran, A. G., Adzick, N. S., Krummel, T. M., Laberge, J.-M., Shamberger, R., & Caldamone, A. (2012). Pediatric Surgery: Expert Consult-Online and Print (Vol. 2). Elsevier Health Sciences.
Farah, R. H., Avala, P., Khaiz, D., Bensardi, F., Elhattabi, K., Lefriyekh, R., Berrada, S., Fadil, A., & Zerouali, N. O. (2015). Spontaneous perforation of Meckel’s diverticulum: a case report and review of literature. The Pan African Medical Journal, 20.
Fraser, A. A., Opie, D. D., Gnecco, J., Nashed, B., & Johnson, D. C. (2018). Spontaneous perforation of Meckel’s diverticulum in an adult female with literature review. Surgical Case Reports, 4, 1–5.
Giambelluca, D., Cannella, R., Caruana, G., Salvaggio, L., Grassedonio, E., Galia, M., Midiri, M., & Salvaggio, G. (2019). CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain. Insights into Imaging, 10, 1–9.
Hansen, C.-C., & Søreide, K. (2018). Systematic review of epidemiology, presentation, and management of Meckel’s diverticulum in the 21st century. Medicine, 97(35), e12154.
Jabri, K. A. Al, & Sherbini, A. El. (2012). Small Bowel Obstruction due to Meckel’s Diverticulum: A Case Report. National Library of Medicine, 21(1).
Javid, P., & Pauli, E. M. (2020). Meckel’s diverticulum. UpToDate.
Keese, D., Rolle, U., Gfroerer, S., & Fiegel, H. (2019). Symptomatic Meckel’s diverticulum in pediatric patients—case reports and systematic review of the literature. Frontiers in Pediatrics, 7, 267.
Kotha, V. K., Khandelwal, A., Saboo, S. S., Shanbhogue, A. K. P., Virmani, V., Marginean, E. C., & Menias, C. O. (2014). Radiologist’s perspective for the Meckel’s diverticulum and its complications. The British Journal of Radiology, 87(1037), 20130743.
Kuru, S. (2018). Meckel’s diverticulum: clinical features, diagnosis and management. Revista Espanola de Enfermedades Digestivas, 110(11), 726–732.
Leader, H., Polott, E., Pinto, J. M., Staab, V. S., Girgis, W., Sun, X., & Naganathan, S. (2022). Perforated Meckel’s Diverticulum. Journal of Pediatric Surgery Case Reports, 80.
Patel, N., & Kay, M. (2021). Lower gastrointestinal bleeding in children: Causes and diagnostic approach.
Schwartz, S. I., & Brunicardi, F. C. (2010). Schwartz’s principles of surgery. McGraw Hill Professional.
Sellars, H., & Boorman, P. (2017). Acute appendicitis. Surgery (Oxford), 35(8), 432–438.
Sun, B., Liu, J., Li, S., Lovell, J. F., & Zhang, Y. (2023). Imaging of Gastrointestinal Tract Ailments. Journal of Imaging, 9(6), 115.
Tekriwal, K., Bhoir, A. A., & Karthik, H. S. (2024). Meckel’s diverticulitis: A frequently overlooked mimic of appendicitis. Case Reports in Clinical Radiology, 2(2), 103–106.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Tea Karina Sudharso, Elizabeth Angelina Maharani Chandra, Anike Natalia Sirait
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
