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Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage

Jeannie C Yang1, Douglas C Rivard, Frank P Morello

  • 1Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.

Pediatric Radiology
|May 21, 2008
PubMed

Insights

A Meckel diverticulum, an embryonic remnant, can cause complications like fistulas and abscesses. This case shows a challenging diagnosis in an 11-year-old boy requiring Meckel diverticulum resection.

Area of Science:

  • Gastroenterology
  • Pediatric Surgery
  • Surgical Pathology

Background:

  • Meckel diverticulum is a congenital anomaly resulting from incomplete closure of the omphalomesenteric duct, found in about 2% of the population.
  • While often asymptomatic, Meckel diverticula can lead to significant complications such as inflammation, diverticulitis, perforation, and bleeding.

Observation:

  • An 11-year-old boy presented with complications after a laparoscopic appendectomy for perforated appendicitis.
  • Initial management included percutaneous drainage of a presumed postoperative abscess, which later revealed an enteric fistula on drain study.
  • Recurrent symptoms of nausea and abdominal pain led to a CT scan showing a persistent enteric fistula and abscess.

Findings:

  • The patient's persistent enteric fistula and abscess were confirmed via CT imaging.
  • Exploratory laparoscopy identified a complicated Meckel diverticulum as the underlying cause.
  • Resection of the Meckel diverticulum was performed, resolving the patient's symptoms.

Implications:

  • This case underscores the diagnostic difficulties associated with complicated Meckel diverticula, particularly when presenting atypically.
  • It highlights the limitations of conventional radiological methods in fully characterizing complex cases.
  • Early identification and surgical management of Meckel diverticulum are crucial for preventing severe complications.

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