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Enterovesical fistula, a rare complication of Meckel's diverticulum: A case report
Bourguiba M A1, Gharbi M1, Ghalleb M1
1General Surgery department A, Charles Nicolle Teaching Hospital, Faculty of Medicine, Uiversity of Tunis el Manar, Tunisia.
Introduction:
Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can exceptionally result in an vesico-diverticulum fistula, as noted in only seven previously reported cases.
Case Report:
A 35-year old Arabic male, quadriplegic,who presented epigastralgia evolving for a week, associated with abdominal distension and cloudy urine. On examination he was feverish (38.5°C), dehydrated with tenderness in the entire distended abdomen; rectal examination revealed a hypotonic sphincter with no other abnormality. After investigations, acute peritonitis diagnosis was retained. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a performed Meckel's diverticulum. Diverticulectomy, ileostomy and bladder sutures were performed after peritoneal cleansing. The postoperative course was uneventful. The anatomo-pathological examination confirmed the diagnosis of a perforated Meckel's diverticulum that did not contain ectopic gastric or pancreatic tissue.
Conclusion:
Vesico-diverticular fistula resulting from a perforated Meckel's diverticulum is a rare complication. To our knowledge, this is only the fourth reported case which is not associated to inflammatory bowel disease.
Insights
A rare case of vesico-diverticular fistula, caused by a perforated Meckel's diverticulum, was successfully treated. This condition, leading to bladder and intestinal communication, is exceptionally uncommon, especially without inflammatory bowel disease.
Area of Science:
- Gastroenterology
- Urology
- Surgical Case Reports
Background:
- Enterovesical fistulas typically arise from diverticulitis, Crohn's disease, or colorectal cancer.
- Perforated Meckel's diverticulum is an extremely rare cause of vesico-diverticular fistula, with only seven prior documented instances.
Purpose of the Study:
- To report a unique case of a vesico-diverticular fistula secondary to a perforated Meckel's diverticulum.
- To highlight the rarity of this specific etiology, particularly in the absence of inflammatory bowel disease.
Main Methods:
- A 35-year-old male presented with symptoms suggestive of acute peritonitis.
- Diagnostic investigations led to exploratory laparotomy, revealing a vesico-diverticular fistula.
- Surgical intervention included diverticulectomy, ileostomy, and bladder repair.
Main Results:
- The exploratory laparotomy confirmed a vesico-diverticular fistula originating from a perforated Meckel's diverticulum.
- The patient underwent successful surgical repair with an uneventful postoperative recovery.
- Histopathological examination ruled out ectopic gastric or pancreatic tissue within the diverticulum.
Conclusions:
- Vesico-diverticular fistula due to perforated Meckel's diverticulum is a rare clinical entity.
- This case represents one of the few documented instances not associated with inflammatory bowel disease.
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