Adenocarcinoma located at a Meckel's Diverticulum: A case report and literature review

Tumors arising from Meckel's diverticulum (MD) reported in the literature are mainly carcinoid and gastrointestinal stromal tumors. We herein report a rare case of adenocarcinoma arising from intestinal mucosa in an MD with multiple liver metastases at the onset of symptoms. A 57-year-old female complaining of bloody stool for 2 weeks was admitted to our hospital. Colonoscopy revealed massive bloody fluids but did not find any neoplasm. Computed tomography (CT) found a heterogeneous mass at the distal ileum and multiple liver metastases. A segmental ileal resection with local mesentery excision was performed to control the bleeding. During surgery, a tumor arising from a diverticulum in the antimesenteric border of ileum was observed. Histologic examination revealed moderate to poorly differentiated adenocarcinoma. Majority of the MD remain asymptomatic and are diagnosed incidentally during small bowel contrast study, laparoscopy or laparotomy done for unrelated conditions, or until complications arise from the diverticulum. Malignancies are reported to account for only 0.5%-3.2% of the complications. The occurrence of adenocarcinoma in an MD is exceedingly rare. In the few cases described so far, the prognosis of adenocarcinoma within an MD has been poor due to the advanced stage as seen at the time of surgery. Despite the availability of many publications, there is a little consensus concerning the management of an incidental finding of MD. Adenocarcinoma in an MD is extremely sporadic and prognosis has been reported as very poor. However, early diagnosis is challenging. When found incidentally during laparotomy, MD should be carefully examined and best treated with prophylactic resection.