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Meckel's Diverticulitis Masquerading as Acute Pancreatitis: A Diagnostic Dilemma

C Danny Darlington1, G Fatima Shirly Anitha2

  • 1Department of Urology, Stanley Medical College, Chennai, Tamil Nadu, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|December 28, 2017
PubMed

Insights

Meckel

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Congenital Anomalies

Background:

  • Meckel's diverticulum, a common congenital gastrointestinal anomaly, arises from the vitellointestinal duct remnant.
  • Clinical presentations vary, with gastrointestinal bleeding common in children and intestinal obstruction in adults.

Observation:

  • A 9-year-old boy presented with acute periumbilical pain and nonbilious vomiting, initially managed for acute pancreatitis and paralytic ileus.
  • Deterioration occurred over 2 days, with bilious vomiting, abdominal distension, and dehydration, prompting further investigation.
  • Imaging suggested ileoileal intussusception; elevated serum amylase levels were noted.

Findings:

  • Exploratory laparotomy revealed Meckel's diverticulum as the lead point for ileoileal intussusception.
  • Histopathology confirmed inflamed heterotopic pancreatic tissue at the diverticulum's apex, explaining the elevated amylase.

Implications:

  • This case highlights an atypical presentation of Meckel's diverticulum.
  • High clinical suspicion is crucial for diagnosing concomitant intussusception secondary to Meckel's diverticulum, especially with unusual accompanying symptoms like elevated amylase.
  • Early recognition and surgical intervention are vital for favorable outcomes in pediatric intussusception.
Keywords:
Heterotopic pancreasileoileal intussusceptioninverted Meckel's diverticulumpancreatitis

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